Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect?

Background Gender bias may represent a threat to resident assessment during surgical training, and there have been concerns that women might be disadvantaged. There is a lack of studies investigating gender differences in ‘entry-level’ real-life procedures, such as laparoscopic appendectomy. We aimed to explore potential gender disparities in self-evaluation and faculty evaluation of a basic surgical procedure performed by junior surgical residents in general surgery. Methods A structured training program in laparoscopic appendectomy was implemented before undertaking evaluation of real-life consecutive laparoscopic appendectomies by junior residents in general surgery. Resident and faculty gender-pairs were assessed. Intraclass correlation coefficient (ICC) was calculated using a single-rater, consistency, 2-way mixed-effects model. Results A total of 165 paired sessions were completed to evaluate resident–faculty scores for the procedure. Overall, 19 residents participated (43% women) and 26 faculty (42% women) were involved. The overall correlation between faculty and residents was good (ICC > 0.8). The female–female pairs scored higher for most steps, achieving excellent (ICC ≥ 0.9) for several steps and for overall performance. Female residents were more likely to give a higher self-evaluated score on own performance particularly if evaluated by a female faculty. Also, female trainees had highest correlation-score with male faculty. Conclusions This study found higher performance scores in female surgical residents evaluated during real-time laparoscopic appendectomy. No negative gender bias toward women was demonstrated. Better insight into the dynamics of gender-based interaction and dynamics in both training, feedback and influence on evaluation during training is needed when evaluating surgical training programs.publishedVersio

Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to measure chest compression decay during simulated advanced life support (ALS) in a cardiac arrest manikin model.</p> <p>Methods</p> <p>19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF). The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA) throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≥ 40 mm, compression rate 100-120/minute for each minute of CPR), bad (initial compression depth < 40 mm, initial compression rate < 100 or > 120/minute) or decay (change from good to bad during the 12 minutes). Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario) over time was also measured.</p> <p>Results</p> <p>Based on compression depth, 5 (26%), 9 (47%) and 5 (26%) were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%), 6 (32%) and 7 (37%) were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002) and to 10% in the 10-12 minute period (P < 0.001).</p> <p>Conclusions</p> <p>In this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare.</p

Does Current Diabetes Technology Improve Metabolic Control? A Cross-Sectional Study on the Use of Insulin Pumps and Continuous Glucose Monitoring Devices in a Nationwide Pediatric Population

Objective To examine the use of multiple daily injections (MDI), insulin pumps, self-measured blood glucose (SMBG), and continuous glucose monitoring (CGM) systems, and their association with glycated hemoglobin (HbA1c), diabetic ketoacidosis (DKA), and severe hypoglycemia. Methods In a pediatric population-based nationwide cross-sectional study, we analyzed data from 2623 participants up to 18 years of age with type 1 diabetes, using 2017 annual data from the Norwegian Childhood Diabetes Registry. HbA1c was adjusted for age, gender, and diabetes duration. Using a linear mixed-effects model, we assessed HbA1c and the incidence of DKA and severe hypoglycemia according to the use of MDI, insulin pumps, SMBG, and CGM. Results We observed that 74.7% of participants were using an insulin pump and 52.6% were using a CGM system. Mean HbA1c was 7.8% (62 mmol/mol). The HbA1c of pump users was 0.14 percentage points (pp) higher than that of MDI users. Fewer pump users than MDI users achieved an HbA1c of < 7.5% (38.3 vs. 41.6%). CGM users had a 0.18 pp lower HbA1c than SMBG users, with 40.5 and 38.0%, respectively, achieving an HbA1c of < 7.5%. The incidence of severe hypoglycemia or hospitalization due to DKA was not different in pump and CGM users compared with nonusers. Compared with other insulin pumps, patch pump use was associated with a significantly lower odds ratio for DKA. Conclusions Despite the broad use of diabetes technology, as many as 61% of our pediatric cohort did not reach the HbA1c target recommended by the International Society for Pediatric and Adolescent Diabetes (ISPAD). Lower HbA1c was associated with CGM use but not with insulin pump use. Acute complications were not less frequent in the groups using insulin pumps or CGM compared with those using MDI and SMBG. Further research is required to explore the lower incidence of DKA among patch pump users.publishedVersio

Predictors for psychological distress 2 months after mild traumatic brain injury

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The impact of referral letter quality on timely access to specialised mental health care: a quantitative study of the reliability of patient triage

Background Patients referred to specialised mental health care are usually triaged based on referral information provided by general practitioners. However, knowledge about this system’s ability to ensure timely access to and equity in specialised mental health care is limited. We aimed to investigate to the degree to which patient triage, based on referral letter information, corresponds to triage based on a hospital specialist’s consultation with the patient, and whether the degree of correspondence is affected by the quality of the referral letter. Methods We gathered information from three specialised mental health centres in Norway regarding patients that were referred and offered health care (N = 264). Data consisted of triage decisions for each patient (i.e., the hospital specialist’s assessment of maximum acceptable waiting time), which were determined on the basis of a) referral information and b) meeting the patient. Referral letter quality was evaluated using the Quality of Referral information-Mental Health checklist. The reliability of priority setting and the impact of referral letter quality on this measure were investigated using descriptive analyses, binary logistic regression and Nadaraya-Watson kernel regression. Results In 143 (54%) cases, the triage decision based on referral information corresponded with the decision based on patient consultation. In 70 (27%) cases, the urgency of need for treatment was underestimated when based on referral information compared with that based on information from patient consultation. Referral letter quality could not explain the differences between the two triage decisions. However, when a cut-off value of 7 on the Quality of Referral information-Mental Health scale was used, low-quality letters were found more frequently among patients whose urgency of need was underestimated, compared with those whose need was overestimated. Conclusions Deciding the urgency of patient need for specialised mental health care based on referral information is a reliable system in many situations. However, the possibility of under- and overestimation is present, implying risks to patient safety and inappropriate use of resources. Improving the content of referral letters does not appear to reduce this risk when the letters are of acceptable quality.publishedVersio

Long-Term Effects of Short-Term Music Therapy for Prison Inmates: Six-Year Follow-Up of a Randomized Controlled Trial

For most interventions to reduce criminal recidivism, long-term effects are uncertain. Music therapy has shown effects on possible precursors of recidivism, but direct evidence on long-term effects is lacking. In an exploratory parallel randomized controlled trial, 66 inmates in a Norwegian prison were allocated to music therapy or standard care and followed up over a median of 6 years, using state registry data. Median time to relapse was 5 years, with no differences between the interventions. The imprisonment of most participants was too short to provide a sufficient number of therapy sessions. Sufficiently powered studies are needed to examine the long-term effects of appropriate doses of therapy.publishedVersio

DC/TMD Examiner Protocol: Longitudinal Evaluation on Interexaminer Reliability

Objectives. The objectives of this study were to assess the interexaminer agreement between one “reference” (gold standard) and each of two examiners, using the DC/TMD examination method, Axis I and to evaluate whether a recalibration changed reliability values. Methods. Participants (4 healthy and 12 TMD patients) in 2013 underwent a clinical examination according to DC/TMDs, Axis I. In 2014, additionally 16 participants (4 healthy and 12 TMD patients) were recruited. Two trainee examiners (one more experienced) and one “reference examiner” (gold standard) at both sessions assessed the participants. Calibration preparation (2013): The clinical protocol was sent to the trainee examiners with a request that its verbal commands should be learned by heart. An eight-hour-course was provided on the day preceding the examination session day. Recalibration preparation (2014): The same examiners in advance to this year’s examination session were also asked to recapture the protocol’s instructions (verbal commands to be learned by heart) and go through the information from the 2013 course and encouraged to contact by e-mail in case of unclear subjects. At a meeting prior to the examination session, they were also given the opportunities to ask questions. The interexaminer agreements in 2013 and 2014 between the “reference” and each examiner were analysed using Bland–Altman plots, intraclass correlation coefficient, Cohen’s kappa, and consistency values. Results. For the majority of the gathered data, no clear change of agreement between 2013 and 2014 could be observed, and only one muscle zone in 2014 could show any clear difference in agreement between the examiners. Conclusions. No clear and consistent difference in the level of agreement between the two examiners could be observed, although one was more experienced than the other. Likewise, for most components of the DC/TMD tool, recalibration of examiners did not change the reliability findings.publishedVersio

Communication and Relational Ties in Inter-Professional Teams in Norwegian Specialized Health Care: A Multicentre Study of Relational Coordination

Introduction: The delivery of integrated care depends on the quality of communication and relationships among health-care professionals in inter-professional teams. The main aim of this study was to investigate individual and team communication and relational ties of teams in specific care processes within specialized health care. Methods: This cross-sectional multi-centre study used data from six somatic hospitals and six psychiatric units (N = 263 [response rate, 52%], 23 care processes) using a Norwegian version of the Relational Coordination Survey. We employed linear mixed-effect regression models and one-way analyses of variance. Results: The mean (standard deviation) relational coordination total score ranged from 4.5 (0.33) to 2.7 (0.50). The communication and relationship sub-scale scores were significantly higher within similar functional groups than between contrasting functional groups (P < .05). Written clinical procedures were significantly associated with higher communication scores (P < .05). The proportion of women in a team was associated with higher communication and relationship scores (P < .05). Conclusion: The Relational Coordination Survey shows a marked variation in team functions within inter-professional teams in specialized health-care settings. Further research is needed to determine the reasons for these variations.publishedVersio

DC/TMD Examiner Protocol: Longitudinal Evaluation on Interexaminer Reliability

Objectives. The objectives of this study were to assess the interexaminer agreement between one “reference” (gold standard) and each of two examiners, using the DC/TMD examination method, Axis I and to evaluate whether a recalibration changed reliability values. Methods. Participants (4 healthy and 12 TMD patients) in 2013 underwent a clinical examination according to DC/TMDs, Axis I. In 2014, additionally 16 participants (4 healthy and 12 TMD patients) were recruited. Two trainee examiners (one more experienced) and one “reference examiner” (gold standard) at both sessions assessed the participants. Calibration preparation (2013): The clinical protocol was sent to the trainee examiners with a request that its verbal commands should be learned by heart. An eight-hour-course was provided on the day preceding the examination session day. Recalibration preparation (2014): The same examiners in advance to this year’s examination session were also asked to recapture the protocol’s instructions (verbal commands to be learned by heart) and go through the information from the 2013 course and encouraged to contact by e-mail in case of unclear subjects. At a meeting prior to the examination session, they were also given the opportunities to ask questions. The interexaminer agreements in 2013 and 2014 between the “reference” and each examiner were analysed using Bland–Altman plots, intraclass correlation coefficient, Cohen’s kappa, and consistency values. Results. For the majority of the gathered data, no clear change of agreement between 2013 and 2014 could be observed, and only one muscle zone in 2014 could show any clear difference in agreement between the examiners. Conclusions. No clear and consistent difference in the level of agreement between the two examiners could be observed, although one was more experienced than the other. Likewise, for most components of the DC/TMD tool, recalibration of examiners did not change the reliability findings.publishedVersio