Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training.

BACKGROUND: Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. METHOD: Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. RESULTS: Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. CONCLUSIONS: Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. TRIAL REGISTRATION: Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.

Diversity Training Goals, Limitations, and Promise: A Review of the Multidisciplinary Literature.

In this review, we utilize a narrative approach to synthesize the multidisciplinary literature on diversity training. In examining hundreds of articles on the topic, we discovered that the literature is amorphous and complex and does not allow us to reach decisive conclusions regarding best practices in diversity training. We note that scholars of diversity training, when testing the efficacy of their approaches, too often use proxy measures for success that are far removed from the types of consequential outcomes that reflect the purported goals of such trainings. We suggest that the enthusiasm for, and monetary investment in, diversity training has outpaced the available evidence that such programs are effective in achieving their goals. We recommend that researchers and practitioners work together for future investigations to propel the science of diversity training forward. We conclude with a roadmap for how to create a more rigorous and relevant science of diversity training.

Engaging White parents to address their White children's racial biases in the Black-White context.

Multiple studies (n = 1065 parents, 625 females, 437 males, 3 nonbinary, 99.06% White; n = 80, 5 to 7-year-old children, 35 girls, 45 boys, 87.50% White; data collection September 2017-January 2021) investigated White U.S. parents' thinking about White children's Black-White racial biases. In Studies 1-3, parents reported that their own and other children would not express racial biases. When predicting children's social preferences for Black and White children (Study 2), parents underestimated their own and other children's racial biases. Reading an article about the nature, prevalence, and consequences of White children's racial biases (Study 3) increased parents' awareness of, concern about, and motivation to address children's biases (relative to a control condition). The findings have implications for engaging White parents to address their children's racial biases.

Racism: Eroding the health of Black communities.

ABSTRACT: Even in the context of major advances in medicine, racial minorities continue to suffer worse medical outcomes. Although race is defined as a social, nonscientific construct, researchers have continued to use it as proxy to explain genetic and evolutionary differences among patients. Poorer health outcomes among Black Americans are known to be related to the psychosocial and physiological stress of racism. Black communities experience premature health deterioration because of the cumulative effects of social, economic, and political oppression and marginalization. Additionally, recent assertions that racism is best seen as a chronic disease has added value to understanding the effect of racism on the health of Black people. Using evidence-based information to assess the health of Black patients is a key step to assist clinicians in promptly addressing this chronic threat to the health of Black patients.

Structural racism, health disparities, and opportunities for PA practice.

ABSTRACT: Social determinants of health are rooted in structural racism. The healthcare community has long recognized the existence of significant race- and ethnicity-related health disparities. Yet pervasive disparities persist despite ongoing calls for institutions and healthcare professionals to promote health equity by addressing bias, discrimination, and social determinants of health. All PAs must take responsibility for the various ways in which we may unwittingly reinforce racism in our profession, and must shift our focus from treating the effects of racism to preventing them.

Parents' Expectations for and Reactions to Children's Racial Biases.

How do parents think about and react to their children's racial biases? Across three studies (N = 519) we investigated whether and how parents' Internal Motivation to Respond without Prejudice Scale (IMS) predicted standards for their children's race-related behavior, and tested parents' affective reactions to imagining their children violating their standards. Studies 1 and 2 demonstrated that parents (of 4- to 12-year-old children) with high IMS set more stringent standards for their children's race-related behavior than their low IMS counterparts. Upon considering their children expressing racial bias, high IMS parents reported negative self-directed affect (i.e., guilt; Studies 2 and 3), an affective response that motivates prejudice reduction in adults. The results have implications for involving parents in prejudice interventions targeting children's biases.

Improving health disparities in PA practices: A quality improvement initiative.

OBJECTIVE: To assess a quality improvement initiative designed to highlight awareness of health disparities and improve healthcare practices among participants. METHODS: Data were collected from 102 clinically practicing PAs over a 2-year timespan via the quality improvement initiative Outside the Box: Reducing Health Disparities. As part of the program, participants reviewed 10 random charts in their practice, documenting how they identified and/or managed common health disparities. Then, participants reviewed the educational materials provided and implemented practice-specific interventions. Thirty days after the initial review, a second random review of charts was executed. RESULTS: Postintervention results showed statistically significant moderate- to large-sized quality improvement across most categories. CONCLUSIONS: This study demonstrates that Outside the Box participation was associated with practice quality improvements among participants in several domains that are known to experience health disparities. Results suggest that increasing awareness of ideal professional behaviors can result in quality improvements in practices.

Stereotyping to infer group membership creates plausible deniability for prejudice-based aggression.

In the present study, participants administered painful electric shocks to an unseen male opponent who was either explicitly labeled as gay or stereotypically implied to be gay. Identifying the opponent with a gay-stereotypic attribute produced a situation in which the target's group status was privately inferred but plausibly deniable to others. To test the plausible deniability hypothesis, we examined aggression levels as a function of internal (personal) and external (social) motivation to respond without prejudice. Whether plausible deniability was present or absent, participants high in internal motivation aggressed at low levels, and participants low in both internal and external motivation aggressed at high levels. The behavior of participants low in internal and high in external motivation, however, depended on experimental condition. They aggressed at low levels when observers could plausibly attribute their behavior to prejudice and aggressed at high levels when the situation granted plausible deniability. This work has implications for both obstacles to and potential avenues for prejudice-reduction efforts.

Investigational screening for Babesia microti in a large repository of blood donor samples from nonendemic and endemic areas of the United States.

BACKGROUND: Babesia microti, a transfusion-transmissible intraerythrocytic parasite, is increasing in frequency in the United States with no available FDA-licensed donor screening assay. We utilized investigational arrayed fluorescence immunoassay (AFIA) and polymerase chain reaction (PCR) to detect B. microti antibodies and DNA in blood donors. STUDY DESIGN AND METHODS: AFIA and real-time PCR were performed on frozen paired EDTA plasma (AFIA) and EDTA whole blood (PCR) samples collected from May to September 2010 to 2011 in nonendemic (Arizona [AZ] and Oklahoma [OK]), moderately endemic (Minnesota [MN] and Wisconsin [WI]), and highly endemic (Connecticut [CT] and Massachusetts [MA]) areas of the United States. AFIA utilized B. microti piroplasm as an antigen substrate; PCR primers and probes targeted the B. microti 18S ribosomal RNA gene. Data from AZ and OK were used to calculate specificity. All AFIA- or PCR-positive or -inconclusive donors were deferred, notified, and invited to participate in a follow-up study involving repeat testing and a demographic and risk-factor questionnaire. Recipient tracing was performed for any cellular component transfused at index, at subsequent donation, or within the prior 12 months. RESULTS: Testing of 13,269 paired samples included 4022 from AZ and OK, 4167 from MN and WI, and 5080 from CT and MA. B. microti antibody and/or DNA prevalences were 0.025% (95% confidence interval [CI], 0.00%-0.14%), 0.12% (95% CI, 0.04%-0.28%), and 0.75% (95% CI, 0.53%-1.03%) in the nonendemic, mid-endemic, and high-endemic regions, respectively. Specificities were 99.95% (95% CI, 99.82%-99.99%) at a 1-in-64 AFIA cutoff and 99.98% (95% CI, 99.86%-100.00%) at a 1-in-128 cutoff. CONCLUSIONS: B. microti prevalence followed expected geographical patterns. Screening was feasible with a performance comparable or superior to other infectious disease blood donor screening assays.

Urologic considerations of placenta accreta: a contemporary tertiary care institutional experience.

BACKGROUND: As the incidence of cesarean delivery has increased, we are experiencing a higher incidence of subsequent placenta accreta and the associated complications, including urologic complications. METHODS: This is a retrospective review of all patients delivered from 2000 to 2011 with a histologically proven diagnosis of placenta accreta. Data were analyzed for baseline maternal characteristics, intraoperative and postoperative outcomes and complications. RESULTS: 83 patients were included in the analysis. The depth of placenta accreta invasion varied in the cohort, with 48, 25 and 27% being classified as placenta accreta, placenta increta and placenta percreta, respectively. 88% of patients had had a previous cesarean delivery, and 58% had more than one prior operative delivery. Cystotomy was encountered in 27% of patients and ureteral injury occurred in 4%. Degree of placenta accreta invasion, number of prior cesarean deliveries and intraoperative blood loss were associated with a higher likelihood of urologic injury. CONCLUSIONS: Urologic injuries are among the most frequently encountered intraoperative complications of placenta accreta. Surgeons involved in these cases need to be aware of this risk and maintain a high level of surveillance intraoperatively.

Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey.

OBJECTIVE: The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. METHODS: THE TASK FORCE AND MLA STAFF CRAFTED A SURVEY TO DETERMINE: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. RESULTS: Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. IMPLICATIONS: Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians.

Are all ostracism experiences equal? A comparison of the autobiographical recall, Cyberball, and O-Cam paradigms.

In the present study, we aimed to compare the primary-need depletion elicited by three common ostracism paradigms: autobiographical recall (e.g., Zhong & Leonardelli in Psychological Science 19:838-842, 2008), Cyberball (Williams, Cheung, & Choi in Journal of Personality and Social Psychology 79:748-762, 2000), and O-Cam (Goodacre & Zadro in Behavior Research Methods 42:768-774, 2010). A total of 152 participants (52 males) were randomly allocated to one of the three paradigms, and their subsequent primary needs were measured (belonging, control, self-esteem, and meaningful existence). O-Cam was found to induce greater total primary-need depletion than did Cyberball and recall, which did not differ significantly from each other. Moreover, when examining the pattern of individual need depletion elicited by each paradigm, O-Cam was found to induce significantly greater depletion of belonging, control, and meaningful existence than did the recall paradigm, and significantly greater depletion of control and self-esteem than did Cyberball. No other comparisons were found to be significant, including the comparisons between the recall and Cyberball paradigms for each individual primary need. Collectively, the findings will assist ostracism researchers in making informed choices regarding (a) which paradigm is appropriate to implement with respect to their research aims, and (b) whether the interchangeable use of paradigms within a program of research is appropriate practice.

Curricular addition of pharmacy robbery education.

BACKGROUND AND PURPOSE: Pharmacy robberies are a common occurrence. From 2010 to 2019, there were over 7500 prescription drug-related armed robbery incidents in the United States. A lecture on pharmacy robbery was added to the pharmacy curriculum in 2017 at Butler University. The primary objective of this study was to assess whether the pharmacy robbery lecture given during the first year of the pharmacy program is adequate, with a secondary objective comparing the results of this survey to one conducted prior to the curricular addition. This information provides an opportunity for schools of pharmacy to consider adding or enhancing drug diversion content into their curriculum. EDUCATIONAL ACTIVITY AND SETTING: A cross-sectional survey of all students enrolled in each professional year of the Doctor of Pharmacy program was conducted spring 2022 to collect information on pharmacy students' knowledge and experience regarding community pharmacy robberies and their perceptions of the pharmacy robbery education in the curriculum. FINDINGS: A total of 285 of 407 students responded for a 70% response rate. More than half (53.5%) feel the pharmacy robbery education received is adequate and 63.9% feel prepared to properly manage a pharmacy robbery situation. The survey asked two pharmacy robbery knowledge-based questions and most students selected the correct response to both (89.9% and 97.8%). More than one-fourth (27.1%) of the respondents reported that the pharmacy they work/worked at had been robbed. When asked if students considered changing their career path because of pharmacy robberies, 9% responded yes. SUMMARY: Pharmacy robbery still exists, and having proper education helps students prepare for and handle community pharmacy robbery situations.

Building Interprofessional Competencies Through a Collaborative Prescribing Activity With Osteopathic, Pharmacy, and Physician Assistant Students.

Introduction: Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process. Methods: We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas. Results: Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant (p < .001) increases in all 20 questions spanning the six ICCAS areas. Discussion: The virtual format allowed multiple institutions to participate from various locations. It broadened the learners' experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.

Making "Fast Friends" Online in Middle Childhood and Early Adolescence.

Close peer relationships are critical to children's and adolescents' healthy development and well-being, yet youth sometimes struggle to make friends. The present work tested whether an online version of the Fast Friends procedure could engender closeness among 9- to 13-year-old youth. Participant dyads (N = 131), matched in age and gender, were randomly assigned to answer personal questions that encourage self-disclosure and play a collaborative game (Fast Friends condition) or to engage in similar activities without self-disclosure or collaboration (control condition). Fast Friends dyads reported feeling closer and expressed more interest in future contact than control dyads. The discussion addresses potential future uses and implications of an online Fast Friends procedure.

A historical overview of IPPE program administrators' roles and responsibilities at US colleges and schools of pharmacy.

INTRODUCTION: The objective of this research was to determine changes in introductory pharmacy practice experience (IPPE) program administrators' demographics, roles, and responsibilities over time, and reflect on internal and external forces resulting in these shifts. This information provides an opportunity for schools to improve functioning of their IPPE administrative offices. METHODS: A 2020 web-based questionnaire was sent to IPPE program administrators at 141 fully accredited and candidate status colleges and schools of pharmacy (hereafter referred to as schools). The responses were compared to previously published results from similar surveys in 2008 and in 2013. RESULTS: One hundred thirteen IPPE administrators responded to the 2020 questionnaire for an 80% response rate. A comparative analysis of the data from 2008, 2013, and 2020 revealed a decrease in average class size and changes over time in six administrative areas. These areas included IPPE administrator responsibilities, position types, primary administrator's time devoted to IPPE administration, utilization of a programmatic decision-making committee, inclusion on the school's executive committee, and the number of clerical fulltime equivalents utilized in managing IPPE programs. CONCLUSIONS: A comparison of data from three studies revealed significant trends in six areas of IPPE administration over time. The primary drivers of change appear to be workload, fluctuating class sizes, and programmatic costs.

Children's evaluations of and reactions to racial discrimination.

Despite the potential benefits of children's confrontations of other children's racial biases-especially for targets of bias-little is known about how young children react upon observing instances of racial discrimination. In the present research, child participants completed a novel measure designed to test their reactions to another child's racially discriminatory behavior. The measure presented scenarios in which a protagonist who matched the participant's race (Asian, Latinx, or White) repeatedly excluded Black children from different social activities. Participants evaluated the protagonist's behavior and had an opportunity to confront the protagonist. Both a pilot study and a full preregistered study revealed that the novel measure had high reliability within participants and substantial variability across participants (pilot study: N = 54 U.S. White 5-7-year-olds, 27 girls, 27 boys, median household income range of $125,001-$150,000; full study: N = 126 U.S. 4-10-year-olds, 33.33% Asian, 33.33% Latinx, 33.33% White, 56 girls, 70 boys, median household income: $120,001-$125,000). In the full study, older children and children whose parents reported more racial socialization rated the protagonist's behavior more negatively; older children were also more likely to confront the protagonist. Neither participants' own race nor their prior exposure to racial diversity impacted their evaluations or confrontations of discrimination. The results have implications for understanding children's potential to serve as agents of social change by regulating other children's racial biases and behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cesarean hysterectomy requiring emergent thoracotomy: a case report of a complication of placenta percreta requiring a multidisciplinary effort.

BACKGROUND: Currently a leading indication for cesarean hysterectomy among multiparous women, placenta accreta is associated with significant maternal morbidity and mortality. CASE: A 34-year-old woman with a pregnancy complicated by placenta previa and previous cesarean deliveries was transferred to our institution following late diagnosis of placenta percreta. She underwent cesarean hysterectomy complicated by substantial hemorrhage. Massive blood product replacement precipitated severe hyperkaIemia and hypocalcemia with resultant asystole. Cardiac bypass with concomitant obligate anticoagulation was temporarily required while normalizing the patient's electrolytes. Numerous surgical and medical interventions were required to achieve hemostasis, and the patient survived to hospital discharge with moderate residual morbidity. CONCLUSION: Optimal management of placenta accreta requires a multidisciplinary approach within a tertiary center possessing extensive resources necessary for managing the most severe complications.

Untested assumptions perpetuate stereotyping: Learning in the absence of evidence.

In the present work, we set out to assess whether and how much people learn in response to their stereotypic assumptions being confirmed, being disconfirmed, or remaining untested. In Study 1, participants made a series of judgments that could be influenced by stereotypes and received feedback that confirmed stereotypes the majority of the time, feedback that disconfirmed stereotypes the majority of the time, or no feedback on their judgments. Replicating past work on confirmation bias, patterns in the conditions with feedback indicated that pieces of stereotype-confirming evidence exerted more influence than stereotype-disconfirming evidence. Participants in the Stereotype-Confirming condition stereotyped more over time, but rates of stereotyping for participants in the Stereotype-Disconfirming condition remained unchanged. Participants who received no feedback, and thus no evidence, stereotyped more over time, indicating that, matching our core hypothesis, they learned from their own untested assumptions. Study 2 provided a direct replication of Study 1. In Study 3, we extended our assessment to memory. Participants made judgments and received a mix of confirmatory, disconfirmatory, and no feedback and were subsequently asked to remember the feedback they received on each trial, if any. Memory tests for the no feedback trials revealed that participants often misremembered that their untested assumptions were confirmed. Supplementing null hypothesis significance testing, Bayes Factor analyses indicated the data in Studies 1, 2, and 3 provided moderate-to-extreme evidence in favor of our hypotheses. Discussion focuses on the challenges these learning patterns create for efforts to reduce stereotyping.

Transfusion requirements in obstetric patients with placenta accreta.

BACKGROUND: Providing transfusion support for patients with placenta accreta is a challenging task. There is no consensus on predelivery transfusion planning for these patients and the prevalence of massive transfusion is unknown. With little published experience, it is difficult to predict blood component usage accurately. Therefore, this retrospective study spanning 14 years quantified blood usage and clinical outcome in a group of patients with placenta accreta. STUDY DESIGN AND METHODS: A retrospective medical record review identified 66 patients with placenta accreta who presented for delivery. Data were extracted from the patients' medical records related to patient demographics, pathology diagnosis, blood component usage, operative course, and clinical outcome. Selected variables were analyzed for statistical association with total blood component usage. RESULTS: The range of blood component usage was 0 to 46 red blood cell (RBC) units, 0 to 48 random-donor platelet unit equivalents, 0 to 64 plasma units, and 0 to 30 cryoprecipitate units. The incidence of transfusion was 95% (mean RBC use, 10 ± 9 units; median, 6.5 units), with 39% of patients requiring 10 or more RBC units and 11% requiring 20 or more RBC units. Blood component use did not differ significantly between the pathology-defined placenta accreta subtypes. Potential clinical laboratory variables that would predict increased blood component use were not identified. CONCLUSION: The delivery of patients with placenta accreta is a high-risk procedure that requires multidisciplinary planning and adequate resources to optimize outcome. Transfusion services should have a protocol for managing these cases that addresses preoperative blood component preparation and intraoperative management, should massive hemorrhage occur.