Learning to Speak Up for Patient Safety: Interprofessional Scenarios for Training Future Healthcare Professionals.

BACKGROUND: Preventable medical errors represent a leading cause of death in the United States. Effective undergraduate medical education (UME) strategies are needed to train medical students in error prevention, early identification of potential errors, and proactive communication. To address this need, a team of faculty from A.T. Still University's School of Osteopathic Medicine in Arizona developed four digital patient safety case scenarios for second-year medical students. These scenarios were designed to integrate interprofessional collaboration and patient safety principles, increase student ability to identify potential errors, and promote proactive communication skills. METHODS: Faculty used Qualtrics to create four digital case scenarios on patient safety covering the following domains: communicating about potential drug-to-drug interactions; effective handoffs; human factors errors, such as fatigue, illness, and stress; and conflicts with supervising resident. In fall 2018, 97 second-year medical students completed the entire safety module in dyad or triad teams. As they worked through each case study, student teams completed 11 assessment questions with instant feedback, and participated in short case debrief discussions. Next, each individual student took a 12-question post-test to assess learning. Descriptive statistics were reviewed for the assessment questions, and case critical thinking discussion answers were reviewed to evaluate student comprehension. RESULTS: The mean score for the module was 95.5% (SD= 6.36%, range = 75%-100%). Seventy-eight students completed the post-test, which had a mean score of 96.5% (SD = 6.51%, range = 66.7%-100%). Student written responses to the four case critical thinking discussion prompts indicated a high level of comprehension. CONCLUSION: Our results demonstrated that digital case studies can provide an innovative mechanism to introduce key patient safety concepts and experiential practice of interprofessional communication in early UME. Our design and implementation of these engaging interprofessional patient safety training modules provided an opportunity for students to learn key communication and safety concepts in small teams. This training method was cost-effective and could be replicated in other online learning or blended learning environments for a wide range of health professions.

Vaccination Capability Inventory of Community, Migrant, and Homeless Health Centers: A Survey Report.

CONTEXT: Federally funded Community, Migrant, and Homeless Health Centers provide health services to the most vulnerable communities in the United States. However, little is known about their capabilities and processes for providing vaccinations to adults. PROGRAM: We conducted the first national survey of health centers assessing their inventory, workflow, capacity for, and barriers to provision of routinely recommended adult vaccines. In addition, we asked health center leaders' perceptions regarding best practices and policy recommendations for adult vaccinations. IMPLEMENTATION: A survey was developed on the basis of domains elicited from advisory panels and focus groups and was sent electronically to leaders of 762 health centers throughout the United States and its territories; data were collected and analyzed in 2018. EVALUATION: A total of 319 survey responses (42%) were obtained. Health centers reported stocking most routinely recommended vaccines for adults; zoster vaccines were not stocked regularly due to supply and storage issues. Respondents most commonly reported adequate reimbursement for vaccination services from private insurance and Medicaid. Most vaccinations were provided during primary care encounters; less than half of health centers reported providing vaccines during specialist visits. Vaccines administered at the health center were most commonly documented in an open field of the electronic health record (96%) or in an immunization information system (72%). Recommendations for best practices related to better documentation of vaccinations and communication with immunization information systems were provided. DISCUSSION: Health centers provide most adult vaccines to their patients despite financial and technological barriers to optimal provisioning. Further studies at point of care could help identify mechanisms for system improvements.

Using Tree Rings to Track Atmospheric Mercury Pollution in Australia: The Legacy of Mining in Tasmania.

Historical records of mercury (Hg) deposition in lake sediments have commonly been used to monitor historic atmospheric concentrations. In the Australian environment, however, freshwater lakes are limited, restricting the region for which depositional archives of Hg can be derived. In this study we show that dendrochemistry can provide a record of atmospheric concentrations at very high resolution. We measured Hg concentrations in growth rings of two tree species from a site in western in Tasmania-Huon Pine ( Lagarostrobus franklinii) and Celery Top Pine ( Phyllocladus aspleniifolius). This region has been heavily mined over the past 150 years. Although much previous work has linked atmospheric Hg to gold mining, the evidence in this study suggests that copper smelters in Queenstown and Zeehan, not gold mining activities, were the main sources of Hg emissions to the atmosphere in this location. Huon Pine had significantly higher background Hg concentrations ( x̅ = 5.62 ng/g) than Celery Top Pine ( x̅ = 2.95 ng/g). No significant increase in Hg concentration during the peak copper smelting phase (1896 to 1935) was observed in Celery Top Pine, while a significant 1.4 fold-increase was observed in Huon Pine. Our results show that of species examined across the globe, Huon Pine is one of the most efficient bioaccumulators of Hg, making it a good proxy for tracking historical Hg emissions in western Tasmania. This ability to measure Hg in the environment is essential if Australia ratifies the Minamata Convention.

Assessing Competency in Family Medicine Residents Using the Osteopathic Manipulative Medicine Mini-Clinical Evaluation Exercise.

CONTEXT: The Mini-Clinical Evaluation Exercise (Mini-CEX) is one example of a direct observation tool used for workplace-based skills assessment. The Mini-CEX has been validated as a useful formative evaluation tool in graduate medical education. However, no Mini-CEX has been reported in the literature that specifically assesses the osteopathic manipulative medicine (OMM) skills of family medicine residents. Therefore, the authors created and studied an OMM Mini-CEX to fill this skills assessment gap. OBJECTIVE: To determine whether the OMM Mini-CEX is perceived as an effective evaluation tool for assessing the OMM core competencies of family medicine residents. METHODS: Faculty and residents of The Wright Center for Graduate Medical Education National Family Medicine Residency program participated in the study. Each resident was evaluated at least once using the OMM Mini-CEX. Surveys were used to assess faculty and resident perceptions of the usefulness and effectiveness of the OMM Mini-CEX for assessing OMM competencies. RESULTS: Eighty-one responses were received during 2 survey cycles within a 7-month period. The internal consistency of the survey responses had a high reliability (Cronbach α=0.93). Considering respondents who agreed that they had a clear understanding of the general purpose of a Mini-CEX, the perceived effectiveness score for the OMM Mini-CEX was higher among those who agreed that a Mini-CEX was a useful part of training than among those who disagreed or were unsure of its usefulness (median score, 4.0 vs 3.4, respectively; P=.047). CONCLUSIONS: The results suggest the OMM Mini-CEX can be a useful direct observation evaluation tool to assess OMM core competencies in family medicine residents. Additional research is needed to determine its perceived effectiveness in other clinical specialties and in undergraduate medical education.

Relationship Between Range of Motion, Strength, Motor Control, Power, and the Tennis Serve in Competitive-Level Tennis Players: A Pilot Study.

BACKGROUND: The tennis serve is a complex skill requiring appropriate energy transfer to maximize serve speed. As the only independently powered shot in tennis, it is important to understand what characteristics contribute to a player's serve. HYPOTHESIS: Upper extremity and lower extremity power variables will be predictive of serve speed. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 42 competitive tennis players underwent range of motion, strength, motor control, power, and serve speed testing. Motion assessment was completed for shoulder external and internal rotation, trunk rotation, hip external and internal rotation, and ankle dorsiflexion. Strength was assessed for the rotator cuff, scapula, and hip musculature. Motor control was evaluated through upper and lower extremity Y-balance testing. Power assessments were made using broad jump, single-leg hop, and seated unilateral shot put testing. Pearson correlation was conducted to assess associations of skill, height, and tested variables to serve speed. Significant variables were used in a stepwise linear regression model, with serve speed as the dependent variable. Variables are listed in relation to the participant's dominant arm. RESULTS: Skill, height, contralateral hip external rotation range of motion, nondominant arm Y-balance anterolateral reach, bilateral single-leg hops, and seated unilateral shot put throws for both arms demonstrated significant positive correlations to serve speed ( P < 0.05). Serve speed was predicted with 84% variance through skill, height, contralateral hip external rotation range of motion, ipsilateral single-leg hop, and the seated unilateral shot put throws. CONCLUSION: The ability to generate increased serve speed is multifactorial. The combination of skill, height, hip motion, and upper and lower extremity power may determine serve speed. CLINICAL RELEVANCE: The findings suggest that motion, motor control, and power testing should be evaluated when working with this population to improve serve speed.

Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach.

BACKGROUND: Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. METHODS: Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. RESULTS: Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. CONCLUSIONS: The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.

The Anorexia Nervosa Genetics Initiative: Study description and sample characteristics of the Australian and New Zealand arm.

OBJECTIVES: Anorexia nervosa is a severe psychiatric disorder with high mortality rates. While its aetiology is poorly understood, there is evidence of a significant genetic component. The Anorexia Nervosa Genetics Initiative is an international collaboration which aims to understand the genetic basis of the disorder. This paper describes the recruitment and characteristics of the Australasian Anorexia Nervosa Genetics Initiative sample, the largest sample of individuals with anorexia nervosa ever assembled across Australia and New Zealand. METHODS: Participants completed an online questionnaire based on the Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) eating disorders section. Participants who met specified case criteria for lifetime anorexia nervosa were requested to provide a DNA sample for genetic analysis. RESULTS: Overall, the study recruited 3414 Australians and 543 New Zealanders meeting the lifetime anorexia nervosa case criteria by using a variety of conventional and social media recruitment methods. At the time of questionnaire completion, 28% had a body mass index ⩽ 18.5 kg/m2. Fasting and exercise were the most commonly employed methods of weight control, and were associated with the youngest reported ages of onset. At the time of the study, 32% of participants meeting lifetime anorexia nervosa case criteria were under the care of a medical practitioner; those with current body mass index < 18.5 kg/m2 were more likely to be currently receiving medical care (56%) than those with current body mass index ⩾ 18.5 kg/m2 (23%). Professional treatment for eating disorders was most likely to have been received from general practitioners (45% of study participants), dietitians (42%) and outpatient programmes (42%). CONCLUSIONS: This study was effective in assembling the largest community sample of people with lifetime anorexia nervosa in Australia and New Zealand to date. The proportion of people with anorexia nervosa currently receiving medical care, and the most common sources of treatment accessed, indicates the importance of training for general practitioners and dietitians in treating anorexia nervosa.

Biomechanical, metabolic and cardiopulmonary responses of masters recreational runners during running at different speeds.

This study tested interactions between age and running speed on biomechanics, metabolic responses and cardiopulmonary responses. Three-hundred participants ran at preferred and standardized speeds. Age group (younger, masters [≥40 years]) by speed (self-selected 8.8 km/h, 11.2 km/h and 13.6 km/h) interactions were tested on main outcomes of sagittal kinematic, temporal spatial, metabolic and cardiopulmonary parameters. At all speeds, angular displacements of the ankle, pelvis and knee were less in masters than younger runners (Hedges g effect size range = 0.30-1.04; all p < 0.05). A significant age group by speed interaction existed for hip angular displacement (Wald χ2 = 10.753; p = 0.013). Masters runners ran at higher relative heart rates (p < 0.05) but at similar rates of oxygen use and energy expenditure. Masters runners used hip-dominant motion and step lengthening as running speed increased, but did not change centre of mass vertical displacement. This may increase mechanical stresses on tissues of the lower extremity in masters runners, especially hamstrings, hip joint and Achilles.

Growing our own: a model for encouraging and nurturing aspiring leaders.

DEVELOPMENTS IN western society have led us to question traditional leadership structures. This is particularly so in the context of care as people's health and social care needs change, technology advances and public expectations rise (Department of Health 1999). Bennis (2000), and Kouzes and Posner (2003), identify a style of leadership known as 'transformational leadership', which describes the ability of leaders to influence others by transforming their behaviour without necessarily being in positions of authority. Such leaders can inspire others to follow them by displaying characteristic leadership behaviours. These leadership behaviours are described by Kotter (1990) and are laid out in Table 1.

Using CD-ROM technology to increase folic acid knowledge among physician assistant students.

The purpose of this study was to examine the effectiveness of incorporating CD-ROM technology to increase the knowledge of folic acid among physician assistant students. Participants included 76 first-year physician assistant students enrolled in a Women's Health course. A pretest and posttest was used to evaluate the knowledge gain after viewing the CD-ROM over a 2-week period. Of the 76 students in the course, 73 completed the pretest and the post-test. Posttest scores were significantly better than pretest scores (t = -11.83; p < or = 0.001), with means 68.63% and 46.18%. Knowledge scores increased by 22.45% from pre-test to posttest. Student evaluation results suggested that the CD-ROM (1) provided folic acid information in a clear and effective manner, (2) adequately covered the folic acid information, (3) increased student awareness and knowledge about folic acid, and (4) may promote early commitment by students to recommend daily folic acid intake to their patients.

Analyses of microbial activity in biomass-recycle reactors using denaturing gradient gel electrophoresis of 16S rDNA and 16S rRNA PCR products.

The relationship between mixed microbial community structure and physiology when grown under substrate-limited conditions was investigated using continuous-flow bioreactors with 100% biomass recycle. Community structure was analyzed by denaturing gradient gel electrophoresis (DGGE) of the PCR and RT-PCR amplified V3 region of 16S rDNA and 16S rRNA templates, respectively. Comparisons were made of communities exposed to different types of transient conditions (e.g., long- and short-term starvation, increasing nutrients). With progressively more stringent substrate limitation over time, the specific content of community RNA declined by more than 10-fold and closely followed the decline in specific growth rate. In contrast, the DNA content was variable (up to 3-fold differences) and did not follow the same trend. Cluster analysis of the presence or absence of individual bands indicated that the fingerprints generated by the two templates were different, and community response was first observed in the rRNA fraction. However, both the rDNA and rRNA fingerprints provided a picture of temporal population dynamics. Dice similarity coefficients gave a quantitative measure of the differences and changes between the communities. In comparison, standard cultivation techniques yielded only a quarter of the phylotypes detected by DGGE, but included the most dominant population based on rRNA. Nucleotide-sequence analyses of the almost complete 16S rRNA genes of these isolates place them in the same group of organisms that is typically cultivated from environmental samples: alpha, beta, and gamma Proteobacteria and the high GC and the low GC Gram-positive divisions.