Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers.

AIMS: A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. METHODS: Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous. RESULTS: A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments. CONCLUSIONS: AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits.

Tenure and Turnover Among State Health Officials From the SHO-CASE Survey: Correlates and Consequences of Changing Leadership.

OBJECTIVE: To examine characteristics associated with tenure length of State Health Officials (SHOs) and examine reasons and consequences for SHO turnover. DESIGN: Surveys of current and former SHOs linked with secondary data from the United Health Foundation. SETTING: Original survey responses from SHOs in the United States. PARTICIPANTS: Respondents included SHOs who served between 1973 and 2017. MAIN OUTCOME MEASURES: Tenure length and consequences of SHO turnover. RESULTS: Average completed tenure among SHOs was 5.3 years (median = 4) and was shorter in recent time periods compared with decades prior. Older age at appointment (ß = -0.109, P = .005) and those holding a management degree (ß = -1.835, P = .017) and/or a law degree (ß = -3.553, P < .001) were each associated with shorter SHO tenures. State Health Officials from states in the top quartile for health rankings had significantly longer average tenures (ß = 1.717, P = .036). Many former SHOs believed that their tenure was too short and reported that their departure had either a significant or very large effect on their agency's ability to fulfill its mission. CONCLUSIONS: State Health Official tenures have become shorter over time and continue to be shorter than industry chief executive officers and best practice recommendations from organizational researchers. States have an opportunity to consider and address how factors within their control influence the stability of the SHO position.

Multidisciplinary Team Reviews of Drug Overdose Deaths and the Use of Minigrants to Advance Recommendations: A Statewide Pilot in Rhode Island.

CONTEXT: Rhode Island has been significantly impacted by the opioid epidemic, ranking 11th in unintentional drug overdose rates in the United States in 2017. Illicit fentanyl was involved in the majority of these deaths. PROGRAM: To enhance surveillance of this epidemic, the RI Department of Health piloted in-depth, multidisciplinary, and multiagency team reviews of drug overdose deaths. The goals were to identify gaps in policies and programming and develop recommendations to prevent future deaths. Time-sensitive minigrants were offered to nonprofit organizations as a novel way to further the recommendations put forth from these reviews. IMPLEMENTATION: Legal agreements between select state agencies and institutions enabled broad team representation and the sharing of information during each meeting. Reviews, revolving around a common theme, were conducted for up to 10 deaths each quarter. Recommendations for prevention were generated by the team and summarized in a report to the Governor's Overdose Prevention and Intervention Task Force and the public within 1 month of each meeting. Announcements of minigrant opportunities and funding to advance the community-specific recommendations were paired with each meeting. EVALUATION: From November 2016 through May 2018, the pilot team convened 7 times, generated 78 recommendations, and distributed 31 minigrants. Early process evaluations of these grants have shown positive impact within local environments. Following the pilot phase, state legislation for these reviews was passed in June 2018. DISCUSSION: The RI Department of Health was able to successfully pilot a multidisciplinary review process for overdose deaths and has recently institutionalized this process through legislation. The successful implementation of many of the team's community-oriented recommendations, supported through a minigrant process, highlights the impact that small financial investments can have to address the opioid epidemic and may be a model for other jurisdictions seeking to advance recommendations from these types of reviews.

Evaluating an intervention addressing stress in emergency department clerical staff.

BACKGROUND: Organizational stress is a significant occupational health challenge and is associated with multiple adverse health and social outcomes. Numerous studies have examined the sources of occupational stress in different workforces, but sparse evidence exists for the effectiveness of interventions to address it. AIMS: To evaluate interventions to reduce occupational stress in emergency department (ED) clerical staff. METHODS: A paper-based, self-report questionnaire examining perceived job demand and control in clerical staff in one UK ED in 2014, 2015 and 2017. Following each questionnaire round, we held focus groups with volunteer participants to discuss responses and then reported findings to management. Managers subsequently met with their workforce to develop interventions to address identified organizational stressors. RESULTS: We observed improvement in workers' perceived job control from 14.44 (13.88-15.00) in 2014 to 16.64 (15.92-17.36) in 2017 and in social support from 15.36 (14.91-15.81) in 2014 to 19.77 (19.12-20.42) in 2017, but not in work demand [10.55 (10.11-10.99) in 2014; 11.65 (10.95-12.35) in 2017]. In the focus groups, participants indicated satisfaction with the interventions implemented to address occupational stress. CONCLUSIONS: The sustained improvements in addressing occupational stressors in these ED clerical workers are encouraging. Further work should examine whether similar improvements can be achieved in clinical staff and for other work stressors such as effort-reward imbalance and organizational justice.

Succession planning in local health departments: results from a national survey.

CONTEXT: Succession planning has received scant attention in the public health sector, despite its potential to generate operational efficiencies in a sector facing chronic budgetary pressures and an aging workforce. OBJECTIVES: We examined the extent to which local health departments (LHDs) are engaged in succession planning and assessed the factors associated with having a succession plan. DESIGN: We conducted a national cross-sectional Web-based survey of workforce recruitment and retention activities in a sample of LHDs responding to the National Association of County & City Health Officials' 2010 Profile Study and then linked these data sets to fit a multivariable logistic regression model to explain why some LHDs have succession plans and others do not. SETTING AND PARTICIPANTS: Top executives in a national sample of LHDs. MAIN OUTCOME MEASURE: Presence or absence of succession planning. RESULTS: Two hundred twenty-five LHDs responded to the survey, yielding a 43.3% response rate, but no statistically significant differences between respondents and nonrespondents were detected. Only 39.5% reported having a succession plan. Performance evaluation activities are more common in LHDs with a succession plan than in LHDs without a plan. In adjusted analyses, the largest LHDs were 7 times more likely to have a succession plan than the smallest. Compared with state-governed LHDs, locally governed LHDs were 3.5 times more likely, and shared governance LHDs were 6 times more likely, to have a succession plan. Every additional year of experience by the top executive was associated with a 5% increase in the odds of having a succession plan. Local health departments that report high levels of concern about retaining staff (vs low concern) had 2.5 times higher adjusted odds of having a succession plan. CONCLUSIONS: This study provides the first national data on succession planning in LHDs and sheds light on LHDs' readiness to meet the workforce-related accreditation standards.

Understanding the work done by NHS commissioning managers: an exploration of the microprocesses underlying day-to-day sensemaking in UK primary care organisations.

PURPOSE: The purpose of this paper is to explore the practical daily work undertaken by middle-level managers in Primary Care Trusts (PCTs), focusing upon the micro-processes by which these managers enact sensemaking in their organisations. DESIGN/METHODOLOGY/APPROACH: The research took a case study approach, undertaking detailed case studies in four PCTs in England. Data collection included shadowing managers, meeting observations and interviews. FINDINGS: The research elucidated two categories of enactment behaviour exhibited by PCT managers: presence/absence; and the production of artefacts. Being "present" in or "absent" from meetings enacted sensemaking over and above any concrete contribution to the meeting made by the actors involved. This paper explores the factors affecting these processes, and describes the situations in which enactment of sense is most likely to occur. Producing artefacts such as meeting minutes or PowerPoint slides also enacted sense in the study sites in addition to the content of the artefact. The factors affecting this are explored. PRACTICAL IMPLICATIONS: The study has practical implications for all managers seeking to maximise their influence in their organisations. It also provides specific evidence relevant to managers working in the new Clinical Commissioning Groups currently being formed in England. ORIGINALITY/VALUE: The study expands the understanding of sensemaking in organisations in two important ways. Firstly, it moves beyond discourse to explore the ways in which behaviours can enact sense. Secondly, it explores the distinction between active and unconscious sensemaking.

Trends and attitudes regarding head and neck oncologic surgery: a survey of United States oral and maxillofacial surgery programs.

PURPOSE: The purposes of this study were to: 1) estimate the prevalence and trends of American oral and maxillofacial surgery (OMS) programs in recruiting head and neck oncologic surgery (HNOS) -trained faculty, performing HNOS oncologic procedures and microvascular reconstruction, and presenting HNOS research at academic meetings; 2) estimate whether HNOS and microvascular reconstruction involvement varies among programs with or without a program director or chair trained in HNOS; 3) estimate whether HNOS involvement varies among those OMS programs that regularly attend and do not attend tumor board; 4) estimate whether HNOS involvement varies among those programs that have and have not presented HNOS research at an academic meeting; 5) estimate whether HNOS involvement varies among doctor of medicine-integrated and 4-year OMS programs. MATERIALS AND METHODS: Investigators developed and distributed a survey to all US OMS program directors and/or chair composed of questions regarding faculty prevalence and recruitment, frequency and trends in cases, and the priority of applicants for residency with regard to HNOS. There were 18 close-ended questions, and one open-ended question. Responses were recorded in categorical, Likert, ordinal, and numerical format. Bivariate associations were calculated using Fisher exact test and logistic regression. RESULTS: Sixty-three of 101 surveys were returned (62.3%). Ten program directors or chair completed a fellowship in HNOS (15.9%). Programs with an HNOS-trained program director or chair were more likely to have another HNOS-trained faculty member (P = .01), performed more malignant tumor resections (P < .001), neck dissections (P < .001), and microvascular free-flap reconstructions (P = .02) than programs without program directors or chair trained in HNOS. Programs that regularly attended tumor board performed an increasing number of malignant tumor resections (P = .008); and neck dissections (P = .003) than programs that did not regularly attend their institution's tumor board. Presentations of HNOS-related research at national meetings did not differ between doctor of medicine-integrated and 4-year OMS programs (P = .7). There was no difference in the prevalence of HNOS-trained program directors and chair between doctor of medicine-integrated and 4-year programs (P = .7). CONCLUSIONS: This study's data and comments suggest that programs involved in HNOS have a strong involvement in expanded scope OMS and related academic activities.

Program Directors' Perspectives of ACGME Requirements and Effectiveness of Training Urology Residents: A National Survey in the Era of the Next Accreditation System.

OBJECTIVE: To qualitatively assess Urology program directors' perspectives on the effectiveness of training residents after implementation of the Accreditation Council for Graduate Medical Education's (ACGME) 2011 Next Accreditation System, and identify differences in current perspectives and prior surveyed perspectives toward the ACGME Outcome Project. METHODS: A national survey was developed by an ad hoc committee and distributed electronically to 105 Urology program directors. Thirty-four (34) multiple-choice, Likert-scale questions were administered. Data were evaluated and the results from the survey were compared to the one performed 15 years earlier to determine changes in the learning environment and effectiveness of training urology residents. RESULTS: The current survey response rate was 89% which was similar to the 2005 response rate of 88%. Most program directors (61%) agreed that 20% protected time for program directors helped with administrative work and 31% felt this time needs to increase for larger residency programs. Seventy percent (70%) agreed that dedicated program administrator time has helped their program. More than half of the respondents agree that the ACGME is training the current workforce effectively. CONCLUSION: Current program directors appear to be more accepting of changes required by the Next Accreditation System as compared to the Outcome Project 15 years ago. Our study supports the need for protected time to train residents and to overcome barriers to change.

A framework for planned policy change.

Recently, more nurses have become more engaged in policy work. This article provides a process for nurses to frame their work from policy inception through policy evaluation. Although policy often takes considerable time to develop, especially at the federal level, it can also arise out of chaos. This framework focuses on planned changes, even in chaotic conditions. The intent of this framework is to help nurses determine where their individual talents can best be used and to appreciate that the full process must be used if an effective policy is to result.

The Society of Black Academic Surgeons CV benchmarking initiative: Early career trends of academic surgical leaders.

BACKGROUND: Surgeons from under-represented backgrounds are less likely to receive academic tenure and obtain leadership positions. Our objective was to query the curriculum vitaes (CVs) of SBAS leadership to develop a benchmarking tool to promote and guide careers in academic surgery. METHODS: CVs from academic leaders were reviewed for academic productivity at early career stages-the first 5-and 10-years. Variables queried: peer-reviewed publications, grant funding, surgical societal involvement, invited lectureships and visiting professorships. RESULTS: Of 20 CVs, 41 leadership positions including 13 SBAS Presidents were identified. At 5- and 10-years, respectively, the academic productivity increased: 20.6 and 52.3 publications; 4.7 and 9.7 grants; 18 and 42.6 lectures/professorships. CONCLUSION: The CV benchmarking tool may be a useful framework for aspiring academic surgeons to track their progress relative to successful SBAS members. Creative strategies like these, paired with faculty mentorship and sponsorship are necessary to improve the ethnic diversity in academic surgery.