Patient Power: A feasibility study on the impact of providing a bedside notepad to encourage patients to ask questions following surgery.

Objective: This study aimed to evaluate a behaviour change strategy to enhance the patient voice in the early post-operative setting. Methods: The Patient Power notepad was evaluated in an uncontrolled, single-group, mixed-methods trial including a patient evaluation survey and staff phone interviews. Results: Patients thought that the notepad was well-designed and prompted them to think of and ask questions. They strongly agreed that healthcare practitioners answered health-related questions fully and carefully. Staff reported that the notepad not only provided an easy mechanism through which patients and their families could communicate with their healthcare team, but it also created a permissive environment where questions were encouraged. Conclusion: The Patient Power notepad provided an easy, acceptable and scalable intervention to encourage patients to engage more in their healthcare and specifically to ask questions about their care. By providing a structured tool for capturing patient concerns, symptoms, and questions, this innovation holds the potential to enhance patient satisfaction, treatment adherence, and overall healthcare outcomes. Innovation: By facilitating comprehensive information exchange and the potential to promote shared decision-making, this innovation has the potential to improve patient satisfaction, treatment adherence, and overall healthcare outcomes.

Understanding and Changing Community Attitudes Toward Vulnerable Families: A Review of Literature and Practice.

Communities can play an important role in protecting children and supporting vulnerable families. However, there is currently a lack of understanding of what communities actually think and do regarding these groups. The purpose of this study was to review and synthesize evidence on community attitudes and behaviors toward vulnerable families. A rapid systematic literature review was conducted, supplemented by 6 semistructured interviews with experienced practitioners. Four databases were searched using key words related to community attitudes and behaviors, parents and families, and family and child protection services. Database searches returned 10 135 unique records, of which 23 met the inclusion criteria. The identified articles investigated a range of attitudes and behaviors, including reporting abuse and neglect; assisting victims of intimate partner violence; attitudes toward parenting practices; and participating in activities that build social support and social capital. Correlates of these attitudes and behaviors included sociodemographic characteristics, individual differences, community characteristics, and incident characteristics. A number of interventions to change community attitudes and behaviors were also identified. Practitioners indicated that success factors for interventions included facilitating active participation from community members; using multifaceted approaches; and increasing empathy toward vulnerable families. Despite increasing evidence around how community members think and act toward vulnerable families, more (particularly review-level) research is needed to determine how to effectively change these attitudes and behaviors.

Feasibility of a rapid diagnosis discussion tool for reducing misdiagnosis of patients presenting to emergency departments with abdominal pain.

OBJECTIVES: Providing accurate and timely diagnoses is challenging in ED settings. We evaluated the feasibility and effectiveness of a short, structured rapid diagnosis discussion (RaDD) between a patient's initial doctor and a second doctor for patients presenting to ED with abdominal pain. METHODS: Controlled pre-post, mixed-methods pilot study in a metropolitan hospital network in Melbourne, Australia. Comparisons were made between an ED using RaDD for a 1-month period (n = 155) and two control EDs within the same hospital network (n = 2227) using standard practices. A short survey of 27 clinicians was also undertaken. RESULTS: Provisional diagnoses changed in 24.7% (95% confidence interval 19.0, 30.4) of all cases for which a RaDD case report sheet was completed, and clinicians' confidence in their decision-making was significantly higher when using RaDD (r = 0.27). RaDD significantly increased the likelihood that patients would be sent to the short stay unit and have a blood test ordered, and significantly reduced the likelihood that patients would be discharged home from the ED or leave at their own risk. Usage of the RaDD tool was low (25.2% of eligible cases), and qualitative feedback indicated that time limitations inhibited uptake. CONCLUSIONS: RaDD encouraged clinicians to take a more cautious, risk-averse approach to care and improved confidence in their diagnostic decisions. However, cost effectiveness of these outcomes and possible implementation barriers need to be further considered in subsequent studies.

The frequency and nature of barriers to escalation of care in two Australian teaching hospitals.

BACKGROUND: Nurses and junior doctors are often the first clinicians to recognise signs of deterioration in patients. However, there can be barriers to having conversations about escalation of care. OBJECTIVES: The aim of this study was to study the frequency and nature of barriers encountered during discussions related to escalation of care for deteriorating hospitalised patients. METHODS: This was a prospective observational study with daily experience sampling surveys related to escalation of care discussions. The study setting involved two teaching hospitals in Victoria, Australia. Consented doctors, nurses, and allied health staff members involved in routine care of adult ward patients participated in the study. The main outcome measures included the frequency of escalation conversations and the frequency and nature of barriers encountered during such conversations. RESULTS/FINDINGS: 31 clinicians participated in the study and completed an experience sampling survey 294 times, mean (standard deviation) = 9.48 (5.82). On 166 (56.6%) days, staff members were on clinical duties, and escalation of care discussions occurred on 67 of 166 (40.4%) of these days. Barriers to escalation of care occurred in 25 of 67 (37.3%) of discussions and most frequently involved lack of staff availability (14.9%), perceived stress in the contacted staff member (14.9%), perceptions of criticism (9.0%), being dismissed (7.5%), or indication of lack of clinical appropriateness in the response (6.0%). CONCLUSIONS: Discussions related to escalation of care by ward clinicians occur in almost half of clinical days and are associated with barriers in one-third of discussions. Interventions are needed to clarify roles and responsibilities and outline behavioural expectations on both sides of the conversation and enable respectful communication amongst individuals involved in discussions of escalation of patient care.

Effectiveness of an educational intervention targeting homophobic language use by young male athletes: a cluster randomised controlled trial.

OBJECTIVE: Homophobic language is common in male sport and associated with negative physical and mental health outcomes for all sport participants, but particularly for gay or bisexual youth populations. Evidence-based interventions are needed to reduce such language and mitigate harm. This study evaluated the effectiveness of a short social-cognitive educational intervention delivered by professional rugby union players in youth sport. METHODS: In a two-arm, cluster randomised controlled trial, 13 Australian youth rugby teams from 9 clubs (N=167, ages 16-20, mean 17.9) were randomised into intervention or control groups. Professional rugby players delivered the intervention in-person. Frequency of homophobic language use was measured 2 weeks before and 2 weeks after the intervention. Hypothesised factors underpinning homophobic language were also measured, including descriptive (other people use), prescriptive and proscriptive injunctive norms (approval/disapproval by others), and attitudes towards the acceptability of homophobic language. RESULTS: At baseline, 49.1% of participants self-reported using homophobic language in the past 2 weeks and 72.7% reported teammates using homophobic language. Significant relationships were found between this behaviour and the hypothesised factors targeted by the intervention. However, generalised estimating equations found the intervention did not significantly reduce homophobic language, or alter the associated norms and attitudes, relative to controls. CONCLUSION: Use of professional rugby athletes to deliver education on homophobic language was not effective. Other approaches to reduce homophobic language (and other forms of discrimination) such as peer-to-peer education, and enforcement of policies prohibiting specific language by coaches, should be explored.

What matters for the scalability of prejudice reduction programs and interventions? A Delphi study.

BACKGROUND: In many countries, policy makers and practitioners turn to prejudice reduction programs and interventions to tackle prejudice in the community. However, successfully addressing prejudice requires an effective intervention that can scale to match the broad span of the problem. The scalability assessment frameworks from health sciences have varying emphasis on four categories-intervention, delivery, costs, and context. For example, the high-level factors in the two Milat et al. scalability assessments are weighted towards details of the intervention (Milae et al. in Health Promot Int 28(3):285-981, 2013; Health Res Policy Syst 2:1-17, 2020). Investigation into scalability, specific to prejudice reduction, is necessary to understand how scalability frameworks apply in a different discipline. METHODS: Using a Delphi approach-a structured method to obtain consensus from experts (Milae et al. Health Promot Int 28(3):285-981, 2013; Linstone and Turoff in The Delphi method-techniques and applications, Addison-Wesley, 1975; de Meyrick in Health Educ 103(1):7-16, 2003)-to bring together 16 prejudice reduction experts from multiple sectors including NGOs, private, government and academia, we developed a scalability assessment framework of criteria that are important for the successful scaling of prejudice interventions. We then applied that framework to exemplars of prejudice reduction interventions published in the academic literature. RESULTS: For prejudice reduction interventions, contextual factors are key considerations for successful scaling. Commonly used prejudice reduction intervention approaches like contact, whether face-to-face or online, can have limited scalability. CONCLUSIONS: To reduce prejudice there needs to be consideration of scalability. This paper presents a first-of-its-kind framework for assessing scalability for prejudice reduction interventions. Applying the empirically developed framework to actual interventions demonstrated that for interventions to be effective and scalable, a greater focus on approaches beyond face-to-face contact is required.

What reduces prejudice in the real world? A meta-analysis of prejudice reduction field experiments.

Despite advances to promote acceptance and equity in many countries, prejudice remains a significant social problem. Promoting intergroup harmony requires knowledge about what works to reduce prejudice in community settings. This meta-analysis of field experiments reveals the most effective intervention types and conditions for reducing negative attitudes towards minority groups in real-world settings. Across 69 intervention arms and 24,378 participants, results reveal that prejudice reduction interventions are effective at improving attitudes towards minority groups in real-world settings (d = 0.51, 95% CI [0.33; 0.68]). The prediction interval was -0.90 to 1.92. In this case, the prediction interval was particularly wide because of the high degree of heterogeneity detected in effect size. Subgroup analyses indicate that less commonly explored approaches, such as perceived variability, may have larger effect sizes than contact-based interventions. Still, more research is needed to confirm the effects of these less-researched approaches. Additionally, results show that interventions are more effective for school and college cohorts than for adults, and that the effects of prejudice reduction interventions endure over time.

Draft Genome Sequences of Four Aerobic Isobutane-Metabolizing Bacteria.

Here, we report the draft genome sequences of four aerobic gaseous alkane-oxidizing bacteria isolated from soil by enrichment culture using isobutane (2-methylpropane) as the sole carbon and energy source. The sequences all reveal microorganisms with multiple alkane-oxidizing monooxygenases, including soluble di-iron monooxygenases (SDIMOs), copper-containing monooxygenases (CuMMOs), and alkane hydroxylases (AHs).

Simulation-based training for increasing health service board members' effectiveness: a cluster randomised controlled trial.

OBJECTIVES: There is a paucity of research on how to improve the functioning of health service boards, despite their importance in influencing patient care. We examined the impact of simulation-based training on health service board members' perceptions of their skills in communicating during board meetings and of board meeting processes. DESIGN: Prospective, cluster randomised controlled trial. SETTING: Health service boards in Victoria, Australia. PARTICIPANTS: Twelve boards were randomised, and pre- and post-intervention data were collected and analysed from 57 members of these boards. INTERVENTIONS: Boards were randomly allocated to either a treatment condition in which they received a 2-hour simulation-based training session or to a wait list control condition. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome variables were board members' perceptions regarding: (1) their skill and confidence in communicating during board meetings and (2) processes at their board meetings. Measures were collected in the intervention group before and 3 months post-training and compared with a wait list control group. RESULTS: Skills and confidence in communicating during board meetings was higher after training (control marginal mean=5.11, intervention marginal mean=5.42, mean difference=0.31, 90% CI (-0.03 to 0.66), one-sided p=0.068, d=0.40). Board meeting processes were also improved after training (control marginal mean=4.97, intervention marginal mean=5.37, mean difference=0.40, 90% CI (0.14 to 0.65), one-sided p=0.005, d=0.54). CONCLUSIONS: Simulation-based training appeared to improve board members' skills and confidence, and perceptions of board meeting processes. A larger scale trial is needed to examine possible impacts on patient outcomes. TRIAL REGISTRATION: Open Science Framework: http://osf.io/jaxt6/; Pre-results.

The effects of local socio-political events on group cohesion in online far-right communities.

In recent years, the reach and influence of far-right ideologies have been extended through online communities with devastating effects in the real world. In this research, we examine how far-right online communities can be empowered by socio-political events that are significant to them. Using over 14 years of data extracted from an Australian national sub-forum of a global online white supremacist community, we investigate whether the group cohesion of the community is affected by local race riots. Our analysis shows that the online community, not only became more cohesive after the riots, but was also reinvigorated by highly active new members who joined during the week of the riots or soon after. These changes were maintained over the longer-term, highlighting pervasive ramifications of the local socio-political context for this white supremacist community. Pre-registered analyses of data extracted from other white supremacist online communities (in South Africa and the United Kingdom) show similar effects on some of the indicators of group cohesion, but of reduced magnitude, and not as enduring as the effects found in the context of the Australian far-right online community.

Political probity increases trust in government: Evidence from randomized survey experiments.

Low levels of trust in government have potentially wide-ranging implications for governing stability, popular legitimacy, and political participation. Although there is a rich normative and empiricial literature on the important consequences of eroding trust in democratic societies, the causes of political trust are less clear. In this article we estimate the effect that changing Americans' views about the perceived honesty and integrity of political authorities (or "political probity") has on their trust in government using randomized survey experiments. In one experiment on a convenience sample and a direct replication on a more representative sample, we find that a single Op-Ed article about political probity increased trust in government by an amount larger than the partisan gap between Democrats and Republicans. These results complement prior observational studies on trust in government by demonstrating that political probity plays an important causal role in shaping Americans' judgments about the trustworthiness of their government and politicians.

What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives.

The purpose of this article is to synthesise review evidence, practice and patient perspectives on interventions to reduce diagnostic error in emergency departments (EDs). A rapid review methodology identified nine systematic reviews for inclusion. Six practice interviews were conducted to identify local contextual insights and implementation considerations. Finally, patient perspectives were explored through a citizen panel with 11 participants. The rapid review found evidence for the following interventions: second opinion, decision aids, guided reflection and education. Practitioners suggested three of the four interventions from the academic review: second opinion, decision aids and education. Practitioners suggested four additional interventions: improving teamwork, engaging patients, learning from mistakes and scheduled test follow-up. Patients most favoured interventions that improved communication through education and patient engagement, while also suggesting that implementation of state-wide standards to reduce variability in care and sufficient staffing are important to address diagnostic errors. Triangulating these three perspectives on the evidence allows for the intersections to be highlighted and demonstrates the usefulness of incorporating practitioner reflections and patient values in developing potential interventions.

Simulation-based training for increasing health service board members' effectiveness: protocol for a cluster-randomised controlled trial.

INTRODUCTION: Research indicates that health service boards can influence quality of care. However, government reviews have indicated that board members may not be as effective as possible in attaining this goal. Simulation-based training may help to increase board members' ability to effectively communicate and hold hospital staff to account during board meetings. METHODS AND ANALYSIS: To test effectiveness and feasibility, a prospective, cluster-randomised controlled trial will be used to compare simulation-based training with no training. Primary outcome variables will include board members' perceived skill and confidence in communicating effectively during board meetings, and board members' perceptions of board meeting processes. These measures will be collected both immediately before training, and 3 months post-training, with boards randomly assigned to intervention or control arms. Primary analyses will comprise generalised estimating equations examining training effects on each of the primary outcomes. Secondary analyses will examine participants' feedback on the training. ETHICS AND DISSEMINATION: Research ethics approval has been granted by Monash University (reference number: 2018-12076). We aim to disseminate results through peer-reviewed journal publication, conference presentation and social media. TRIAL REGISTRATION NUMBER: Open Science Framework: http://osf.io/jaxt6/; Pre-results.

Short Message Service Reminders to Parents for Increasing Adolescent Human Papillomavirus Vaccination Rates in a Secondary School Vaccine Program: A Randomized Control Trial.

PURPOSE: In Victoria (Australia), the human papillomavirus (HPV) vaccine is delivered within a state-wide secondary school vaccine program, administered by local government. This study aimed to test the hypothesis that sending a short message service (SMS) reminder to parents who had consented to their child's receiving the HPV vaccine would lead to greater uptake of the vaccine within the program. The secondary aim was to assess the effect of self-regulatory versus motivational message content in the SMS. METHODS: A randomized control trial design was used across 31 schools within seven local government areas. Parents of 4,386 consented adolescents were randomized into three study conditions: motivational SMS versus self-regulatory SMS versus no SMS. Follow-up extended beyond the final school visit to the end of the calendar year to capture those who may have attended a catch-up vaccination session. RESULTS: On the day of the final school visit, 85.71% of consented students in the control condition received the HPV vaccine, compared with 88.35% (2.64% point increase) in the motivational message condition, and 89.00% (3.29% point increase) in the self-regulatory message condition, χ2 (2, N = 4,386) = 8.31, p = .016. Both intervention messages were similarly effective at increasing vaccination rates. This effect was maintained in the extended follow-up period. CONCLUSIONS: The trial findings supported the hypothesis that SMS reminders to parents/guardians would lead to greater uptake of the HPV vaccine in adolescents participating in school-based vaccination. Also, this effect was observed whether we used a motivational or self-regulatory message framework. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12617001307392). Registration Date: September 12, 2017. Retrospectively registered.

Communication-based interventions for increasing influenza vaccination rates among Aboriginal children: A randomised controlled trial.

BACKGROUND: In Australia, the influenza vaccine is funded for Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) children aged 6 months to <5 years old. In Victoria, only 2% of Aboriginal children are vaccinated against influenza. OBJECTIVE: To evaluate whether sending a letter or sending a pamphlet directly to parents/guardians would improve influenza vaccine uptake amongst Aboriginal identified children. DESIGN: The study involved a multi-arm, parallel, randomised controlled trial with two intervention groups and one control group. PARTICIPANTS & SETTING: Participants included parents or guardians of Victorian children (aged 6 months to <5 years) who identified as Aboriginal. Households (n = 5534) were randomised (using a random number generator) to receive either a personalised letter (n = 1845), a pamphlet (n = 1845), or no direct communication (control) (n = 1844). The letter and the pamphlet were designed using the INSPIRE framework - a set of behaviour change techniques for action-oriented communication. MAIN OUTCOME MEASURE: The proportion of households where all eligible children received the influenza vaccine between 2 May 2017 and 1 September 2017. RESULTS: The control group's vaccination rate was 4.4%, higher than previous years. The pamphlet group achieved a similar vaccination rate (4.5%). The letter group's vaccination rate of 5.9% was significantly higher than the control group [χ2 (1, n = 3689) = 4.33, p = .037]. CONCLUSIONS: Sending a personalised letter directly to parents/guardians was an effective strategy for increasing influenza vaccination among Aboriginal children. The ineffectiveness of the pamphlet may be due to the lack of personalisation and the authority associated with the letter. Additional research is required to understand participant responses to the material. TRIAL REGISTRATION: This research was retrospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on 13 September 2017 (ACTRN12617001315303).