Changing medical student attitudes to patient safety: A multicentre study

Background: Although patient safety is becoming widely taught in medical schools, its effect has been less rigorously evaluated. We describe a multicentre study to evaluate student changes in patient safety attitudes using a standardized instrument, the Attitudes to Patient Safety Questionnaire3 (APSQ3). Methods: A patient safety training package designed for medical students was delivered in the first year and second year in four Australian medical schools. It comprises eight face-to-face modules, each of two hours. Seminars start with an interactive introduction using questions, video and role play, followed by small group break-outs to discuss a relevant case study. Groups are led by medical school tutors with no prior training in patient safety. Students and tutors then reassemble to give feedback and reinforce key concepts. Knowledge and attitudes to patient safety were measured using the APSQ3, delivered prior to safety teaching, at the end of the first and second years and 12 months after teaching ceased. Results: A significant improvement in attitude over time was demonstrated for four of nine key items measured by the APSQ3: value of patient safety teaching; danger of long working hours, value of team work and the contribution patients can make in reducing error. Informal feedback from students was very positive. Conclusion: We showed persistent, positive learning from a patient safety education intervention 12 months after teaching finished. Building on the introduction of patient safety teaching into medical schools, pathways for motivated students such as appropriate electives, option terms and team-based research projects would be of value

Leadership in complex networks: the importance of network position and strategic action in a translational cancer research network

BackgroundLeadership behaviour in complex networks is under-researched, and little has been written concerning leadership of translational research networks (TRNs) that take discoveries made ‘at the bench’ and translate them into practices used ‘at the bedside.’ Understanding leaders’ opportunities and behaviours within TRNs working to solve this key problem in implementing evidence into clinical practice is therefore important. This study explored the network position of governing body members and perceptions of their role in a new TRN in Sydney, Australia. The paper asks three questions: Firstly, do the formal, mandated leaders of this TRN hold key positions of centrality or brokerage in the informal social network of collaborative ties? Secondly, if so, do they recognise the leadership opportunities that their network positions afford them? Thirdly, what activities associated with these key roles do they believe will maximise the TRN’s success? MethodsSemi-structured interviews of all 14 governing body members conducted in early 2012 explored perceptions of their roles and sought comments on a list of activities drawn from review of successful transdisciplinary collaboratives combined with central and brokerage roles. An on-line, whole network survey of all 68 TRN members sought to understand and map existing collaborative connections. Leaders’ positions in the network were assessed using UCInet, and graphs were generated in NetDraw. ResultsSocial network analysis identified that governing body members had high centrality and high brokerage potential in the informal network of work-related ties. Interviews showed perceived challenges including ‘silos’ and the mismatch between academic and clinical goals of research. Governing body members recognised their central positions, which would facilitate the leadership roles of leading, making decisions, and providing expert advice necessary for the co-ordination of effort and relevant input across domains. Brokerage potential was recognised in their clearly understood role of representing a specialty, campus or research group on the governing body to provide strategic linkages. Facilitation, mentoring and resolving conflicts within more localised project teams were spoken of as something ‘we do all the time anyway,’ as well as something they would do if called upon. These leadership roles are all linked with successful collaborative endeavours in other fields. ConclusionsThis paper links the empirical findings of the social network analysis with the qualitative findings of the interviews to show that the leaders’ perceptions of their roles accord with both the potential inherent in their network positions as well as actual activities known to increase the success of transdisciplinary teams. Understanding this is key to successful TRNs

RezRIDERS: A Tribally-Driven, Extreme Sport Intervention & Outcomes

Reducing Risk through Interpersonal Development, Empowerment, Resiliency, and Self-Determination (RezRIDERS) is a tribally-driven youth empowerment program designed to deter substance abuse and depression symptomology among high-risk American Indian youth while increasing hope/optimism, self-efficacy, and pro-social bonding. The quasi-experimental intervention took place between 2012-2015 in the Pueblo of Jemez (New Mexico, USA). The community-based program served fifty-five total youth. RezRIDERS has four major curricular components: 1) Extreme Sport activity clusters paired with; 2) Indigenized behavioral-cognitive lessons; 3) Tribal Research Team providing program oversight and cultural mentoring; and 4) Community action projects addressing youth-identified community issues. This unique program is a modern version of challenge and journeying that Indigenous people historically experienced as norms. Using qualitative and quantitative data, intervention pilot-testing assessed feasibility and efficacy of the program

Disentangling canid howls across multiple species and subspecies: Structure in a complex communication channel.

Wolves, coyotes, and other canids are members of a diverse genus of top predators of considerable conservation and management interest. Canid howls are long-range communication signals, used both for territorial defence and group cohesion. Previous studies have shown that howls can encode individual and group identity. However, no comprehensive study has investigated the nature of variation in canid howls across the wide range of species. We analysed a database of over 2000 howls recorded from 13 different canid species and subspecies. We applied a quantitative similarity measure to compare the modulation pattern in howls from different populations, and then applied an unsupervised clustering algorithm to group the howls into natural units of distinct howl types. We found that different species and subspecies showed markedly different use of howl types, indicating that howl modulation is not arbitrary, but can be used to distinguish one population from another. We give an example of the conservation importance of these findings by comparing the howls of the critically endangered red wolves to those of sympatric coyotes Canis latrans, with whom red wolves may hybridise, potentially compromising reintroduced red wolf populations. We believe that quantitative cross-species comparisons such as these can provide important understanding of the nature and use of communication in socially cooperative species, as well as support conservation and management of wolf populations.Recording work was approved by the Institutional Animal Care and Use Committee of the University of Tennessee. AK is supported by a Herchel Smith postdoctoral fellowship at the University of Cambridge. Part of this work was carried out while AK was a Postdoctoral Fellow at the National Institute for Mathematical and Biological Synthesis, an Institute sponsored by the National Science Foundation through NSF Award #DBI-1300426, with additional support from The University of Tennessee, Knoxville. BH is thankful to the State Forest Departments of Himachal Pradesh, J&K, and Maharashtra, and to various zoos in India for permitting us to record howls. HRG is grateful to all who helped with the project: the staff at Colchester Zoo; the Wildwood Trust, the Borror Laboratory of Bioacoustics; the British Library; Lupus Laetus; Polish Mammal Research Institute; Tigress Productions; the BBC Natural History Unit; Longleat Safari Park; Tierstimmen Archiv; Wild Sweden; Wolf Park; the Macaulay Sound Library and the UK Wolf Conservation Trust; and Mike Collins, Teresa Palmer, Monty Sloan, Karl-Heinz Frommolt, Yorgos Iliopoulos, Christine Anhalt, Louise Gentle, Richard Yarnell, Victoria Allison Hughes and Susan Parks. BRM thanks the USDA/APHIS/WS/National Wildlife Research Center for supporting his doctoral research and providing access to captive coyotes; recording work was approved by the NWRC IACUC. SW thanks Mariana Olsen for assistance with data collection, and Yellowstone National Park for permission to record.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.beproc.2016.01.00

Changing medical student attitudes to patient safety: a multicentre study

Background: Although patient safety is becoming widely taught in medical schools, its effect has been less rigorously evaluated. We describe a multicentre study to evaluate student changes in patient safety attitudes using a standardised instrument, the Attitudes to Patient Safety Questionnaire3 (APSQ3).Methods: A patient safety training package designed for medical students was delivered in the first year and second year in four Australian medical schools. It comprises eight face-to-face modules, each of two hours. Seminars start with an interactive introduction using questions, video and role play, followed by small group break-outs to discuss a relevant case study. Groups are led by medical school tutors with no prior training in patient safety. Students and tutors then reassemble to give feedback and reinforce key concepts. Knowledge and attitudes to patient safety were measured using the APSQ3, delivered prior to safety teaching, at the end of the first and second years and 12 months after teaching ceased.Results: A significant improvement in attitude over time was demonstrated for four of nine key items measured by the APSQ3: value of patient safety teaching; danger of long working hours, value of team work and the contribution patients can make in reducing error. Informal feedback from students was very positive.Conclusion: We showed persistent, positive learning from a patient safety education intervention 12 months after teaching finished. Building on the introduction of patient safety teaching into medical schools, pathways for motivated students such as appropriate electives, option terms and team-based research projects would be of value

Exploring the experiences of an exercise-based telerehabilitation program among Canadian community-dwelling adults with stroke

Purpose: Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. Methods: An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. Results: Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. Conclusion: Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance

The development, design, testing, refinement, simulation and application of an evaluation framework for communities of practice and social-professional networks

Background. Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance. Methods and design. Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later existing, health care communities of practice and social-professional networks to assess their effectiveness in achieving desired outcomes. Peak stakeholder groups have agreed to involve a wide range of members and participant organisations, and will facilitate access to various policy, managerial and clinical networks. Discussion. Given its scope and size, the project represents a valuable opportunity to achieve breakthroughs at two levels; firstly, by introducing novel and innovative aims and methods into the social research process and, secondly, through the resulting evaluation framework and tools. We anticipate valuable outcomes in the improved understanding of organisational performance and delivery of care. The project's wider appeal lies in transferring this understanding to other health jurisdictions and to other industries and sectors, both nationally and internationally. This means not merely publishing the results, but contextually interpreting them, and translating them to advance the knowledge base and enable widespread institutional and organisational application

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection

IMPORTANCE: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. OBJECTIVE: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. EXPOSURE: SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: PASC and 44 participant-reported symptoms (with severity thresholds). RESULTS: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. CONCLUSIONS AND RELEVANCE: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC

Researching COVID to Enhance Recovery (RECOVER) Adult Study Protocol: Rationale, Objectives, and Design

IMPORTANCE: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options

Scaling of maneuvering performance in baleen whales: larger whales outperform expectations

Despite their enormous size, whales make their living as voracious predators. To catch their much smaller, more maneuverable prey, they have developed several unique locomotor strategies that require high energetic input, high mechanical power output and a surprising degree of agility. To better understand how body size affects maneuverability at the largest scale, we used bio-logging data, aerial photogrammetry and a high-throughput approach to quantify the maneuvering performance of seven species of free-swimming baleen whale. We found that as body size increases, absolute maneuvering performance decreases: larger whales use lower accelerations and perform slower pitch-changes, rolls and turns than smaller species. We also found that baleen whales exhibit positive allometry of maneuvering performance: relative to their body size, larger whales use higher accelerations, and perform faster pitch-changes, rolls and certain types of turns than smaller species. However, not all maneuvers were impacted by body size in the same way, and we found that larger whales behaviorally adjust for their decreased agility by using turns that they can perform more effectively. The positive allometry of maneuvering performance suggests that large whales have compensated for their increased body size by evolving more effective control surfaces and by preferentially selecting maneuvers that play to their strengths.We thank the crews of many research vessels including the R/V John Martin, R/V Fluke, ARSV Laurence M. Gould, R/V Sanna, M/V Antonie, M/V Northern Song, the Cascadia Research Collective and the Shallow Marine Surveys Group; in particular, we thank John Douglas, Andrew Bell, Shaun Tomlinson, Steve Cartwright, Tony D'Aoust, Dennis Rogers, Kelly Newton, Heather Riley, Gina Rousa and Mark Rousa. We also thank Brandon L. Southall, Alison K. Stimpert and Stacy L. DeRuiter for their role in collecting data as part of the SOCAL-BRS project. We thank Matt S. Savoca, Julian Dale and Danuta M. Wisniewska for assistance with data collection. Finally, we thank John H. Kennedy, Michael A. Thompson and the NSF Office of Polar Programs.Ye