A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers.

Introduction: Debriefings give healthcare workers voice through the opportunity to discuss unanticipated or difficult events and recommend changes. The typical goal of routine debriefings has been to improve clinical outcomes by learning through discussion and reflection of events and then transferring that learning into clinical practice. However, little research has investigated the effects of debriefings on the emotional experiences and well-being of healthcare workers. There is some evidence that debriefings are a multi-faceted and cost-effective intervention for minimising negative health outcomes, but their use is inconsistent and they are infrequently adopted with the specific intention of giving healthcare workers a voice. The purpose of this systematic scoping review is therefore to assess the scope of existing evidence on debriefing practices for the well-being and emotional outcomes of healthcare workers. Methods: Following screening, 184 papers were synthesised through keyword mapping and exploratory trend identification. Results: The body of evidence reviewed were clustered geographically, but diverse on many other criteria of interest including the types of evidence produced, debriefing models and practices, and outcomes captured. Discussion: The current review provides a clear map of our existing understanding and highlights the need for more systematic, collaborative and rigorous bodies of evidence to determine the potential of debriefing to support the emotional outcomes of those working within healthcare. Systematic Review Registration: https://osf.io/za6rj.

An oral history of health psychology in the UK.

Purpose An oral history of the development of health psychology in the United Kingdom. Methods Standard oral history methods produced interviews with 53 UK health psychologists, averaging 92 min in length. All interviewees entered the field from the 1970s to the 2000s, representing all four countries in the United Kingdom. A reconstructive mode of analysis, along with the few existing sources, was used to create a narrative of the history of health psychology in the United Kingdom. Audio recordings and transcripts will be archived for use by future researchers. Findings In the 1970s, medical schools in London recruited psychologists to teach, while also conducting pragmatic research on issues in healthcare. At the same time, some clinical psychologists began to work with physical health conditions in general hospitals. Partly influenced by developments in the United States and Europe, an identity of 'health psychology' developed and spread to researchers and practitioners doing work in psychology and health. In the 1980s, the field continued to attract researchers, including social psychologists working with health behaviours and outcomes, and clinical psychologists working in health care settings. During this time, it became formalized as a scientific field with the creation of the BPS Health Psychology Section, courses, and journals. In the 1990s, the field moved towards professional practice, which was controversial with other BPS divisions. However, it continued to grow and develop through the 2000s and 2010s. Conclusion Reflections on the development of UK health psychology represent the first historical narrative produced from oral testimony of those who were present at the time. Statement of Contribution What is already known on this subject? Health psychology emerged in the 1970s, initially in the United States following an APA Task Force report. It developed from a range of precursor movements including psychosomatic medicine, while in the United Kingdom medical psychology was an additional precursor. The development of health psychology has been discussed for a range of countries including the United States and others, but historical scholarship relating to the United Kingdom has been limited. What does this study add? From an oral history project, a narrative of UK health psychology's development is built up. Influences included opportunities at medical schools from the 1970s onward. Growing interest in health behaviours as a test of social psychology theory was important. The experiences of clinical psychologists working in health care settings are demonstrated. Multidisciplinary influences on the emergence and shaping of health psychology are evident.

Offshore workers and health behaviour change: an exploration using the Theoretical Domains Framework.

BACKGROUND: Previous research has identified the importance of promoting behaviour change within the offshore workforce. This qualitative study sought to: identify self-care behaviours perceived to require behaviour change within the offshore workforce, and explore perceived potential behavioural determinants. MATERIALS AND METHODS: This study included the perspectives of both offshore workers (OWs, n = 16) and healthcare practitioners (HCPs, n = 12) from the global workforce. Telephone interviews were conducted, recorded electronically and transcribed. Transcripts were analysed independently by two researchers using a Framework Approach and the Theoretical Domains Framework (TDF) to support coding. RESULTS: Healthy eating and alcohol intake were behaviours perceived by OWs and HCPs to require change within the offshore workforce. Knowledge (e.g. availability of nutritional knowledge), intentions (e.g. role of motivation), memory, attention and decision process (e.g. effect of boredom), environmental context and resources (e.g. influence of environmental stressors), social influences (e.g. influence of others), emotion (e.g. influence of emotional state) and behavioural regulation (e.g. influence of willpower). TDF domains were reported by both OWs and HCPs in relation to OWs' healthy eating and physical activity behaviours. CONCLUSIONS: The determinants identified as mechanisms of behaviour may be targeted in future interventions which aim to promote engagement in self-care within the offshore workforce.

The state of the art and future opportunities for using longitudinal n-of-1 methods in health behaviour research: a systematic literature overview.

n-of-1 studies test hypotheses within individuals based on repeated measurement of variables within the individual over time. Intra-individual effects may differ from those found in between-participant studies. Using examples from a systematic review of n-of-1 studies in health behaviour research, this article provides a state of the art overview of the use of n-of-1 methods, organised according to key methodological considerations related to n-of-1 design and analysis, and describes future challenges and opportunities. A comprehensive search strategy (PROSPERO:CRD42014007258) was used to identify articles published between 2000 and 2016, reporting observational or interventional n-of-1 studies with health behaviour outcomes. Thirty-nine articles were identified which reported on n-of-1 observational designs and a range of n-of-1 interventional designs, including AB, ABA, ABABA, alternating treatments, n-of-1 randomised controlled trial, multiple baseline and changing criterion designs. Behaviours measured included treatment adherence, physical activity, drug/alcohol use, sleep, smoking and eating behaviour. Descriptive, visual or statistical analyses were used. We identify scope and opportunities for using n-of-1 methods to answer key questions in health behaviour research. n-of-1 methods provide the tools needed to help advance theoretical knowledge and personalise/tailor health behaviour interventions to individuals.

The self-reference effect on memory in early childhood.

The self-reference effect in memory is the advantage for information encoded about self, relative to other people. The early development of this effect was explored here using a concrete encoding paradigm. Trials comprised presentation of a self- or other-image paired with a concrete object. In Study 1, 4- to 6-year-old children (N = 53) were asked in each trial whether the child pictured would like the object. Recognition memory showed an advantage for self-paired objects. Study 2 (N = 55) replicated this finding in source memory. In Study 3 (N = 56), participants simply indicated object location. Again, recognition and source memory showed an advantage for self-paired items. These findings are discussed with reference to mechanisms that ensure information of potential self-relevance is reliably encoded.

Testing an integrated behavioural and biomedical model of disability in N-of-1 studies with chronic pain.

BACKGROUND: Previous research has supported an integrated biomedical and behavioural model explaining activity limitations. However, further tests of this model are required at the within-person level, because while it proposes that the constructs are related within individuals, it has primarily been tested between individuals in large group studies. We aimed to test the integrated model at the within-person level. METHOD: Six correlational N-of-1 studies in participants with arthritis, chronic pain and walking limitations were carried out. Daily measures of theoretical constructs were collected using a hand-held computer (PDA), the activity was assessed by self-report and accelerometer and the data were analysed using time-series analysis. RESULTS: The biomedical model was not supported as pain impairment did not predict activity, so the integrated model was supported partially. Impairment predicted intention to move around, while perceived behavioural control (PBC) and intention predicted activity. PBC did not predict activity limitation in the expected direction. CONCLUSIONS: The integrated model of disability was partially supported within individuals, especially the behavioural elements. However, results suggest that different elements of the model may drive activity (limitations) for different individuals. The integrated model provides a useful framework for understanding disability and suggests interventions, and the utility of N-of-1 methodology for testing theory is illustrated.

Testing the integration of ICF and behavioral models of disability in orthopedic patients: replication and extension.

OBJECTIVE: Disability from chronic illness is a major problem for society, yet the study of its determinants lacks an overall theoretical paradigm. Johnston (1996) has proposed conceptualizing disability as behavior and integrating biomedical and behavioral predictors. Dixon, Johnston, Rowley, and Pollard (2008) tested a model including constructs from the International Classification of Functioning, Disability and Health (ICF) and the theory of planned behavior (TPB) using structural equation modeling; it fitted better and explained more variance than the ICF or TPB alone. We replicated their study with a new sample from the same population (orthopedic patients awaiting joint replacement) and also tested the model after the patients had surgery. METHODS: Two weeks before surgery, 342 orthopedic patients who had joint pain (most with arthritis) completed a questionnaire, with 228 completing it again 1 year after surgery. The authors tested Dixon et al.'s best-fit models cross-sectionally (before and after surgery) and assessed the goodness of fit of these imposed models to our data using structural equation modeling. RESULTS: Findings strongly supported those of Dixon et al. Before surgery, results were very similar to Dixon et al. with all models accounting for significant variance and fitting well, but the integrated model fitted better and accounted for more variance. One year after surgery, Dixon et al.'s models showed even stronger fit to the data. CONCLUSIONS: Although behavioral and biomedical (ICF) models were supported, the integrated model provided a better explanation of disability in this population than either of these models alone and suggests biopsychosocial interventions to reduce disability.

Advancing otolaryngology education in the new millennium.

Just as the practice of otolaryngology has changed over the years, so too the educational enterprise that supports the growth and development of the field continues to evolve. Changes in otolaryngology education have been driven by multiple internal and external factors. These changes need to be understood, and a proactive, cooperative approach by the members of this specialty is required to help shape the future in a way that will ultimately benefit both patients and the specialty itself. Rapid growth in the clinical sciences, accelerating technologic developments, and expanding quality improvement initiatives mandate that modern otolaryngologist-head and neck surgeons actively engage in continuing education. As described in many of the articles in this issue of the Otolaryngologic Clinics of North America, the resident in otolaryngology is graduating into a career of lifelong learning.

Na(+)/Ca(2+) exchanger expression and function in a rabbit model of myocardial infarction.

INTRODUCTION: In general, sarcolemmal Na(+)/Ca(2+) exchanger (NCX) protein and activity is increased in hearts with ventricular dysfunction. However, in a subset of studies, reduced activity of NCX has been reported. Left ventricular dysfunction (LVD) was induced in the rabbit eight weeks after an apical myocardial infarction. METHODS: Using single microelectrode voltage clamp to assess the NCX activity in isolated ventricular cells, a decrease in NCX activity by approximately 30% was observed. Immunoblot analysis indicated increased NCX protein levels by approximately 20% in the LVD group. The cause of this paradox is unknown. Overexpression of the protein sorcin increased the activity of NCX without affecting NCX protein levels. RESULTS: Sorcin protein (dimer) levels were significantly lower in the LVD group (0.67+/-0.05 n=15, P<0.05) compared to sham (1.0+/-0.16, n=15). Sorcin monomer levels were not significantly different (sham: 1.0+/-0.26, LVD: 0.83+/-0.13). Mathematical modeling of NCX suggests that a reduction of NCX activity during diastole to that in LVD could be achieved by holding the diastolic membrane potential at -60 mV instead of -80 mV. Holding E(m) at -60 mV decreased NCX-mediated Ca(2+) efflux rates to values comparable to those seen in LVD and increased SR Ca(2+) content and peak systolic [Ca(2+)] in sham and LVD cardiomyocytes. CONCLUSIONS: In conclusion, reduced sorcin expression may be linked to the lower NCX activity in the rabbit model of LVD. Reduced NCX activity during diastole increases SR Ca(2+) content and Ca(2+) transient amplitude.

Optimal design of O-to-Z flaps for closure of facial skin defects.

OBJECTIVE: To determine the optimal design of an O-to-Z flap for closure of facial skin defects. METHODS: Prospective cadaver study. Multiple 2-cm-diameter circular skin defects were created in fresh cadavers. Three types of O-to-Z flaps were designed, varying the angle of a curved line about concentric radii of the defect: acute, intermediate, or wide angle flap. The tension of closure of each was measured and compared at different lengths of incision and extents of undermining. RESULTS: The acute angle flap had a significantly lower closing tension at all lengths of incision and extents of undermining than the intermediate and wide angle flaps. Increasing the amount of undermining alone without incising the flap did not significantly decrease the closing tension. Incising the acute angle flap to 4 radii created a nearly tension-free closure. CONCLUSIONS: The optimal design for reducing tension of the O-to Z flap is an acute angle flap. The optimal length of incision and undermining necessary to minimize closing tension is discussed.

Obstructive supraglottic schwannoma: a case report and review of the literature.

OBJECTIVE: At the conclusion of the current presentation, the participants should be able to describe the etiology, presentation, histopathologic identification, and treatment options for schwannoma of the larynx. OBJECTIVES: Nerve sheath tumors rarely occur within the larynx. The goal of the current report is to acquaint the clinician with the presentation and treatment options for this disease. STUDY DESIGN: Retrospective case report and review of the literature. METHODS: We report one case of schwannoma of the supraglottic larynx at the Department of Otolaryngology, University of Texas Medical Branch (Galveston, TX). In addition, we review English-language publications regarding laryngeal nerve sheath tumors. RESULTS: Laryngeal nerve sheath tumors have an insidious course, commonly involve the supraglottic larynx, and can lead to upper airway obstruction. Cure is achieved by complete surgical excision. CONCLUSIONS: Median thyrotomy has proven to be safe and successful in the treatment of supraglottic schwannoma.