Implementing human factors in clinical practice

OBJECTIVES: To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. METHODS: Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. RESULTS: The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. CONCLUSIONS: In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice

The feasibility of nurse-delivered, low-intensity cognitive behavioural therapy for irritable bowel syndrome.

Introduction: This study assessed the feasibility of nurse-delivered cognitive behavioural therapy (CBT) for the treatment of irritable bowel syndrome (IBS). Methods and analysis: A mixed-method design was used, and 20 participants were randomly allocated to high-intensity CBT (n=5), guided self-help (n=5), self-help only (n=5) or treatment as usual (n=5). Ten intervention participants completed semi-structured interviews. Quantitative data were analysed using descriptive statistics; qualitative data were analysed using group thematic analysis. Results: Barriers to the interventions were lack of therapist contact, negative preconceptions about treatment and factors relating to supporting materials. Treatment facilitators included therapist-facilitated relaxation, narratives located within self-help materials and social support mechanisms. Conclusion: Further development of the low-intensity interventions in collaboration with service users is required to improve intervention acceptability and relevance.N/

Assessment of commercially available computerized neurocognitive testing in the adolescent concussed athlete: A retrospective analysis.

Background: Clinicians frequently use computer-based neurocognitive assessments to aid in the diagnosis and management of Sport Related Concussion (SRC). With practitioners using varied Neuro-Cognitive Assessment Tools (NCAT), questions arise concerning among NCAT and how these differences may affect patient care. The purpose of the current study is to offer a comparative analysis of two widely accepted, commercially available computer-based neurocognitive testing modalities in the adolescent concussed athlete. Hypothesis: There will be a difference between the C3 Logix® vs ImPACT® scoring in the IRPT and RTP Study Design: Retrospective chart review. Methods: In order to identify patients that were diagnosed with SRC, the records of patients reporting to a Sports Medicine practice were reviewed from a period of 18 months. All patients were assessed with either the ImPACT® or C3 Logix NCAT®. The date of the injury (DOI) as well as the patient’s symptom level (IVAL), time to initiation of the return to play protocol (IRTP), and time to the return to play (RTP) were recorded. Results: Two hundred and twenty-two records (222) were identified. There was no difference in the symptom score (P = 0.22) at the IEVAL between C3 Logix® (31.5±27.0) and ImPACT® (23.2±21.9), in the IRTP (P = 0.22) between the C3 Logix® (6.2±4.3 days) and ImPACT® (5.1±4.3 days) or RTP (P = 0.46) between C3 Logix (12.1±4.9 days) and ImPACT (15.6±19.8 days). Weak to moderate correlations were found between symptom scores, IRTP, and RTP. Conclusions: Clinicians made similar recommendations, independent of the NCAT used, as when to initiate the return to play protocol and when the patient could ultimately return to play. Clinical Relevance: The particular NCAT utilized by clinician was not a primary factor in the clinical judgement towards the management of the patient with SRC

MiCASA is a new method for quantifying cellular organization

While many tools exist for identifying and quantifying individual cell types, few methods are available to assess the relationships between cell types in organs and tissues and how these relationships change during aging or disease states. We present a quantitative method for evaluating cellular organization, using the mouse thymus as a test organ. The thymus is the primary lymphoid organ responsible for generating T cells in vertebrates, and its proper structure and organization is essential for optimal function. Our method, Multitaper Circularly Averaged Spectral Analysis (MiCASA), identifies differences in the tissue-level organization with high sensitivity, including defining a novel type of phenotype by measuring variability as a specific parameter. MiCASA provides a novel and easily implemented quantitative tool for assessing cellular organization

Inducible systemic RNA silencing in Caenorhabditis elegans

Introduction of double-stranded RNA (dsRNA) can elicit a gene-specific RNA interference response in a variety of organisms and cell types. In many cases, this response has a systemic character in that silencing of gene expression is observed in cells distal from the site of dsRNA delivery. The molecular mechanisms underlying the mobile nature of RNA silencing are unknown. For example, although cellular entry of dsRNA is possible, cellular exit of dsRNA from normal animal cells has not been directly observed. We provide evidence that transgenic strains of Caenorhabditis elegans transcribing dsRNA from a tissue-specific promoter do not exhibit comprehensive systemic RNA interference phenotypes. In these same animals, modifications of environmental conditions can result in more robust systemic RNA silencing. Additionally, we find that genetic mutations can influence the systemic character of RNA silencing in C. elegans and can separate mechanisms underlying systemic RNA silencing into tissue-specific components. These data suggest that trafficking of RNA silencing signals in C. elegans is regulated by specific physiological and genetic factors

ECG measurement parameters of athletes are reliable when made with a smartphone based ECG device

Pre-participation cardiac screening including electrocardiogram (ECG) is a subject of controversy among sports medicine practitioners. Opponents of pre-participation ECG screen site concerns regarding the cost and accuracy of the testing. Recently, a single lead ECG accessory has become available for use with smartphones. The purpose of this study was to evaluate the between and within rater validity and reliability of the Kardia device in recording the ECG parameters rate, rhythm, and PR, QRS, and QT intervals. The ECG parameter made with the smartphone were also compared to same measures made using a 12 lead electrocardiograph. This investigation used a repeated measures cross-sectional design. The investigation was conducted in 2 separate phases using separate participant samples. Phase 1 (N=10) was used to determine the within rater reliability with the Kardia device. Phase 2 (N=12) was used to determine the reliability between the Kardia device and the 12 lead electrocardiograph. The between rater and between device reliability for the rate, QT interval and QRS duration parameters ranged good to very good (ICC = 0.667 – 0.981). The current investigation showed that the reliability of the ECG parameters measured using the smartphone technology ranged from good to very good. This paper serves as support for a technological advancement that will help advance the debate on the utility of ECG testing as part of the athletic pre-participation physical

Supporting Physical Activity in the Childcare Environment (SPACE): Rationale and study protocol for a cluster randomized controlled trial Energy balance-related behaviors

Background: Young children are prone to low levels of physical activity in childcare. Researchers have identified that preschoolers tend to be more active outdoors than indoors, with higher activity levels occurring during the first 10 minutes of outdoor playtime. Additionally, interventions incorporating either staff training or the inclusion of play equipment have been effective at increasing children\u27s activity in this setting. As such, the overarching objective of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention is to improve the physical activity levels of preschoolers during childcare hours, utilizing a combination of the above components. The purpose of this manuscript is to provide a detailed account of the protocol, innovative methods, and evaluation plans used in the implementation of the SPACE study; in an effort to support the development of further research in this field. Methods/Design: The SPACE study, a cluster randomized controlled trial, involves 22 childcare centres randomly allocated to either the experimental (n = 11) or the control (n = 11) group. Childcare centres receiving the intervention will adopt an 8-week physical activity intervention with the following components: 1. shorter, more frequent bouts of outdoor playtime (4 × 30 min periods rather than 2 × 60 min periods); 2. new portable play equipment (e.g., obstacle course, balls); and, 3. staff training (1 × 4 hr workshop). Actical accelerometers will be used to assess total physical activity with measurements taken at baseline (i.e., week 0), immediately post-intervention (i.e., week 8), and at 6- and 12-month follow-up. As secondary objectives, we aim to evaluate the effectiveness of the intervention on preschoolers\u27: a) sedentary time; b) standardized body mass index scores (percentiles); c) health-related quality of life; and childcare providers\u27 physical activity-related knowledge and self-efficacy to implement physical activity. Discussion: The SPACE study aims to increase the low levels of physical activity observed within childcare centres. The findings of this work may be useful to policy makers and childcare providers to consider modifications to the current childcare curriculum and associated outdoor play time

The Implementation and Feasibility of the Supporting Physical Activity in the Childcare Environment (SPACE) Intervention: A Process Evaluation

This study describes the process evaluation of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention, consisting of educator physical activity training, provision of portable play equipment, and a modified outdoor schedule (i.e., 4 × 30-minute periods). Educators (N = 49) from 11 childcare centers in London, Ontario, Canada, delivered the 8-week intervention to 200 preschoolers (Mage = 3.38 years). Workshop attendance was documented while adherence to the outdoor schedule and number and timing of outdoor sessions offered (i.e., dose) were recorded in a daily log. Questionnaire-based program evaluation (n = 41) and in-person group interviews (n = 7) were completed postintervention to assess educator perspectives on the barriers and facilitators to implementation (i.e., context), the feasibility and perceived effectiveness of the intervention, educator and preschooler enjoyment, communication among researchers and childcare personnel, and the future implementation of the intervention. Descriptive statistics were calculated, and responses to open-ended questions were inductively coded. Educator workshop attendance was 96%, and 88% of classrooms adhered to the four daily outdoor periods. Educators delivered 90% of the scheduled outdoor sessions, and 87% of these met the 30-minute criteria. Educators expressed that the increase in number of transitions made the outdoor playtimes challenging to implement, yet rated the feasibility of the training and equipment as high. Educators perceived the intervention to be both enjoyable and effective at increasing preschoolers’ physical activity. They indicated effective communication and revealed that they intended to continue to use their physical activity knowledge and to offer the play equipment once the intervention had concluded. These findings demonstrate that the SPACE intervention is viable in center-based childcare