Nurse-physician co-leadership: exploring a strategy to enhance quality and patient safety in U.S. Hospitals

University of Minnesota Ph.D. dissertation. May 2014. Major: Nursing. Advisor: Laura Duckett. 1 computer file (PDF); x, 141 pages, appendices A-D.Background: The healthcare industry has been mandated by regulatory bodies to improve quality and patient safety in hospitals. The struggle to implement and sustain effective performance improvement processes is linked to leadership, especially at the department level where the rubber hits the road. Although many advances have been made, there is a sustained need to continue looking for additional strategies. A new leadership model in healthcare, nurse and physician co-leadership, may be an effective strategy to use to bridge diffuse power structures found in the knowledge-based, pluralistic organization. Effectively used by at least 10% of business worldwide, only a few hospitals across the country have implemented this leadership model. Anecdotal evidence is promising, but empirical evidence is lacking. Study Question and Aims: The research question was, "How do nurse and physician co-leaders' description of their work together reflect their roles and relationships?" The specific aims were to explore: (a) the factors that hindered or enhanced the role development of the partners; and (b) the nature and dynamics of the co-leaders' working relationship. Design: Qualitative inquiry was used to obtain evidence from practice. Eight nurse and physician co-leaders were interviewed individually about their shared role and responsibilities, and their collaborative work together within a co-leadership structure. A deductive content analysis approach was used. Coding started with nine categories, which were derived from an extensive review of the literature on co-leadership in business, education, and healthcare. Cross case analysis revealed 40+ sub-categories.Findings: Nurse-physician co-leadership is a form of plural leadership where two formal leaders together lead a hospital unit, sharing power to build a more democratic process, but also taking back power and influence from diffuse sources of power commonly found in the hospital setting. Two essential themes, the Shared Role Space: Moving from I to We and Partnered Leadership: Dynamic Interplay of Complementary Competencies, emerged from the data to describe the experience, and a conceptual framework was proposed. Numerous factors were revealed that enhanced or hindered the co-leaders' role development. The dynamic interplay of co-leaders' work together was portrayed. Conclusion: Co-leadership is different than inter-professional collaboration or teamwork. Clinicians and administrators are offered a toolkit to help ensure successful development of the nurse-physician co-leadership model in hospitals. Researchers are offered a framework to measure outcomes, but are warned about confusing terms, and the presence of intermediate outcomes in research focused on post-heroic leadership models. This plural leadership model is a strategy worth exploring to address the challenges of successfully implementing quality and patient safety innovations in hospitals

An evaluation of praise as a reinforcer for preschoolers\u27 behavior

Behavior analysts and educators often recommend using praise, particularly descriptive praise, despite mixed empirical findings to support this recommendation. We evaluated the effectiveness of praise as a reinforcer during a reinforcer assessment using known tasks with preschoolers in Study 1. Praise functioned as a reinforcer for 2 of 6 participants; the remaining 4 participants required additional reinforcers (edibles) to show a reinforcement effect. We then compared the effectiveness of descriptive versus general praise for acquisition of unknown tacts and assessed participants’ preference for the different types of praise for 4 participants from Study 1. Results showed the efficacy of and preference for general and descriptive praise was idiosyncratic

Mapping Changes in Fractional Vegetation Cover on the Namib Gravel Plains with Satellite-Retrieved Land Surface Emissivity Data

Monitoring changes in vegetation cover over time is crucial for understanding the spatial distribution of rainfall, as well as the dynamics of plants and animals in the Namib desert. Traditional vegetation indices have limitations in capturing changes in vegetation cover within water-limited ecosystems like the Namib gravel plains. Spectral emissivity derived from thermal infrared remote sensing has recently emerged as a promising tool for distinguishing between bare ground and non-green vegetation in arid environments. This study investigates the potential of satellite-derived emissivities for mapping changes in fractional vegetation cover across the Namib gravel plains. Analyzing Moderate Resolution Imaging Spectroradiometer (MODIS) band 29 (λ = 8.55 µm) emissivity time series from 2001 to 2021, our findings demonstrate the ability of both Normalized Difference Vegetation Index (NDVI) and emissivity to detect sudden vegetation growth on the gravel plains. Emissivity additionally allows monitoring the extent of desiccated grass over several years after a rainfall event. Our results support a relationship between the change in fractional vegetation cover, the amount of rainfall and emissivity change magnitude. Information from NDVI and emissivity therefore provide complementary information for assessing vegetation in arid environments

The health-related quality of life, mental health and mental illnesses of patients with inclusion body myositis (IBM) : results of a mixed methods systematic review

BACKGROUND: Inclusion body myositis (IBM) is a rare neuromuscular disease (NMD) and effective therapies are not available. Thus, it is relevant to determine the health-related quality of life (HRQoL) in IBM patients including aspects of mental health and illnesses. OBJECTIVES: To identify and summarize the assessment of HRQoL, mental health and illnesses in IBM, the major factors that determine and influence them as well as the respective influence of IBM in general and compared to other NMD as a systematic review. METHODS: We performed a mixed methods systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted within the databases PubMed, PsycINFO, LIVIVO and the Cochrane Database. Data were narratively summarized and categorized in the physical, psychological and social HRQoL dimensions. RESULTS: The systematic screening totalled 896 articles. Six studies were finally identified, comprising of 586 IBM patients. The applied patient reported outcome measures (PROMs) varied. Quantitatively, the main physical impairments (e.g. weakness, functioning, role perception) were assessed using the general population or other NMD as comparators. Results on social and psychological HRQoL were frequently inconsistent. Qualitatively, psychological and social limitations accompanied IBM related physical deteriorations. CONCLUSIONS: A research gap exists regarding rigour determinants of HRQoL and mental illness in IBM. In-depth qualitative studies could help to prepare the ground for the assessment of long-term HRQoL data combined with appropriately focussed psychological PROMs advancing the understanding of the HRQoL in IBM throughout the course of the disease from a patient perspective. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13023-022-02382-x

Echocardiographic Evidence for Valvular Toxicity of Benfluorex: A Double-Blind Randomised Trial in Patients with Type 2 Diabetes Mellitus

OBJECTIVES: REGULATE trial was designed to compare the efficacy and safety of benfluorex versus pioglitazone in type 2 diabetes mellitus (DM) patients. METHODS: Double-blind, parallel-group, international, randomised, non-inferiority trial. More than half of the 196 participating centres were primary care centres. Patients eligible had type 2 DM uncontrolled on sulfonylurea. 846 were randomised. They received study treatment for 1 year. 423 patients were allocated to benfluorex (150 to 450 mg/day) and 423 were allocated to pioglitazone (30 to 45 mg/day). Primary efficacy criterion was HbA(1c). Safety assessment included blinded echocardiographic evaluation of cardiac and valvular status. RESULTS: At baseline, patients were 59.1 ± 10.5 years old with HbA1c 8.3 ± 0.8%, and DM duration 7.1 ± 6.0 years. During the study, mean HbA1c significantly decreased in both groups (benfluorex: from 8.30 ± 0.80 to 7.77 ± 1.31 versus pioglitazone: from 8.30 ± 0.80 to 7.45 ± 1.30%). The last HbA1c value was significantly lower with pioglitazone than with benfluorex (p<0.001) and non-inferiority of benfluorex was not confirmed (p = 0.19). Among the 615 patients with assessable paired echocardiography (310 benfluorex, 305 pioglitazone), 314 (51%) had at least one morphological valvular abnormality and 515 (84%) at least one functional valvular abnormality at baseline. Emergent morphological abnormalities occurred in 8 patients with benfluorex versus 4 with pioglitazone (OR 1.99), 95% CI (0.59 to 6.69). Emergent regurgitation (new or increased by one grade or more) occurred more frequently with benfluorex (82 patients, 27%) than with pioglitazone (33 patients, 11%) (OR 2.97), 95% CI (1.91 to 4.63) and were mainly rated grade 1; grade 2 (mild) was detected in 2 patients with benfluorex and 3 with pioglitazone. There was no moderate or severe regurgitation. CONCLUSION: After 1 year of exposure, our results show a 2.97 fold increase in the incidence of valvular regurgitation with benfluorex and provide evidence for the valvular toxicity of this drug

Fast and deep: energy-efficient neuromorphic learning with first-spike times

For a biological agent operating under environmental pressure, energy consumption and reaction times are of critical importance. Similarly, engineered systems also strive for short time-to-solution and low energy-to-solution characteristics. At the level of neuronal implementation, this implies achieving the desired results with as few and as early spikes as possible. In the time-to-first-spike-coding framework, both of these goals are inherently emerging features of learning. Here, we describe a rigorous derivation of learning such first-spike times in networks of leaky integrate-and-fire neurons, relying solely on input and output spike times, and show how it can implement error backpropagation in hierarchical spiking networks. Furthermore, we emulate our framework on the BrainScaleS-2 neuromorphic system and demonstrate its capability of harnessing the chip's speed and energy characteristics. Finally, we examine how our approach generalizes to other neuromorphic platforms by studying how its performance is affected by typical distortive effects induced by neuromorphic substrates.Comment: 20 pages, 8 figure

Controlling multiple orderings in metal thiocyanate molecular perovskites Ax{Ni[Bi(SCN)6]}

We report four new A-site vacancy ordered thiocyanate double double perovskites, A1–x{Ni[Bi(SCN)6](1–x)/3}, A = K+, NH4+, CH3(NH3)+ (MeNH3+) and C(NH2)3+ (Gua+), including the first examples of thiocyanate perovskites containing organic A-site cations. We show, using a combination of X-ray and neutron diffraction, that the structure of these frameworks depends on the A-site cation, and that these frameworks possess complex vacancy-ordering patterns and cooperative octahedral tilts distinctly different from atomic perovskites. Density functional theory calculations uncover the energetic origin of these complex orders and allow us to propose a simple rule to predict favoured A-site cation orderings for a given tilt sequence. We use these insights, in combination with symmetry mode analyses, to show that these complex orders offer a new route to non-centrosymmetric perovskites which render them as excellent candidates for piezo- and ferroelectric applications