Development of a Data Management System to Support Quality Improvement in IPE

It is vital to understand best practices in interprofessional education (IPE) that teaches competencies needed to practice collaboratively to improve patient care.1 Universities are increasingly looking for evidence of their own best practices and a better understanding of the return on investment in IPE. Continuous quality improvement, which seeks to discern what works for addressing a particular problem, for whom, and under what set of specific conditions can support our work in this area but real time and relevant data is needed to support this process.2,3 The Indiana University Center for Interprofessional Health Education and Practice (CIPHEP) brings together students to learn about, from, and with each other while collaborating across professions to improve health and health outcomes. In preparation for the launch of a university-wide curriculum across 9 campuses in August 2017, it is critical that we have a mechanism in place to enable continuous quality improvement. The purpose of this project was to develop a comprehensive data management system while enabling multi-level assessment of learners. As an evaluation-specific sub-component of a larger system, the database tracks metrics such as competencies addressed and assessed, resources utilized, assessment of learners using multi-faceted evaluation measures, and provides learners with an online portfolio demonstrating interprofessional learning outcomes. Given the span of competencies necessary to successfully practice in a collaborative healthcare team, the evaluation data management system hosts an expanding question bank of valid and reliable assessment and reflection questions to tailor evaluations and assessments towards measuring the learners’ connection with one or more interprofessional competencies. CIPHEP’s vision for the data management system is to collect valid and reliable data on both the learners and IPE events in order to systematically assess outcomes, implement quality improvement initiatives, and make data-driven decisions that will serve in the best interest of our learners. Objectives: By the end of this interactive discussion, participants will: 1) Identify the value of evaluating program outcomes in assessing the effectiveness of interprofessional education within a community-based student experience. 2) Describe the value of using a comprehensive data management system for quality improvement purposes. References 1) Institute of Medicine. (2015). Measuring the impact of interprofessional education (IPE) on collaborative practice and patient outcomes. Washington DC: National Academies Press. 2) Berwick, D. (2008). “The science of improvement.” JAMA. 299(10). 3) Bryk, A.S., Gomez, L. and A. Grunow. (2011). “Getting ideas into action: Building networked improvement communities in education.” Carnegie Foundation for the Advancement of Teaching. Stanford, CA, 2010

Lime stabilisation for earthworks: a UK perspective

Lime stabilisation is a versatile technique applied during earthworks operations. Modern soil recycling units are much more efficient at pulverising fill material and intermixing the added binder/water than machinery available 20 years ago. While supplier innovation adds flexibility to the site working method, specifications have not been sufficiently updated to permit optimal application. This review paper details the physico-chemical changes instigated through the lime-clay soil reaction, updating previous reviews. It aims to assist scientific debate, current practitioners and future specification changes. For example, the application of the minimum 24 h mellowing periods (mandatory to UK specifications) with high reactivity, quicklime powders is concluded to cause increased air voids in the compacted fill. Increased air voids are associated with reduced long-term strength and potential volume change from water ingress, which is of particular concern for sulfate swelling. Shorter mellowing periods and/or use of hydrated lime may lesson this issue; however, a 'one size fits all' approach is discouraged in preference to site-specific methodologies refined to suit the fill material and project requirements. The discussion also summarises working methods which may lower the risk of sulfate swell and defines areas requiring further practical research

The Effect of an Informational Training Video on Parental Changes in Scoring of the ASQ-3

Introduction Research indicates that parents often raise concerns regarding their child’s development prior to physician recognition of the problem1 Parent-reported screening tools can bridge the communication gap between health professionals and parents Parental scoring did not significantly correlate with healthcare professionals2 This discrepancy may stem from training on scoring and administration of the screening tool Objective This study investigated the effect of an informational training video (ITV) on changing parental scoring of the Ages and Stages Questionnaire, 3rd edition (ASQ-3) Outcome Measure: ASQ-3 Standardized developmental screening tool used to test children aged 1-66 months via 21 questionnaires. Test items are organized into five developmental domains Selected for extensive psychometric properties3 Utilized the 36-month, 42-month, 48-month, 54-month and 60-month ASQ-3 Questionnaires. Converted questionnaires into Google Forms for easy administration Participants 13 parents of preschool-aged children recruited from Lasting Impressions Child care Center in St.Paul, MN and through social media posts on Facebook and Instagram Children ranged from age 34 months, 16 days to 66 months Methods After parents indicated interest in participation, an email allowed them to access the first Google form comprised of consent, demographic information, and the age appropriate ASQ-3 Two weeks after first submission, participants received a second email with instructions to watch the six-minute ITV and fill out the second ASQ-3 The ITV included a brief overview of domains and instruction of item administration and scoring Results Data was analyzed using Wilcoxon Signed-Rank Test to determine a change in scoring after viewing the ITV Results demonstrated significance across four of five domains with Problem Solving the only nonsignificant domain, possibly due to collection error resulting in smaller N or parental influence Conclusion Evidence suggests watching a training video on ASQ-3 administration changes parental scoring of their child’s performance on tested items Post-video training change in scores may demonstrate a change in parental knowledge of precision scoring Clinical Relevance Using the ASQ-3 tool may augment parental contributions to the developmental surveillance and screening process This could impact not only the accuracy of scoring the ASQ – 3, but also on the physician’s willingness to incorporate parent feedback in decisions on referral to early interventio

Impact of Student Experiences in Team-based Practice in a Student-run Outreach Clinic

If trainees from differing health professions work together in a team-based setting to provide quality care to underserved individuals, they may be more inclined to work in an interprofessional collaborative health care team. The purpose of the study was to learn about student experiences at the Indiana University Student Outreach Clinic (IUSOC) as it relates to caring for underserved individuals. The IUSOC is a free clinic run out of the Neighborhood Fellowship Church in Indianapolis, Indiana. The IUSOC clinic provides primary care-based medical services free of charge for the uninsured and underserved within the community. The patient population includes individuals with medical problems of varying acuity. Health profession students from dentistry, medicine, nursing, pharmacy, public health, and social work co-located in the clinic recently agreed to move more intentionally into interprofessional collaborative care to more effectively address a variety of patient needs. This specific assessment is the result of a unique collaboration between the IUSOC, the Indiana Area Health Education Center Network, IU School of Medicine Office of Diversity Affairs, and the IU Center for Interprofessional Health Education and Practice. The goal was to determine if students volunteering in the IUSOC are leaving with the willingness and ability to serve vulnerable populations in an interprofessional collaborative manner. In the spring of 2016, a pilot assessment was conducted with 269 health profession student volunteers. The 18-question survey assessed student’s perception of their experience serving in an interprofessional team, working with individuals from diverse backgrounds, understanding of the unique needs of underserved individuals, and their future practice intents. The results of this pilot assessment is critical as we determine how to maximize the student experience at the IUSOC so that they are equipped with the competencies necessary to practice in an interprofessional collaborative manner with diverse teams throughout the healthcare community. Objectives: By the end of this interactive discussion, participants will: Identify the value of evaluating program outcomes in assessing the effectiveness of interprofessional education within a community-based student experience. Describe the value of using a collaborative partnership to maximize the opportunity for interprofessional/team based education among health profession students in a clinical learning environment. Identify strategic next steps for assessing student competence in interprofessional team-based care

Impact of Virtual Simulation and Coaching on the Interpersonal Collaborative Communication Skills of Speech-Language Pathology Students: A Pilot Study

Communication between clinicians, teachers, and family members is a critical skill when addressing and providing for the individual needs of patients. However, graduate students in speech-language pathology (SLP) programs often have limited opportunities to practice these skills prior to or during externship placements. The purpose of this study was to explore the use of virtual-reality based rehearsal with coaching on the interpersonal collaborative communication skills of SLP graduate students when delivering information regarding a singular patient to different stakeholders. Three graduate students completing their third semester in a SLP program participated in the study. Each participant was provided a clinical case scenario and asked to deliver recommendations related to the client’s communication abilities to a single adult avatar portraying either a parent, teacher, or pediatrician. This task was repeated twice to allow assessment of performance across multiple trials. A brief reflection and coaching period was provided between trials with the same avatar. All interactions were scored using the Situation, Background, Assessment, Recommendation, and Communication (SBAR-C) tool. All participants demonstrated improved communication skills between their first and second trial with each avatar as measured by the SBAR-C. Social validity surveys with participants revealed that they found the intervention to be valid and acceptable

The 1.1 angstrom resolution structure of a periplasmic phosphate-binding protein from Stenotrophomonas maltophilia: a crystallization contaminant identified by molecular replacement using the entire Protein Data Bank

During efforts to crystallize the enzyme 2,4-dihydroxyacetophenone dioxygenase (DAD) from Alcaligenes sp. 4HAP, a small number of strongly diffracting protein crystals were obtained after two years of crystal growth in one condition. The crystals diffracted synchrotron radiation to almost 1.0 Å resolution and were, until recently, assumed to be formed by the DAD protein. However, when another crystal form of this enzyme was eventually solved at lower resolution, molecular replacement using this new structure as the search model did not give a convincing solution with the original atomic resolution data set. Hence, it was considered that these crystals might have arisen from a protein impurity, although molecular replacement using the structures of common crystallization contaminants as search models again failed. A script to perform molecular replacement using MOLREP in which the first chain of every structure in the PDB was used as a search model was run on a multi-core cluster. This identified a number of prokaryotic phosphate-binding proteins as scoring highly in the MOLREP peak lists. Calculation of an electron-density map at 1.1 Å resolution based on the solution obtained with PDB entry 2q9t allowed most of the amino acids to be identified visually and built into the model. A BLAST search then indicated that the molecule was most probably a phosphate-binding protein from Stenotrophomonas maltophilia (UniProt ID B4SL31; gene ID Smal_2208), and fitting of the corresponding sequence to the atomic resolution map fully corroborated this. Proteins in this family have been linked to the virulence of antibiotic-resistant strains of pathogenic bacteria and with biofilm formation. The structure of the S. maltophilia protein has been refined to an R factor of 10.15% and an Rfree of 12.46% at 1.1 Å resolution. The molecule adopts the type II periplasmic binding protein (PBP) fold with a number of extensively elaborated loop regions. A fully dehydrated phosphate anion is bound tightly between the two domains of the protein and interacts with conserved residues and a number of helix dipoles

Validity of a self-reported measure of familial history of obesity

<p>Abstract</p> <p>Background</p> <p>Familial history information could be useful in clinical practice. However, little is known about the accuracy of self-reported familial history, particularly self-reported familial history of obesity (FHO).</p> <p>Methods</p> <p>Two cross-sectional studies were conducted. The aims of study 1 was to compare self-reported and objectively measured weight and height whereas the aims of study 2 were to examine the relationship between the weight and height estimations reported by the study participants and the values provided by their family members as well as the validity of a self-reported measure of FHO. Study 1 was conducted between 2004 and 2006 among 617 subjects and study 2 was conducted in 2006 among 78 participants.</p> <p>Results</p> <p>In both studies, weight and height reported by the participants were significantly correlated with their measured values (study 1: r = 0.98 and 0.98; study 2: r = 0.99 and 0.97 respectively; p < 0.0001). Estimates of weight and height for family members provided by the study participants were strongly correlated with values reported by each family member (r = 0.96 and 0.95, respectively; p < 0.0001). Substantial agreement between the FHO reported by the participants and the one obtained by calculating the BMI of each family members was observed (kappa = 0.72; p < 0.0001). Sensitivity (90.5%), specificity (82.6%), positive (82.6%) and negative (90.5%) predictive values of FHO were very good.</p> <p>Conclusion</p> <p>A self-reported measure of FHO is valid, suggesting that individuals are able to detect the presence or the absence of obesity in their first-degree family members.</p

The economics of vision impairment and its leading causes: A systematic review

Vision impairment (VI) can have wide ranging economic impact on individuals, households, and health systems. The aim of this systematic review was to describe and summarise the costs associated with VI and its major causes. We searched MEDLINE (16 November 2019), National Health Service Economic Evaluation Database, the Database of Abstracts of Reviews of Effects and the Health Technology Assessment database (12 December 2019) for partial or full economic evaluation studies, published between 1 January 2000 and the search dates, reporting cost data for participants with VI due to an unspecified cause or one of the seven leading causes globally: cataract, uncorrected refractive error, diabetic retinopathy, glaucoma, age-related macular degeneration, corneal opacity, trachoma. The search was repeated on 20 January 2022 to identify studies published since our initial search. Included studies were quality appraised using the British Medical Journal Checklist for economic submissions adapted for cost of illness studies. Results were synthesized in a structured narrative. Of the 138 included studies, 38 reported cost estimates for VI due to an unspecified cause and 100 reported costs for one of the leading causes. These 138 studies provided 155 regional cost estimates. Fourteen studies reported global data; 103/155 (66%) regional estimates were from high-income countries. Costs were most commonly reported using a societal (n = 48) or healthcare system perspective (n = 25). Most studies included only a limited number of cost components. Large variations in methodology and reporting across studies meant cost estimates varied considerably. The average quality assessment score was 78% (range 35–100%); the most common weaknesses were the lack of sensitivity analysis and insufficient disaggregation of costs. There was substantial variation across studies in average treatment costs per patient for most conditions, including refractive error correction (range $12–$201 ppp), cataract surgery (range $54–$3654 ppp), glaucoma (range $351–$1354 ppp) and AMD (range $2209–$7524 ppp). Future cost estimates of the economic burden of VI and its major causes will be improved by the development and adoption of a reference case for eye health. This could then be used in regular studies, particularly in countries with data gaps, including low- and middle-income countries in Asia, Eastern Europe, Oceania, Latin America and sub-Saharan Africa