Factors and interventions determining the functioning of health care teams in county-level hospitals in less affluent areas of China:a qualitative study

Background: Teamwork is essential for the quality and safety of care, and researchon teamwork in health care has developed rapidly in many countries. However,evidence from less affluent, non-Western countries is scarce, while improvingteamwork may be especially relevant to be able to increase the quality of care inthese settings. This study aims to understand the main factors that influence, andinterventions used to improve, the functioning of health care teams in the contextof county-level hospitals in less affluent areas of China.Methods: We conducted semistructured interviews to explore the factors thatinfluence team functioning and the interventions implemented to improve teamfunctioning in these hospitals. 15 hospital presidents and 15 team leaders wereselected as respondents.Results: From the interviews, we have identified five main factors that influenceteam functioning in these hospitals: “stuck in the middle”, local county setting,difficulty in attracting and retaining talent, strong focus on task design, andstrong focus on leadership. The interventions for improving team functioningcan mostly be categorized as the following: 1) measures to attract and retaintalent (e.g., increase salary, train talent in national or provincial level hospitals,and provide fast-track promotions), 2) interventions focused on monodisciplinaryteams (e.g., changing the team structure and leadership, and skill training), and3) interventions to establish and improve multidisciplinary teams (e.g., simulationtraining and continuous team process improvements).Conclusion: With the introduction of multidisciplinary teams, interventions intoteam processes have started to receive more attention. The findings depict anoverview of the main factors and interventions as specifically relevant for teamfunctioning in county-level hospitals in less affluent areas of China and mayhelp these hospitals benefit from additional process interventions to improveteamwork and the quality of care

What Do We Know About Teamwork in Chinese Hospitals?:A Systematic Review

Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals. Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality. Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive. Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069

Numerical Study of Turbid Slab Optical Properties Reconstruction from Multiple Scattering Signals Using Time-Based Markov Chain Model

The reconstruction of optical properties for opaque mediums is highly desired for medical, atmosphere and aerosol applications. However, the modeling and reconstruction process is highly related with multiple scattering phenomena, which elevates both the complexity and computational costs for such efforts. This work introduces a time-based Markov chain method, which uses a sparse transition matrix to represent the likelihood for a photon to transit in the turbid media. The accuracy of the time-based Markov chain model was verified against the forwarding calculations of the scattering-based Markov chain model and Monte Carlo simulations. Then, reconstruction was performed with backscattered photon angular distributions. Based on the characteristics of the sparse transition matrix, the optical properties (droplet diameters) could be obtained layer by layer with transmitted photon distributions at different time durations. It is shown that the time-based Markov chain model can reconstruct the optical properties of a turbid slab with satisfactory accuracy and lower computational costs

Data_Sheet_1_Factors and interventions determining the functioning of health care teams in county-level hospitals in less affluent areas of China: a qualitative study.pdf

BackgroundTeamwork is essential for the quality and safety of care, and research on teamwork in health care has developed rapidly in many countries. However, evidence from less affluent, non-Western countries is scarce, while improving teamwork may be especially relevant to be able to increase the quality of care in these settings. This study aims to understand the main factors that influence, and interventions used to improve, the functioning of health care teams in the context of county-level hospitals in less affluent areas of China.MethodsWe conducted semistructured interviews to explore the factors that influence team functioning and the interventions implemented to improve team functioning in these hospitals. 15 hospital presidents and 15 team leaders were selected as respondents.ResultsFrom the interviews, we have identified five main factors that influence team functioning in these hospitals: “stuck in the middle”, local county setting, difficulty in attracting and retaining talent, strong focus on task design, and strong focus on leadership. The interventions for improving team functioning can mostly be categorized as the following: 1) measures to attract and retain talent (e.g., increase salary, train talent in national or provincial level hospitals, and provide fast-track promotions), 2) interventions focused on monodisciplinary teams (e.g., changing the team structure and leadership, and skill training), and 3) interventions to establish and improve multidisciplinary teams (e.g., simulation training and continuous team process improvements).ConclusionWith the introduction of multidisciplinary teams, interventions into team processes have started to receive more attention. The findings depict an overview of the main factors and interventions as specifically relevant for team functioning in county-level hospitals in less affluent areas of China and may help these hospitals benefit from additional process interventions to improve teamwork and the quality of care.</p

Data_Sheet_2_Factors and interventions determining the functioning of health care teams in county-level hospitals in less affluent areas of China: a qualitative study.pdf

BackgroundTeamwork is essential for the quality and safety of care, and research on teamwork in health care has developed rapidly in many countries. However, evidence from less affluent, non-Western countries is scarce, while improving teamwork may be especially relevant to be able to increase the quality of care in these settings. This study aims to understand the main factors that influence, and interventions used to improve, the functioning of health care teams in the context of county-level hospitals in less affluent areas of China.MethodsWe conducted semistructured interviews to explore the factors that influence team functioning and the interventions implemented to improve team functioning in these hospitals. 15 hospital presidents and 15 team leaders were selected as respondents.ResultsFrom the interviews, we have identified five main factors that influence team functioning in these hospitals: “stuck in the middle”, local county setting, difficulty in attracting and retaining talent, strong focus on task design, and strong focus on leadership. The interventions for improving team functioning can mostly be categorized as the following: 1) measures to attract and retain talent (e.g., increase salary, train talent in national or provincial level hospitals, and provide fast-track promotions), 2) interventions focused on monodisciplinary teams (e.g., changing the team structure and leadership, and skill training), and 3) interventions to establish and improve multidisciplinary teams (e.g., simulation training and continuous team process improvements).ConclusionWith the introduction of multidisciplinary teams, interventions into team processes have started to receive more attention. The findings depict an overview of the main factors and interventions as specifically relevant for team functioning in county-level hospitals in less affluent areas of China and may help these hospitals benefit from additional process interventions to improve teamwork and the quality of care.</p

Unraveling the Role of RNase L Knockout in Alleviating Immune Response Activation in Mice Bone Marrow after Irradiation

Ionizing radiation (IR) induces severe hematopoietic injury by causing DNA and RNA damage as well as activating the immune responses, necessitating the development of effective therapeutic strategies. Ribonuclease L (RNase L) as an innate immune response pathway is triggered by exogenous and endogenous abnormal dsRNA under viral infection and dyshomeostasis, thereby activating the immune responses. Thus, we investigated the effect of RNase L on irradiation-induced bone marrow damage using RNase L knockout (RNase L−/−) mice. Phenotypic analysis revealed that RNase L knockout mitigates irradiation-induced injury in the bone marrow. Further investigation into the mechanism of RNase L by RNA-seq, qRT-PCR, and CBA analysis demonstrated that RNase L deficiency counteracts the upregulation of genes related to immune responses induced by irradiation, including cytokines and interferon-stimulated genes. Moreover, RNase L deficiency inhibits the increased levels of immunoglobulins in serum induced by irradiation. These findings indicate that RNase L plays a role in the immune response induced by irradiation in the bone marrow. This study further enhances our understanding of the biological functions of RNase L in the immune response induced by irradiation and offers a novel approach for managing irradiation-induced bone marrow injury through the regulation of RNase L activation