A study protocol outlining the development and evaluation of a training program for frontline managers on leading well-being and the psychosocial work environment in Danish hospital settings - a cluster randomized waitlist controlled trial.

BACKGROUND: Hospital staff are often exposed to stressful psychosocial working conditions and report high levels of stress and burnout, which may negatively impact the safety of employees and patients. Managers hold unique knowledge of workplace conditions and needs of employees, but leadership interventions to improve the well-being of managers and employees in hospital settings are scarce. This study evaluates the effects of a leadership intervention based on a health-oriented leadership approach on the well-being and psychosocial work environment aspects of managers and employees. METHODS/DESIGN: The study is designed as a randomized, waitlist-controlled trial with two groups (intervention and waitlist control group) and measurements at baseline, 6- and 12-month follow-up. We aim to include 200 frontline managers in Danish hospital settings and their approximately 5,000 employees. The leadership training comprises five full day modules and four smaller group-training sessions over a period of 5 months. The main aim is to improve stress, burnout, self-care, and perceived level of staff-care among managers and employees. Sickness absence will also be assessed at both manager and employee level. In addition, several psychosocial factors will be assessed at the employee level. A quantitative and qualitative process evaluation will also be conducted. DISCUSSION: Action towards supporting the mental health of hospital employees is important to maintain a strong healthcare system. There is increasing recognition that best practice in workplace mental health requires an integrated approach that prevents harm and promotes positive mental health. There is also increasing understanding of the key role managers' play in maintaining well-being within the workplace, however they often report a lack of knowledge and skills to promote employee mental health. The current leadership training program has been developed for frontline managers working in a hospital setting. The aim is to increase managers' application of strategies to facilitate a healthy psychosocial work environment to benefit well-being and mental health among staff and managers themselves. TRIAL REGISTRATION: The study was retrospectively registered on November 21, 2022 in Clinical Trial.gov with identifier: NCT05623371.

A smartphone application for treating depressive symptoms: study protocol for a randomised controlled trial.

BACKGROUND: Depression is a commonly occurring disorder linked to diminished role functioning and quality of life. The development of treatments that overcome barriers to accessing treatment remains an important area of clinical research as most people delay or do not receive treatment at an appropriate time. The workplace is an ideal setting to roll-out an intervention, particularly given the substantial psychological benefits associated with remaining in the workforce. Mobile health (mhealth) interventions utilising smartphone applications (apps) offer novel solutions to disseminating evidence based programs, however few apps have undergone rigorous testing. The present study aims to evaluate the effectiveness of a smartphone app designed to treat depressive symptoms in workers. METHODS: The present study is a multicentre randomised controlled trial (RCT), comparing the effectiveness of the intervention to that of an attention control. The primary outcome measured will be reduced depressive symptoms at 3 months. Secondary outcomes such as wellbeing and work performance will also be measured. Employees from a range of industries will be recruited via a mixture of targeted social media advertising and Industry partners. Participants will be included if they present with likely current depression at baseline. Following baseline assessment (administered within the app), participants will be randomised to receive one of two versions of the Headgear application: 1) Intervention (a 30-day mental health intervention focusing on behavioural activation and mindfulness), or 2) attention control app (mood monitoring for 30 days). Participants will be blinded to their allocation. Analyses will be conducted within an intention to treat framework using mixed modelling. DISCUSSION: The results of this trial will provide valuable information about the effectiveness of mhealth interventions in the treatment of depressive symptoms in a workplace context. TRIAL REGISTRATION: The current trial is registered with the Australian and New Zealand Clinical Trials Registry ( ACTRN12617000547347 , Registration date: 19/04/2017).

Managers' response to mental health issues among their staff.

BACKGROUND: Many organizations are implementing mental health training for managers to facilitate better communication between managers and employees suffering from mental health problems. Much of this training focuses on improving managers' mental health literacy and reducing stigma. However, it is unclear whether this focus is appropriate or whether other targets, such as improving skills and confidence, should be given greater consideration. AIMS: To test whether knowledge, attitudes and confidence are associated with managers' behavioural responses to mental health issues among their staff. METHODS: Managers from a large Australian fire and rescue service completed a questionnaire addressing their knowledge, attitudes, confidence and behavioural responses when managing employee mental health issues. The relationship was assessed using logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Eighty-five managers responded (response rate 66%). Managers' confidence was the strongest predictor of their behaviour. Managers who felt confident discussing mental health were significantly more likely to make contact with an employee who was suspected to be suffering from a mental illness (OR 15.79, 95% CI 3.03-82.37, P < 0.01) or was on sickness leave for mental health reasons (OR 19.84, 95% CI 2.25-175.15, P < 0.01). Non-stigmatizing attitudes towards mental illness also significantly predicted contact with a staff member off work due to mental health problems (OR 5.22, 95% CI 1.21-22.54, P < 0.05). CONCLUSIONS: Our findings suggest that manager mental health training should focus on building their confidence and reducing stigma in order to have the greatest chance of altering workplace practices.

Survival following an acute coronary syndrome: a pet theory put to the test.

OBJECTIVE: The aim of this study was to revisit findings from previous studies reporting that pet ownership improves outcome following an admission for acute coronary syndrome (ACS). METHOD: Four hundred and twenty-four patients admitted to a cardiac unit with an ACS completed questions regarding pet ownership in hospital. Rates of cardiac death and readmission were assessed 1 year following hospitalization. RESULTS: Pet owners were more likely to experience a death or readmission following their hospitalization, after controlling for key psychosocial and medical covariates. When dog and cat owners were considered separately, cat ownership was significantly associated with increased risk of death or readmission. CONCLUSION: In this independent study, pet ownership at baseline, and cat ownership in particular, was associated with increased cardiac morbidity and mortality in the year following an admission for an acute coronary syndrome, a finding contrary to previous reports.

An algorithm for automatic analysis of portal images: clinical evaluation for prostate treatments.

The aim of this study is to assess the clinical value of an algorithm for automatic analysis of portal images by measuring the method's performance in a clinical study of treatment of prostate cancer. The algorithm is based on chamfer matching and measures displacements of patients relative to prescribed radiation beam positions. In this paper we propose a method to quantify the mean standard deviation (MSD) of the performance of automatic analysis relative to the MSD of the performance of trained radiographers using the clinical data set only, i.e. without using additional phantoms or simulations. The clinical data set in this study consists of 99 regional AP prostate images of 15 different patients. To assess the performance the automatic analysis in relation to that of the human observers, we studied the results of the unsupervised automatic analysis, as well as the results of a less-trained human observer and a well-trained human observer assisted by the automatic analysis (in this combination, automatic analysis is done first and the result is modified by the well-trained observer if the observer does not agree). First, the intra-observer variations of the well-trained observer are measured by repetitive analysis of a small subset of the clinical data. The distribution of differences in analysis between two arbitrary observers is described by the chi 2 distribution, and is tabulated in literature. We define the agreement histogram of an observer O as an estimator for the chi 2 distribution between O and the well-trained human observer, parameterized by the ratio of the intra-observer variations of O and the well-trained observer.(ABSTRACT TRUNCATED AT 250 WORDS)

Time trend of patient setup deviations during pelvic irradiation using electronic portal imaging.

An electronic portal imaging device (EPID) was used to detect patient setup displacement during the course of a 3-field pelvic irradiation of two groups of patients: 10 rectal and 10 prostate carcinomas. These patients were irradiated with conventional treatment techniques in routine clinical practice. A total of 469 portal images and 60 simulator films were used to determine the values of setup deviations in the X- Y- and Z-directions of a fixed coordinate system, corresponding to the medio-lateral, cranio-caudal and antero-posterior direction, respectively. The absolute displacement averaged over all setups and patients ranged between 0.4 mm and 1.4 mm with a standard deviation (S.D.) of 1.6-3.9 mm. The overall distribution along each direction could be separated into a distribution of random deviations (S.D.s ranging from 1.2 to 2.8 mm) around the mean deviation of each patient and a distribution of the means themselves: the distribution of systematic deviations (S.D.s ranging from 1.0 to 2.6 mm). Significant gradual displacement as a function of time was detected in 5 out of the 20 patients, 2 in the rectum and 3 in the prostate group. This "time trend" was found along each of the 3 directions specified. The magnitude of the time-dependent displacement throughout the course of treatment ranged between 4 and 11 mm. It can be concluded that for treatments requiring a high level of precision, portal images should be made and analyzed during the whole treatment course in order to detect and correct significant time trends.

Vaccination of fiber-modified adenovirus-transfected dendritic cells to express HER-2/neu stimulates efficient HER-2/neu-specific humoral and CTL responses and reduces breast carcinogenesis in transgenic mice.

HER-2/neu transgene-modified dendritic cell (DC)-based vaccines are potent at eliciting HER-2/neu-specific antitumor immunity. In this study, we constructed a recombinant adenovirus (RGD)AdVneu with fiber gene modified by RGD insertion into the viral knob's H1 loop. We transfected DCs with (RGD)AdVneu, and assessed/compared HER-2/neu-specific humoral and cytotoxic T lymphocyte (CTL) responses and antitumor immunity derived from the original AdVneu-transfected DCs (DCneu1) and (RGD)AdVneu-transfected DCs (DCneu2). We demonstrated that DCneu2 displayed increased HER-2/neu expression by 8.3-fold compared to DCneu1. We also demonstrated that DCneu2 vaccination induced stronger HER-2/neu-specific humoral and CTL immune responses than DCneu1 vaccination. DCneu2 vaccination protected all the mice from HER-2/neu-expressing Tg1-1 tumor cell challenge in wild-type FVB/NJ mice, compared to a partial protection in DCneu1-immunized mice. In addition, DCneu2 vaccination also significantly delayed tumor growth than DCneu1 immunization (P<0.05) in Tg FVBneuN mice. Three immunizations of DCneu2 starting at the mouse age of 2 months also significantly delayed breast cancer development in Tg mice compared to DCneu2 vaccine (P<0.05). Importantly, DCneu2 vaccine reduced breast carcinogenesis by 9% in Tg mice with self HER-2/neu tolerance. Therefore, vaccination of fiber-modified adenovirus-transfected DCs to enhance expression of tumor antigens such as HER-2/neu is likely representative of a new direction in DC-based vaccine of breast cancer.

HER-2/neu-gene engineered dendritic cell vaccine stimulates stronger HER-2/neu-specific immune responses compared to DNA vaccination.

HER-2/neu is a candidate for developing breast cancer-targeted immunotherapeutics. Although DNA-based and HER-2/neu transgene-modified dendritic cell (DC)-based vaccines are potent at eliciting HER-2/neu-specific antitumor immunity, there has been no side-by-side study comparing them directly. The present study utilizes an in vivo murine tumor model expressing HER-2/neu antigen to compare the efficacy between adenovirus (AdVneu)-transfected dendritic cells (DC(neu)) and plasmid DNA (pcDNAneu) vaccine. Our data showed that DC(neu) upregulated the expression of immunologically important molecules and inflammatory cytokines and partially converted regulatory T (Tr)-cell suppression through interleukin-6 (IL-6) secretion. Vaccination of DC(neu) induced stronger HER-2/neu-specific humoral and cellular immune responses than DNA vaccination, which downregulated HER-2/neu expression and lysed HER-2/neu-positive tumor cells in vitro, respectively. In two HER-2/neu-expressing tumor models, DC(neu) completely protected mice from tumor cell challenge compared to partial or no protection observed in DNA-immunized mice. In addition, DC(neu) significantly delayed breast cancer development in transgenic mice in comparison to DNA vaccine (P<0.05). Taken together, we have demonstrated that HER-2/neu-gene-modified DC vaccine is more potent than DNA vaccine in both protective and preventive animal tumor models. Therefore, DCs genetically engineered to express tumor antigens such as HER-2/neu represent a new direction in DC vaccine of breast cancer.

Comparison of the effects of dry and liquid heparin on neonatal arterial blood gases.

We compared the effects of liquid and vaporized dry heparin on neonatal arterial blood gases. A total of 35 paired simultaneously drawn neonatal arterial blood samples were collected. In one of every paired sample, 0.05 cc of liquid heparin was used and in the other sample vaporized heparin syringes were used. Blood was drawn into every syringe to a total volume of 0.2 ml, pH, arterial oxygen tension (PaO2), and arterial carbon dioxide tension (PaCO2) of the paired samples were analyzed using the paired Student t method. There was no statistical difference in pH and PaO2 but the PaCO2 was statistically lower (p less than 0.0005) with liquid heparin. We conclude that the effects of heparin on neonatal arterial blood gases is dilutional in nature and that they are due to mixing heparin with its very low PaCO2 with the blood sample. If by mistake more heparin than necessary is used, the effects can be dramatic. We therefore suggest using syringes with vaporized heparin in obtaining neonatal arterial blood gases to obtain reliable and consistent results.