Objective Assessment of Surgical Operative Performance by Observational Clinical Human Reliability Analysis (OC-HRA):A Systematic Review

Background: Both morbidity and mortality data (MMD) and learning curves (LCs) do not provide information on the nature of intraoperative errors and their mechanisms when these adversely impact on patient outcome. OCHRA was developed specifically to address the unmet surgical need for an objective assessment technique of the quality of technical execution of operations at individual operator level. The aim of this systematic review was to review of OCHRA as a method of objective assessment of surgical operative performance.Methods: Systematic review based on searching 4 databases for articles published from January 1998 to January 2019. The review complies with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and includes original publications on surgical task performance based on technical errors during operations across several surgical specialties.Results: Only 26 published studies met the search criteria, indicating that the uptake of OCHRA during the study period has been low. In 31% of reported studies, the operations were performed by fully qualified consultant/attending surgeons and by surgical trainees in 69% in approved training programs. OCHRA identified 7869 consequential errors (CE) during the conduct of 719 clinical operations (mean = 11 CEs). It also identified ‘hazard zones’ of operations and proficiency–gain curves (P-GCs) that confirm attainment of persistent competent execution of specific operations by individual trainee surgeons. P-GCs are both surgeon and operation specific.Conclusions: Increased OCHRA use has the potential to improve patient outcome after surgery, but this is a contingent progress towards automatic assessment of unedited videos of operations. The low uptake of OCHRA is attributed to its labor-intensive nature involving human factors (cognitive engineering) expertise. Aside from faster and more objective peer-based assessment, this development should accelerate increased clinical uptake and use of the technique in both routine surgical practice and surgical training.</p

Market Size, Competition, and the Product Mix of Exporters

We build a theoretical model of multi-product firms that highlights how market size and geography (the market sizes of and bilateral economic distances to trading partners) affect both a firm\'s ex-ported product range and its exported product mix across market destinations (the distribution of sales across products for a given product range). We show how tougher competition in an export market induces a firm to skew its export sales towards its best performing products. We find very strong confirmation of this competitive effect for French exporters across export market destina-tions. Trade models based on exogenous markups cannot explain this strong significant link between destination market characteristics and the within-firm skewness of export sales (after controlling for bilateral trade costs. Theoretically, this within firm change in product mix driven by the trading environment has important repercussions on firm productivity and how it responds to changes in that trading environment.

The Importance of Culture in Evaluation: A Practical Guide for Evaluators

Offers guidance on designing and conducting a cross-culturally competent program evaluation that takes into account how culture, social identity or group membership, and privilege and power affect responses. Discusses challenges and ways to address them

Market size, competition, and the product mix of exporters

We build a theoretical model of multi-product firms that highlights how competition across market destinations affects both a firm's exported product range and product mix. We show how tougher competition in an export market induces a firm to skew its export sales towards its best performing products. We find very strong confirmation of this competitive effect for French exporters across export market destinations. Theoretically, this within firm change in product mix driven by the trading environment has important repercussions on firm productivity. A calibrated fit to our theoretical model reveals that these productivity effects are potentially quite large

Neurocognitive impairment is associated with lower health literacy among persons living with HIV infection.

This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which encompasses the ability to access, understand, appraise, and apply health-related information. Participants included 56 HIV seropositive individuals, 24 of whom met Frascati criteria for HAND, and 24 seronegative subjects who were comparable on age, education, ethnicity, and oral word reading. Each participant was administered a brief battery of well-validated measures of health literacy, including the Expanded Numeracy Scale (ENS), Newest Vital Sign (NVS), Rapid Estimate of Adult Literacy in Medicine (REALM), and Brief Health Literacy Screen (BHLS). Results revealed significant omnibus differences on the ENS and NVS, which were driven by poorer performance in the HAND group. There were no significant differences on the REALM or the BHLS by HAND status. Among individuals with HAND, lower scores on the NVS were associated with greater severity of neurocognitive dysfunction (e.g., working memory and verbal fluency) and self-reported dependence in activities of daily living. These preliminary findings suggest that HAND hinders both fundamental (i.e., basic knowledge, such as numeracy) and critical (i.e., comprehension and application of healthcare information) health literacy capacities, and therefore may be an important factor in the prevalence of health illiteracy. Health literacy-focused intervention may play an important role in the treatment and health trajectories among persons living with HIV infection

Effects of Equal Volume But Different Plyometric Jump Training Intensities on Components of Physical Fitness in Physically Active Young Males

An 8-week single-blind randomized controlled trial was conducted to compare the effects of separate programs of equal volume, but different intensity, plyometric jump training (PJT), on physical fitness in healthy adults. Thirty-eight physically active males (mean age: 21.8 +/- 2.5 years) participated. Subjects were randomly assigned to one of 3 PJT groups or a control (CON, n = 9) according to their jump performance. Plyometric jump training was conducted at maximal (PJT-100, n = 10), high (PJT-80, n = 9), or moderate (PJT-65, n = 10) intensity within each group. Baseline and follow-up tests were performed for the assessment of countermovement jump (CMJ) height, CMJ height with arm swing (CMJA), and drop jump height from a 20-cm drop box (DJ20), linear speed (30 m), and change-of-direction speed (CODS) (the Illinois CODS test). Results revealed significant group x time interactions for CMJ, CMJA, DJ20, 30-m sprint, and CODS (all p < 0.001; d = 0.39-0.76). Post hoc analyses showed significant improvements in all 5 fitness measures for PJT-100 (all p < 0.01, Delta 3.7-13.5%, d = 0.26-1.4). For PJT-80, 3 of 5 fitness tests demonstrated significant change (CMJ: p < 0.001, Delta 5.9%, d = 0.33; CMJA: p < 0.001, Delta 7.0%, d = 0.43; CODS: p < 0.001, Delta 3.9%, d = 0.9), and for PJT-65, only 1 test was significant (CMJ: p < 0.05, Delta 2.8%, d = 0.15). No significant changes were observed in CON. Except for similar gains in DJ20 and 30-m sprint in PJT-100 and PJT-80, gains in physical fitness were, in general, greater (p < 0.05) after PJT-100 vs. PJT-80 vs. PJT-65 vs. CON. Therefore, maximal PJT intensity may induce larger physical fitness gains, although high and moderate intensities may also be useful, but to a lesser extent

Do coursework summative assessments predict clinical performance? A systematic review

BACKGROUND: Two goals of summative assessment in health profession education programs are to ensure the robustness of high stakes decisions such as progression and licensing, and predict future performance. This systematic and critical review aims to investigate the ability of specific modes of summative assessment to predict the clinical performance of health profession education students. METHODS: PubMed, CINAHL, SPORTDiscus, ERIC and EMBASE databases were searched using key terms with articles collected subjected to dedicated inclusion criteria. Rigorous exclusion criteria were applied to ensure a consistent interpretation of ‘summative assessment’ and ‘clinical performance’. Data were extracted using a pre-determined format and papers were critically appraised by two independent reviewers using a modified Downs and Black checklist with level of agreement between reviewers determined through a Kappa analysis. RESULTS: Of the 4783 studies retrieved from the search strategy, 18 studies were included in the final review. Twelve were from the medical profession and there was one from each of physiotherapy, pharmacy, dietetics, speech pathology, dentistry and dental hygiene. Objective Structured Clinical Examinations featured in 15 papers, written assessments in four and problem based learning evaluations, case based learning evaluations and student portfolios each featured in one paper. Sixteen different measures of clinical performance were used. Two papers were identified as ‘poor’ quality and the remainder categorised as ‘fair’ with an almost perfect (k = 0.852) level of agreement between raters. Objective Structured Clinical Examination scores accounted for 1.4–39.7% of the variance in student performance; multiple choice/extended matching questions and short answer written examinations accounted for 3.2–29.2%; problem based or case based learning evaluations accounted for 4.4–16.6%; and student portfolios accounted for 12.1%. CONCLUSIONS: Objective structured clinical examinations and written examinations consisting of multiple choice/extended matching questions and short answer questions do have significant relationships with the clinical performance of health professional students. However, caution should be applied if using these assessments as predictive measures for clinical performance due to a small body of evidence and large variations in the predictive strength of the relationships identified. Based on the current evidence, the Objective Structured Clinical Examination may be the most appropriate summative assessment for educators to use to identify students that may be at risk of poor performance in a clinical workplace environment. Further research on this topic is needed to improve the strength of the predictive relationship. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12909-017-0878-3) contains supplementary material, which is available to authorized users

The struggling infectious diseases fellow: Remediation challenges and opportunities

Remediation of struggling learners is a challenge faced by all educators. In recognition of this reality, and in light of contemporary challenges facing infectious diseases (ID) fellowship program directors, the Infectious Diseases Society of America Training Program Directors\u27 Committee focused the 2018 National Fellowship Program Directors\u27 Meeting at IDWeek on Remediation of the Struggling Fellow. Small group discussions addressed 7 core topics, including feedback and evaluations, performance management and remediation, knowledge deficits, fellow well-being, efficiency and time management, teaching skills, and career development. This manuscript synthesizes those discussions around a competency-based framework to provide program directors and other educators with a roadmap for addressing common contemporary remediation challenges

Equality in Health: An Annotated Bibliography With Resources on Health Disparities and Cultural and Linguistic Competency

Provides citations for articles, reports, books, and online resources on racial/ethnic disparities in health and health care, strategies to reduce them, assessment tools for cultural and linguistic competency, training and education, and other issues