Using an audience response system to calibrate dental faculty assessing student clinical competence.

In order to best prepare students to become competent and confident practitioners in a clinical environment upon graduating dental school, it is imperative for them to receive consistent and productive feedback from the supervising faculty. Through academic engagement, and more specifically faculty calibration, it may be possible to eliminate the disconnect that sometimes exists between faculty expectations and terminology, and those of the students. In terms of definitions, academic engagement reflects faculty scholarly development activities that support integration of relevant, current theory of best practices consistent with the school\u27s mission, expected learner outcomes, and supporting strategies.1-6, 32 The difficulty lies in finding an effective, yet cost efficient way to conduct that faculty calibration and ensure that students are receiving consistent and reliable feedback in order to mold them into the most competent clinicians they are capable of becoming. It can be stated that professional faculty engagement is the cornerstone of providing consistent and calibrated clinical instruction to students for patient centered care learner outcomes.7-11 A significant part of faculty engagement with professional students is to provide foundational knowledge, attitude and skills for both formative and summative assessment of competence.12-18. We hypothesize that the introduction of faculty calibration to the clinical faculty will result in more consistent feedback, leading to more predictable results and ultimately more competent clinicians. This, in turn, will increase student perception of clinical faculty yielding an increase in the belief that they are receiving quality, accurate and consistent instruction.24-30

Needlestick Injuries to Nurses, in Context

Injuries with used needles and other “sharps” put health care workers at risk for serious bloodborne infections, such as HIV and hepatitis B and C. To some extent, this risk can be lessened through safer techniques (such as not recapping needles) and safer devices (such as needleless and self-sheathing equipment). But these injuries occur within a context (often a hospital unit) with organizational features that may themselves contribute to an increased or decreased risk. This Issue Brief summarizes a series of studies that investigate whether workplace aspects of the hospital (such as staffing levels, and organizational structure and climate) affect the risk of needlestick injuries to nurses

Associations between rationing of nursing care and inpatient mortality in Swiss hospitals

Objectives To explore the relationship between inpatient mortality and implicit rationing of nursing care, the quality of nurse work environments and the patient-to-nurse staffing ratio in Swiss acute care hospitals. Design Cross-sectional correlational design. Setting Eight Swiss acute care hospitals examined in a survey-based study and 71 comparison institutions. Participants A total of 165 862 discharge abstracts from patients treated in the 8 RICH Nursing Study (the Rationing of Nursing Care in Switzerland Study) hospitals and 760 608 discharge abstracts from patients treated in 71 Swiss acute care hospitals offering similar services and maintaining comparable patient volumes to the RICH Nursing hospitals. Main outcome measures The dependent variable was inpatient mortality. Logistic regression models were used to estimate the effects of the independent hospital-level measures. Results Patients treated in the hospital with the highest rationing level were 51% more likely to die than those in peer institutions (adjusted OR: 1.51, 95% CI: 1.34-1.70). Patients treated in the study hospitals with higher nurse work environment quality ratings had a significantly lower likelihood of death (adjusted OR: 0.80, 95% CI: 0.67-0.97) and those treated in the hospital with the highest measured patient-to-nurse ratio (10:1) had a 37% higher risk of death (adjusted OR: 1.37, 95% CI: 1.24-1.52) than those in comparison institutions. Conclusions Measures of rationing may reflect care conditions that place hospital patients at risk of negative outcomes and thus deserve attention in future hospital outcomes research studie

Cause for Concern: Nurses’ Reports of Hospital Care in Five Countries

According to most experts, the U.S. faces a growing shortage of registered nurses, threatening the quality of care hospitals can provide. In the setting of nurse shortages and simultaneous concern about patient safety, nurses’ job satisfaction and their assessment of quality of care become critical. This Issue Brief highlights a crossnational survey that describes nurses’ perceptions of their hospital work environment, and identifies core problems in work design and workforce management in five countries

Hospital Nurse Staffing, Education, and Patient Mortality

A serious shortage of hospital nurses in the U.S., evident in the past decade, is expected to continue and worsen in the next 15 years. Increasingly, the public and the health professions are acknowledging that nurse understaffing represents a serious threat to patient safety in U.S. hospitals. Although anecdotal evidence has linked patient deaths to inadequate nurse staffing, the numbers and kinds of nurses needed for patient safety is unknown. This Issue Brief highlights two studies that clarify the impact of nurse staffing levels on surgical patient outcomes, and examine the effect of nurses’ experience and educational level on patient mortality in the 30 days after a surgical admission

Implementation of a surgical unit-based safety programme in African hospitals: a multicentre qualitative study.

Background: A Surgical Unit-based Safety Programme (SUSP) has been shown to improve perioperative prevention practices and to reduce surgical site infections (SSI). It is critical to understand the factors influencing the successful implementation of the SUSP approach in low- and middle-income settings. We undertook a qualitative study to assess viability, and understand facilitators and barriers to implementing the SUSP approach in 5 African hospitals. Methods: Qualitative study based on interviews with individuals from all hospitals participating in a WHO-coordinated before-after SUSP study. The SUSP intervention consisted of a multimodal strategy including multiple SSI prevention measures combined with an adaptive approach aimed at improving teamwork and safety culture. Results: Thirteen interviews (5 head surgeons, 3 surgeons, 5 nurses) were conducted with staff from five hospital sites. Identified facilitators included influential individuals (intrinsic motivation of local SUSP teams, boundary spanners, multidisciplinary engagement, active leadership support), peer-to-peer learning (hospital networking and positive deviance, benchmarking), implementation fitness (enabling infrastructures, momentum from previous projects), and timely feedback of infection rates and process indicators. Barriers (organisational 'constipators', workload, mistrust, turnover) and local solutions to these were also identified. Conclusions: Participating hospitals benefitted from the SUSP programme structures (e.g. surveillance, hospital networks, formation of multidisciplinary teams) and adaptive tools (e.g. learning from defects, executive rounds guide) to change perceptions around patient safety and improve behaviours to prevent SSI. The combination of technical and adaptive elements represents a promising approach to facilitate the introduction of evidence-based best practices and to improve safety culture through local team engagement in resource-limited settings

Structure Slicing: Extending Logical Regions with Fields

Abstract—Applications on modern supercomputers are in-creasingly limited by the cost of data movement, but mainstream programming systems have few abstractions for describing the structure of a program’s data. Consequently, the burden of managing data movement, placement, and layout currently falls primarily upon the programmer. To address this problem we previously proposed a data model based on logical regions and described Legion, a programming system incorporating logical regions. In this paper, we present structure slicing, which incorporates fields into the logical region data model. We show that structure slicing enables Legion to automatically infer task parallelism from field non-interference, decouple the specification of data usage from layout, and reduce the overall amount of data moved. We demonstrate that structure slicing enables both strong and weak scaling of three Legion applications including S3D, a production combustion simulation that uses logical regions with thousands of fields, with speedups of up to 3.68X over a vectorized CPU-only Fortran implementation and 1.88X over an independently hand-tuned OpenACC code. I

Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study

Objectives To explore the association between implicit rationing of nursing care and selected patient outcomes in Swiss hospitals, adjusting for major organizational variables, including the quality of the nurse practice environment and the level of nurse staffing. Rationing was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Additional data were collected using an adapted version of the International Hospital Outcomes Study questionnaire. Design Multi-hospital cross-sectional surveys of patients and nurses. Setting Eight Swiss acute care hospitals Participants Nurses (1338) and patients (779) on 118 medical, surgical and gynecological units. Main outcome measures Patient satisfaction, nurse-reported medication errors, patient falls, nosocomial infections, pressure ulcers and critical incidents involving patients over the previous year. Results Generally, nurses reported rarely having omitted any of the 20 nursing tasks listed in the BERNCA over their last 7 working days. However, despite relatively low levels, implicit rationing of nursing care was a significant predictor of all six patient outcomes studied. Although the adequacy of nursing resources was a significant predictor for most of the patient outcomes in unadjusted models, it was not an independent predictor in the adjusted models. Low nursing resource adequacy ratings were a significant predictor for five of the six patient outcomes in the unadjusted models, but not in the adjusted ones. Conclusion As a system factor in acute general hospitals, implicit rationing of nursing care is an important new predictor of patient outcomes and merits further stud