Exploring Predictors of Teamwork Performance in an Interprofessional Education Setting

Abstract EXPLORING PREDICTORS OF TEAMWORK PERFORMANCE IN AN INTERPROFESSIONAL EDUCATION SETTING By Danah M. Alsane, MS. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Pharmaceutical Science at Virginia Commonwealth University Virginia Commonwealth University, 2016 Advisor: Patricia Slattum, Pharm.D., Ph.D. Professor and Director of the Geriatric Pharmacotherapy Program Department of Pharmacotherapy and Outcomes Science Objectives: The primary objective of this study was to explain how individual characteristics influence teamwork development. In addition, it evaluated how teamwork development, in conjunction with content knowledge, impact students’ performance on a team-based project in an Interprofessional Quality Improvement and Patient Safety (IPQIPS) course. Methods: This cross sectional study included medical, pharmacy, and nursing students enrolled in an IPQIPS course offered for the first time at VCU. Predictors of teamwork development examined included collective orientation (measured using the Collective Orientation Scale, which included dominance and affiliation subscales), and prior interprofessional teamwork experience (measured using self-report). The Team Development Measure (TDM) was used to measure teamwork development. The Statistical Process Control Quiz (SPCQ) was used to assess content knowledge acquired during the course. The final project score was used to evaluate students’ performance on a team-based project. Structural equation modeling was used to test study hypotheses. Results: Among the proposed predictors (dominance, affiliation, and interprofessional teamwork experience), only dominance was related to TDM. No significant relationship was found between teamwork development combined with content knowledge and successful accomplishment of team-based project. Conclusion: This study was the first to our knowledge to simultaneously assess the impact of individual characteristics on teamwork development, and how teamwork development (combined with individual student knowledge) influences students’ performance on team-based project in an interprofessional education setting. Although findings were not conclusive, several potential avenues for future study are highlighted

Medications and Falls

Educational Objectives: 1. To describe potential causes of falls and ways to prevent them. 2. To illustrate how medications can contribute to an increased risk of falls and recommend strategies for reducing this risk

EVALUATION OF QUANTITATIVE ELECTROENCEPHALOGRAPHY FOR ASSESSMENT OF CENTRAL NERVOUS SYSTEM STIMULANT RESPONSE

The objective of this investigation was to evaluate quantitative electroencephalography (EEG) as a measure of CNS stimulation. The reproducibility and sensitivity of quantitative EEG was compared to neuroendocrine, mood, and psychomotor performance measures. The study was conducted in two parts. The first part investigated the inter- and intra-individual variability associated with a series of pharmacological response measures under baseline (no drug) conditions. It was an open-label pilot study in which eight healthy male volunteers underwent a series of tests (EEG, visual continuous performance task (CPT), a finger tapping task, and self-rated mood scales) repeated eight times over a 12 hour period on three occasions, one week apart. The second part evaluated the sensitivity of quantitative EEG to dextroamphetamine (DA) compared to other response measures. It was a double-blind, placebo-controlled, four-period crossover study in eight healthy male volunteers. Subjects received 5 mg, 10 mg, or 20 mg DA or placebo orally, and underwent the same series of tests as well as blood collection for serum prolactin and DA determination, eight times over a 12 hour period. A GC method allowing quantitation of 2ng/mL DA in serum was developed. The greatest between-day, within-day, and intrasubject variability was associated with quantitative EEG. Learning effects were observed for the psychometric tests, and first session effects were apparent for several of the tests including the EEG. EEG response to DA was observed only in the 3 subjects who had baseline alpha activity greater than 35%. There was a statistically significant decrease in serum prolactin levels after DA administration, with the largest decrease observed after the 5 mg dose. Mood scales showed that 3 of 9 subjects experienced dysphoria after DA dosing. The effect on mood was generally greater as the dose increased. One subject was discontinued from the study because he experienced intense dysphoria after the 5 mg dose. Doses could not be distinguished based on the results of the psychometric tests. Effects on mood, serum prolactin levels, and performance as measured by CPI and finger tapping were not correlated with the EEG changes observed. Pharmacokinetic evaluation showed that the rate of DA absorption appears to decrease as the dose increases. Quantitative EEG conducted under our study conditions and study population was not more sensitive for the assessment of CNS stimulation than the other response measures evaluated. The sensitivity may be improved by screening volunteers to select subjects with higher background alpha activity

The Association between Sleep Problems, Sleep Medication Use, and Falls in Community-Dwelling Older Adults: Results from the Health and Retirement Study 2010

Background. Very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls among community-dwelling older adults. The objective of this study was to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. Methods. The study population comprised a nationally representative sample of noninstitutionalized older adults participating in the 2010 Health and Retirement Study. Proportion of adults reporting sleep problems, sleep medication use, and fall was calculated. Multiple logistic regression models were constructed to examine the impact of sleep problems and sleep medication use on the risk of falls after controlling for covariates. Results. Among 9,843 community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the participants. Older adults who do have sleep problems and take sleep medications had a significant high risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. The other two groups also had significantly greater risk for falls. Conclusion. Sleep problems added to sleep medication use increase the risk of falls. Further prospective studies are needed to confirm these observed findings

Chronic Health Conditions as a Risk Factor for Falls among the Community-Dwelling US Older Adults: A Zero-Inflated Regression Modeling Approach

Falls are an important health concern among older adults due to age-related changes in the body. Having a medical history of chronic health condition may pose even higher risk of falling. Only few studies have assessed a number of chronic health conditions as risk factor for falls over a large nationally representative sample of US older adults. In this study, Behavioral Risk Factor Surveillance System (BRFSS) 2014 participants aged 65 years and older (n = 159,336) were evaluated. It was found that 29.7% (n = 44,550) of the sample experienced at least one fall and 16.3% (n = 20,444) experienced more than one fall in the past 12 months. According to the study findings, having a medical history of stroke, CKD, arthritis, depression, and diabetes independently predict the risk of first-time falling as well as the risk of recurrent falling in older adult population while controlling for other factors. On the other hand, having a medical history of the heart attack, angina, asthma, and COPD did not predict the risk of first-time falling, but did predict the risk of recurrent falling after experiencing the first fall in this population

Mentorship in the Field of Aging: Purposes, Pivots, and Priorities

The Gerontological Society of America (GSA) is a multi-disciplinary organization dedicated to advancing the field of aging and improving the lives of older adults. With a long-standing commitment to mentorship and career development, this article focuses on GSA’s Mentoring Consultancies and Career Conversations events and their pivot to meet the needs and demands of current and future gerontologists amid the COVID-19 pandemic. This article provides a description of these events in the context of planning, content, and member engagement. Recommendations are provided to other organizations seeking to enrich their membership through mentorship and career development activities

Exploring Predictors for Teamwork Performance in an Interprofessional Quality Improvement and Patient Safety Course for Early Learners

Background: This study evaluated predictors of team development and performance on a final project in a large Interprofessional Quality Improvement and Patient Safety course.Methods and findings: Predictors examined were prior interprofessional teamwork experience and collective orientation preferences for dominance and affiliation. TheTeam Development Measure assessed perceived level of team development at the end of the course. Structural equation modelling was used to test the relationships, and only dominance was related to team development. Team development was not related to performance on the final project.Conclusions: This study is the first to simultaneously assess predictors of team development and the relationship between team development and course performance in interprofessional education. Although findings were not conclusive, several avenues for future study are highlighted

Predictors of Emergent Emergency Department Visits and Costs in Community-Dwelling Older Adults

Background: The number of yearly emergency department (ED) visits by older adults in the United States has been increasing. Purpose: The objectives were to (1) describe the demographics, health-related variables, and ED visit characteristics for community-dwelling older adults using an urban, safety-net ED; (2) examine the association between demographics, health-related variables, and ED visit characteristics with emergent vs nonemergent ED visits; and (3) examine the association between demographics, health-related variables, ED visit characteristics, and ED visit costs. Methods: A cross-sectional, retrospective analysis of administrative electronic medical record and billing information from 2010 to 2013 ED visits (n = 7805) for community-dwelling older adults (⩾65 years old) from an academic medical center in central Virginia was conducted. Results: Most of the ED visits were by women (62%), African Americans (75%), and approximately 50% of ED visits were nonemergent (n = 3871). Men had 1.2 times the odds of an emergent ED visit (95% confidence interval [CI]: 1.02-1.37). The ED visits by white patients had 1.3 times the odds of an emergent ED visit (95% CI: 1.09-1.57) and 14% higher costs (white race: 95% CI: 1.07-1.21) compared with African American patients. Emergent ED visits were 60% more likely to have higher costs than nonemergent visits (95% CI: 1.52-1.69). White race and arrival by ambulance were associated with both emergent ED visits and higher total ED visit costs in this sample of ED visits by community-dwelling older adults. Conclusions: Strategies to maximize opportunities for care in the primary care setting are warranted to potentially reduce nonemergent ED utilization in community-dwelling older adults