Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial.

BACKGROUND: Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting. METHODS: Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140). RESULTS: With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points. CONCLUSIONS: The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

Twelve tips for Natural Language Processing in medical education program evaluation.

With the increasing application of Natural Language Processing (NLP) in Medicine at large, medical educators are urged to gain an understanding and implement NLP techniques within their own education programs to improve the workflow and make significant and rapid improvements in their programs. This paper aims to provide twelve essential tips inclusive of both conceptual and technical factors to facilitate the successful integration of NLP in medical education program evaluation. These twelve tips range from advising on various stages of planning the evaluation process, considerations for data collection, and reflections on preprocessing of data in preparation for analysis and interpretation of results. Using these twelve tips as a framework, medical researchers, educators, and administrators will have an understanding and reference to navigating applications of NLP and be able to unlock its potential for enhancing the evaluation of their own medical education programs.

Using statewide death certificate data to understand trends and characteristics of polydrug overdose deaths in Tennessee, 2013-2017.

PURPOSE: Population-based data on trends and characteristics on polydrug overdoses are critically needed to help understand the changing drug epidemic in the United States, and to identify risk patterns and targets for overdose prevention for prescription and illicit opioid deaths. We conducted a statewide study in Tennessee to evaluate characteristics and trends of polydrug overdose deaths during 2013-2017. METHODS: We identified polydrug overdose deaths using ICD-10 codes and literal cause-of-death text in the death statistical files. We evaluated trends, contributing drugs, and demographic characteristics of overdoses (n = 2567 single-drug and n = 4683 polydrug deaths). Average annual percent change estimates (AAPCs) with associated 95% CIs were estimated using Poisson regression. RESULTS: Polydrug overdoses increased annually, with higher AAPC for polydrug compared with single-drug overdoses (AAPC: 13.6%, 95% CI: 10.6%-16.7% and 5.2%, 95% CI: 2.9%-7.5%, respectively). The highest increases in polydrug overdoses were observed in males (AAPC: 15.4%, non-Hispanic blacks (AAPC: 33.3%), and decedents aged 18-34 years (AAPC: 21.3%). CONCLUSIONS: All drug and opioid polydrug deaths increased during 2013-2017, with the highest increases seen in males, blacks, and younger age groups. Over 80% of illicit opioid overdoses involved more than one drug, highlighting the need to go beyond opioids to prevent overdoses.