COULD WINTER ANNUAL CROP CHOICE INCREASE NO-TILL DOUBLE-CROP SOYBEAN YIELD IN KENTUCKY?

Double-cropping soybean (Glycine max L.) after a winter annual crop is common in Kentucky. The preceding winter annual crop may affect double-crop soybean yield in Kentucky. Producers and agronomists have reported greater double-crop soybean yields when preceded by winter canola (Brassica napus L.) rather than winter wheat (Triticum aestivum L.). Explanations for these yield differences remain unresolved. The objectives of this study are to: (1) evaluate double-crop soybean productivity in field environments following four winter annual crop treatments; (2) determine differences of early soybean growth in greenhouse (GH) and cold chamber (CC) environments; and (3) characterize soybean cultivar susceptibility to winter annual leachate in a laboratory. Three winter annuals (canola, barley (Hordeum vulgare L.), wheat) and a non-planted control (fallow) were established in fall 2014 and 2015 near Princeton, KY. Double-crop soybean were established in summer 2015 and 2016. Following winter annual harvest, soil cores were collected for GH and CC experiments. Following winter annual harvest in 2016, stover was collected for laboratory experiments. Results from GH, CC, and laboratory experiments suggest soybean is sensitive to the preceding crop and winter annual leachate. However, yield was not sensitive to the preceding crop

Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review

Background An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice. Objectives To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors. Design A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards. Data sources Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group. Review methods Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations. Results A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection. Limitations Limitations were the low quality of included literature and limited number of UK-based studies. Future work Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS. Study registration This study is registered as PROSPERO CRD42018088779. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information. </jats:sec

A CME course aimed at addressing disruptive physician behavior.

Examine the results of a study of physicians with disruptive behavior who went through a special training program to help them better control their anger and outbursts

Sexual boundary violation index: A validation study

This paper explores the psychometric properties of the Boundary Violation Index (BVI), a screening instrument designed to assess the attitudes, thoughts, and behaviors of physicians at risk of sexual misconduct with patients and staff. Items for the BVI were selected and validated using a two phase process of administration of the tool along with the Sexual Addiction Screening Test (SAST) to physicians referred to a CME course for boundary violating behaviors (n = 60 and 272) along with a control group (n = 118). Criterion-related validity in relation to the SAST was strong (r = 0.68, p \u3c 0.001) and construct validity was demonstrated by the difference between intervention and comparison group BVI scores (p \u3c 0.001). A BVI score of ≥6 for interpreting substantive risk had a sensitivity of 83% and specificity of 81%, and represented a greater than 20-fold greater risk (Exp B = 20.5, 95% CI 11.8-35.7, model p \u3c 0.001) for membership in the intervention group. The BVI offers promise as a preliminary tool for identification of physicians at risk for boundary violating behaviors and may have utility for medical education and/or monitoring purposes