Impact of clinicians' behavior, an educational intervention with mandated blood pressure and the hypotension prediction index software on intraoperative hypotension: a mixed methods study.

PURPOSE: Intraoperative hypotension (IOH) is associated with adverse outcomes. We therefore explored beliefs regarding IOH and barriers to its treatment. Secondarily, we assessed if an educational intervention and mandated mean arterial pressure (MAP), or the implementation of the Hypotension Prediction Index-software (HPI) were associated with a reduction in IOH. METHODS: Structured interviews (n = 27) and questionnaires (n = 84) were conducted to explore clinicians' beliefs and barriers to IOH treatment, in addition to usefulness of HPI questionnaires (n = 14). 150 elective major surgical patients who required invasive blood pressure monitoring were included in three cohorts to assess incidence and time-weighted average (TWA) of hypotension (MAP < 65 mmHg). Cohort one received standard care (baseline), the clinicians of cohort two had a training on hypotension and a mandated MAP > 65 mmHg, and patients of the third cohort received protocolized care using the HPI. RESULTS: Clinicians felt challenged to manage IOH in some patients, yet they reported sufficient knowledge and skills. HPI-software was considered useful and beneficial. No difference was found in incidence of IOH between cohorts. TWA was comparable between baseline and education cohort (0.15 mmHg [0.05-0.41] vs. 0.11 mmHg [0.02-0.37]), but was significantly lower in the HPI cohort (0.04 mmHg [0.00 to 0.11], p < 0.05 compared to both). CONCLUSIONS: Clinicians believed they had sufficient knowledge and skills, which could explain why no difference was found after the educational intervention. In the HPI cohort, IOH was significantly reduced compared to baseline, therefore HPI-software may help prevent IOH. TRIAL REGISTRATION: ISRCTN 17,085,700 on May 9th, 2019.

Effects of operational parameters on the performance of unialgal Oedogonium sp. filamentous algae nutrient scrubbers under controlled environmental conditions.

Filamentous algae nutrient scrubber (FANS) operating parameters can strongly influence algal biomass productivity and nutrient removal. However, few studies to date have investigated the effects of FANS operating parameters such as initial standing crop, harvesting frequency and influent flow rate on biomass productivity and nutrient removal performance, especially for FANS that cultivate a single species of algae. Therefore, the overall aim of this study was to investigate how operating parameters affect the biomass productivity and nutrient removal performance of Oedogonium sp. - a promising species for unialgal FANS. The initial standing crop had a significant effect on biomass productivity, with productivities being highest (8.6 ± 0.5 g DW biomass m-2day-1) when the initial standing crop was 60-70 g DW m-2. However, the daily nutrient removal rate was highest (0.47 ± 0.06 g N m-2 day-1and 1.24 ± 0.13 g P m-2 day-1) at the highest initial standing crop (100-110 DW m-2). Biomass productivity was highest with a three-day growth period, regardless of size of the initial standing crop. Therefore, a four-day harvesting interval was selected as the optimal harvesting regime to promote exponential growth and high biomass production. Influent flow rate had a significant effect on biomass productivity, which was highest (9.3 ± 1.7 g DW m-2 day-1) for the 1 L min-1 flow rate. This flow rate also gave the highest instantaneous nutrient removal rate (0.05 ± 0.02 g N m-3 and 0.14 ± 0.05 g P m-3). Current results suggest that an optimum initial standing crop of 70-80 g DW m-2, harvesting frequency of four days and influent flow rate of 1 L min-1 (16.7 L min-1 m-1 width) were optimal for Oedogonium sp. cultivated on FANS to maximize their biomass production and nutrient removal under controlled laboratory conditions. These results contribute to understanding the impacts of operating parameters on optimizing unialgal Oedogonium sp. FANS biomass production and nutrient removal performance.

Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review.

BACKGROUND: Measures exist to improve early recognition of, and response to, deteriorating patients in hospital. However, deteriorating patients continue to go unrecognized. To address this, interventions have been developed that invite patients and relatives to escalate patient deterioration to a rapid response team (RRT). OBJECTIVE: To systematically review articles that describe these interventions and investigate their effectiveness at reducing preventable deterioration. SEARCH STRATEGY: Following PRISMA guidelines, four electronic databases and two web search engines were searched to identify literature investigating patient and relative led escalation. INCLUSION CRITERIA: Articles investigating the implementation or use of systems involving patients and relatives in the detection of clinical patient deterioration and escalation of patient care to address any clinical or non-clinical outcomes were included. Articles' eligibility was validated by a second reviewer (20%). DATA EXTRACTION: Data were extracted according to pre-defined criteria. DATA SYNTHESIS: Narrative synthesis was applied to included studies. MAIN RESULTS: Nine empirical studies and 36 grey literature articles were included in the review. Limited studies were conducted to establish the clinical effectiveness of patient and relative led escalation. Instead, studies investigated the impact of this intervention on health-care staff and available resources. Although appropriate, this reflects the infancy of research in this area. Patients and relatives did not overwhelm resources by activating the RRT. However, they did activate it to address concerns unrelated to patient deterioration. CONCLUSIONS: Activating a RRT may not be the most appropriate or cost-effective method of resolving non-life-threatening concerns.

Exploration of likely engagement with Monetary Contingency Contracts for weight loss: a questionnaire study.

Monetary Contingency Contracts (MCCs) are schemes that ask individuals to pledge money that is returned contingent on behaviour change. In relation to weight loss, this study explored likely levels of engagement with MCCs, how much individuals would be willing to pay into an MCC, and how these amounts vary under different contract conditions. Fifty-six individuals with BMI above 25 who were motivated to lose weight were recruited. The majority of participants (87.5%) indicated that they would be willing to engage with weight loss MCCs, but showed more reluctance to subscribe to pair-based MCCs which offered; (a) refunds contingent on the weight loss of a weight loss partner, and (b) 'all or nothing refunds' in which no reward is given for any weight loss below the target weight loss goal. This study provides preliminary evidence that individuals motivated to lose weight may be willing to engage with weight loss MCCs. Further research is needed to explore reasons for reluctance to subscribe to MCCs with certain conditions, to inform the design of future experimental studies testing the efficacy of MCCs as part of an intervention for weight loss.

The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study.

BACKGROUND: There is growing interest in the role of patients in improving patient safety. One such role is providing feedback on the safety of their care. Here we describe the development and feasibility testing of an intervention that collects patient feedback on patient safety, brings together staff to consider this feedback and to plan improvement strategies. We address two research questions: i) to explore the feasibility of the process of systematically collecting feedback from patients about the safety of care as part of the PRASE intervention; and, ii) to explore the feasibility and acceptability of the PRASE intervention for staff, and to understand more about how staff use the patient feedback for service improvement. METHOD: We conducted a feasibility study using a wait-list controlled design across six wards within an acute teaching hospital. Intervention wards were asked to participate in two cycles of the PRASE (Patient Reporting & Action for a Safe Environment) intervention across a six-month period. Participants were patients on participating wards. To explore the acceptability of the intervention for staff, observations of action planning meetings, interviews with a lead person for the intervention on each ward and recorded researcher reflections were analysed thematically and synthesised. RESULTS: Recruitment of patients using computer tablets at their bedside was straightforward, with the majority of patients willing and able to provide feedback. Randomisation of the intervention was acceptable to staff, with no evidence of differential response rates between intervention and control groups. In general, ward staff were positive about the use of patient feedback for service improvement and were able to use the feedback as a basis for action planning, although engagement with the process was variable. Gathering a multidisciplinary team together for action planning was found to be challenging, and implementing action plans was sometimes hindered by the need to co-ordinate action across multiple services. DISCUSSION: The PRASE intervention was found to be acceptable to staff and patients. However, before proceeding to a full cluster randomised controlled trial, the intervention requires adaptation to account for the difficulties in implementing action plans within three months, the need for a facilitator to support the action planning meetings, and the provision of training and senior management support for participating ward teams. CONCLUSIONS: The PRASE intervention represents a promising method for the systematic collection of patient feedback about the safety of hospital care.

High spatial and temporal variation in biomass composition of the novel aquaculture target Ecklonia radiata.

The biomass composition of kelp varies within species both spatially and temporally. However, this variation in biomass quality has not yet been investigated for the native kelp Ecklonia radiata within New Zealand, where the kelp is a target for the emerging seaweed aquaculture industry. In this study we quantified spatial and temporal variation in the composition of E. radiata biomass, collected from 12 sites around the North Island of New Zealand and from 12 months across a full year at a single site (n = 138). High spatial variation was detected for most components, including alginate (range: 16.6 - 22.7% DW, n = 12), fucoidan (range: 1.2 - 1.6% DW, n = 12), phlorotannins (range: 4.8 - 9.3% DW, n = 72), and glucose (range: 9.3 - 22.6% DW, n = 12). The biomass composition of E. radiata varied significantly among sites but with no clear patterns among regions, indicating that geographic differences were mostly local rather than regional, possibly due to site-specific environmental conditions. Significant temporal variation (measured by positive autocorrelation between months) was detected in the content of lipids, proteins, glucose, guluronic acid, nitrogen, phosphorous, iodine, arsenic, and mercury, and for the mannuronic to guluronic acid (M:G) ratio. Overall, E. radiata had comparable biomass composition to that of commercially grown northern hemisphere species but with substantially higher phlorotannin content. These results demonstrate that E. radiata could be a viable southern hemisphere alternative for a broad range of commercial applications. Supplementary Information: The online version contains supplementary material available at 10.1007/s10811-023-02969-2.

High gene flow across large geographic scales reduces extinction risk for a highly specialised coral feeding butterflyfish.

The vulnerability of ecologically specialised species to environmental fluctuations has been well documented. However, population genetic structure can influence vulnerability to environmental change and recent studies have indicated that specialised species may have lower genetic diversity and greater population structuring compared to their generalist counterparts. To examine whether there were differences in population genetic structure between a dietary specialist (Chaetodon trifascialis) and a dietary generalist (Chaetodon lunulatus) we compared the demographic history and levels of gene flow of two related coral-feeding butterflyfishes. Using allele frequencies of ≥11 microsatellite loci and >350 bases of mitochondrial control region sequence our analyses of C. trifascialis and C. lunulatus from five locations across the Pacific Ocean revealed contrasting demographic histories and levels of genetic structure. Heterozygosity excess tests, neutrality tests and mismatch distributions were all highly significant in the dietary specialist C. trifascialis (all P < 0.01), suggesting genetic bottlenecks have occurred in all locations. In contrast, we found little evidence of genetic bottlenecks for the dietary generalist C. lunulatus. High gene flow and low genetic structuring was detected among locations for C. trifascialis (amova: R(ST) = 0.0027, P = 0.371; Φ(ST) = 0.068, P < 0.0001). Contrary to our expectations, a greater level of genetic structuring between locations was detected for C. lunulatus (amova: R(ST) = 0.0277, Φ(ST) = 0.166, both P < 0.0001). These results suggest that dietary specialisation may affect demographic history through reductions in population size following resource declines, without affecting population structure through reductions in gene flow in the same way that habitat specialisation appears to. Although C. trifascialis is highly vulnerable to coral loss, the high gene flow detected here suggests populations will be able to recover from local declines through the migration of individuals.

Testing a workplace physical activity intervention: a cluster randomized controlled trial.

BACKGROUND: Increased physical activity levels benefit both an individuals' health and productivity at work. The purpose of the current study was to explore the impact and cost-effectiveness of a workplace physical activity intervention designed to increase physical activity levels. METHODS: A total of 1260 participants from 44 UK worksites (based within 5 organizations) were recruited to a cluster randomized controlled trial with worksites randomly allocated to an intervention or control condition. Measurement of physical activity and other variables occurred at baseline, and at 0 months, 3 months and 9 months post-intervention. Health outcomes were measured during a 30 minute health check conducted in worksites at baseline and 9 months post intervention. The intervention consisted of a 3 month tool-kit of activities targeting components of the Theory of Planned Behavior, delivered in-house by nominated facilitators. Self-reported physical activity (measured using the IPAQ short-form) and health outcomes were assessed. RESULTS AND DISCUSSION: Multilevel modelling found no significant effect of the intervention on MET minutes of activity (from the IPAQ) at any of the follow-up time points controlling for baseline activity. However, the intervention did significantly reduce systolic blood pressure (B=-1.79 mm/Hg) and resting heart rate (B=-2.08 beats) and significantly increased body mass index (B=.18 units) compared to control. The intervention was found not to be cost-effective, however the substantial variability round this estimate suggested that further research is warranted. CONCLUSIONS: The current study found mixed support for this worksite physical activity intervention. The paper discusses some of the tensions involved in conducting rigorous evaluations of large-scale randomized controlled trials in real-world settings.

Are all ulvans equal? A comparative assessment of the chemical and gelling properties of ulvan from blade and filamentous Ulva.

Green seaweeds of the genus Ulva are rich in the bioactive sulfated polysaccharide ulvan. Herein we characterise ulvan from Ulva species collected from the Bay of Plenty, Aotearoa New Zealand. Using standardised procedures, we quantified, characterised, and compared ulvans from blade (U. australis, U. rigida, U. sp. B, and Ulva sp.) and filamentous (U. flexuosa, U. compressa, U. prolifera, and U. ralfsii) Ulva species. There were distinct differences in composition and structure of ulvans between morphologies. Ulvan isolated from blade species had higher yields (14.0-19.3 %) and iduronic acid content (IdoA = 7-18 mol%), and lower molecular weight (Mw = 190-254 kDa) and storage moduli (G' = 0.1-6.6 Pa) than filamentous species (yield = 7.2-14.6 %; IdoA = 4-7 mol%; Mw = 260-406 kDa; G' = 22.7-74.2 Pa). These results highlight the variability of the physicochemical properties of ulvan from different Ulva sources, and identifies a morphology-based division within the genus Ulva.

Classifying health-related behaviours: exploring similarities and differences amongst behaviours.

OBJECTIVES: The classification of health behaviours may provide a useful framework for understanding their characteristics and therefore the ways in which they are similar and different. However, to date, little research has attempted to identify these characteristics and explore the dimensions along which behaviours differ. This paper uses an inductive approach to explore this issue. DESIGN AND METHODS: In Study 1, 25 repertory grid interviews and 3 focus groups encompassing lay public and health professionals identified 25 ways of describing health behaviours. These were refined into 11 key characteristics. In Study 2, 180 members of the general public rated 20 health behaviours on each of these characteristics. RESULTS: Principal components analysis indicated behaviours were perceived along three key dimensions: 'easy immediate pay-offs' versus 'effortful long-term pay-offs'; 'private unproblematic' versus 'public and problematic'; and 'important routines' versus 'unimportant one-offs'. Risk behaviours were clearly differentiated being perceived as 'easy immediate pay-offs' and 'public-problematic'. In contrast with other approach behaviours such as diet or self-examination, physical activity behaviours were perceived as 'effortful long-term pay-offs'. CONCLUSIONS: This research provides an useful starting point in the development of a framework that allows us to better understand differences and similarities between health behaviours. These dimensions may be important to consider when researchers set out to predict or change behaviour.

Correction: Algal Bioremediation of Waste Waters from Land-Based Aquaculture Using Ulva: Selecting Target Species and Strains.

[This corrects the article DOI: 10.1371/journal.pone.0077344.].

Evidence, theory and context: using intervention mapping to develop a worksite physical activity intervention.

BACKGROUND: The workplace is an ideal setting for health promotion. Helping employees to be more physically active can not only improve their physical and mental health, but can also have economic benefits such as reduced sickness absence. The current paper describes the development of a three month theory-based intervention that aims to increase levels of moderate intensity physical activity amongst employees in sedentary occupations. METHODS: The intervention was developed using an intervention mapping protocol. The intervention was also informed by previous literature, qualitative focus groups, an expert steering group, and feedback from key contacts within a range of organisations. RESULTS: The intervention was designed to target awareness (e.g. provision of information), motivation (e.g. goal setting, social support) and environment (e.g. management support) and to address behavioural (e.g. increasing moderate physical activity in work) and interpersonal outcomes (e.g. encourage colleagues to be more physically active). The intervention can be implemented by local facilitators without the requirement for a large investment of resources. A facilitator manual was developed which listed step by step instructions on how to implement each component along with a suggested timetable. CONCLUSION: Although time consuming, intervention mapping was found to be a useful tool for developing a theory based intervention. The length of this process has implications for the way in which funding bodies allow for the development of interventions as part of their funding policy. The intervention will be evaluated in a cluster randomised trial involving 1350 employees from 5 different organisations, results available September 2009.

Biochemical evolution in response to intensive harvesting in algae: Evolution of quality and quantity.

Evolutionary responses to indirect selection pressures imposed by intensive harvesting are increasingly common. While artificial selection has shown that biochemical components can show rapid and dramatic evolution, it remains unclear as to whether intensive harvesting can inadvertently induce changes in the biochemistry of harvested populations. For applications such as algal culture, many of the desirable bioproducts could evolve in response to harvesting, reducing cost-effectiveness, but experimental tests are lacking. We used an experimental evolution approach where we imposed heavy and light harvesting regimes on multiple lines of an alga of commercial interest for twelve cycles of harvesting and then placed all lines in a common garden regime for four cycles. We have previously shown that lines in a heavy harvesting regime evolve a "live fast" phenotype with higher growth rates relative to light harvesting regimes. Here, we show that algal biochemistry also shows evolutionary responses, although they were temporarily masked by differences in density under the different harvesting regimes. Heavy harvesting regimes, relative to light harvesting regimes, had reduced productivity of desirable bioproducts, particularly fatty acids. We suggest that commercial operators wishing to maximize productivity of desirable bioproducts should maintain mother cultures, kept at higher densities (which tend to select for desirable phenotypes), and periodically restart their intensively harvested cultures to minimize the negative consequences of biochemical evolution. Our study shows that the burgeoning algal culture industry should pay careful attention to the role of evolution in intensively harvested crops as these effects are nontrivial if subtle.

The effect of pair-based monetary contingency contracts for weight loss: Results from a randomized controlled pilot study.

OBJECTIVE: Monetary contingency contracts (MCCs), in which deposited money is returned contingent on weight loss, could promote weight/adiposity reduction. This study piloted individual- and pair-based MCCs (when refunds are contingent on two individuals losing weight) and assessed effects on weight/body composition. METHODS: Seventy-seven participants with BMI greater than 25 kg/m2 were recruited. In a non-blinded, randomized controlled trial conducted in a university laboratory setting, participants were randomized in pairs via a computer-generated sequence to one of four conditions: partner with pair-based refund (P-PBR), partner with individual refund (P-IR), individual weight loss with individual refund (I-IR), or no MCC (comparison). Refunds were contingent on weight loss after 4 and 8 weeks; weight/body composition was measured at 0, 4, and 8 weeks. Primary outcome measures were change in weight and fat mass. RESULTS: Seventy-seven participants (P-PBR n = 16; P-IR n = 20; I-IR n = 22; comparison n = 19) were recruited. Deposit amount was significantly positively associated with reductions in weight/BMI. At 8 weeks, the P-PBR condition reduced fat mass more than all other conditions (P < 0.05) and reduced weight/BMI more than the I-IR condition (P < 0.05). CONCLUSIONS: The large effect of P-PBR on fat mass suggests it would be valuable to conduct a fully powered, randomized controlled trial of pair-based MCCs.

Promoting adherence to antibiotics: a test of implementation intentions.

OBJECTIVE: This prospective study tested whether implementation intentions increased adherence to short-term antibiotics in a patient sample. Implementation intentions specify exactly when and where an individual will undertake an activity. They may help people achieve health behaviours, such as taking medicines. METHODS: A total of 220 patients with an antibiotics prescription were randomly assigned to four groups (control, Theory of Planned Behaviour (TPB) questionnaire, TPB questionnaire+formed own implementation intention for taking the medicine, TPB questionnaire+researcher formed implementation intention). Participants were telephoned at the end of the course to record adherence. Two hundred and seven participants completed the study. RESULTS: At follow-up, adherence was high (75.8% reported no tablets left). Analysis revealed no significant difference in adherence between groups. CONCLUSION: High adherence to antibiotics was achieved, but not improved by implementation intentions. PRACTICE IMPLICATIONS: Providing information and telephone follow-up may have been the unintended effective intervention in this study.

The utility of monetary contingency contracts for weight loss: a systematic review and meta-analysis.

Financial incentives to improve health have received increasing attention, but are subject to ethical concerns. Monetary Contingency Contracts (MCCs), which require individuals to deposit money that is refunded contingent on reaching a goal, are a potential alternative strategy. This review evaluates systematically the evidence for weight loss-related MCCs. Randomised controlled trials testing the effect of weight loss-related MCCs were identified in online databases. Random-effects meta-analyses were used to calculate overall effect sizes for weight loss and participant retention. The association between MCC characteristics and weight loss/participant retention effects was calculated using meta-regression. There was a significant small-to-medium effect of MCCs on weight loss during treatment when one outlier study was removed. Group refunds, deposit not paid as lump sum, participants setting their own deposit size and additional behaviour change techniques were associated with greater weight loss during treatment. Post-treatment, there was no significant effect of MCCs on weight loss. There was a significant small-to-medium effect of MCCs on participant retention during treatment. Researcher-set deposits paid as one lump sum, refunds delivered on an all-or-nothing basis and refunds contingent on attendance at classes were associated with greater retention during treatment. Post-treatment, there was no significant effect of MCCs on participant retention. The results support the use of MCCs to promote weight loss and participant retention up to the point that the incentive is removed and identifies the conditions under which MCCs work best.

Methods for the induction of reproduction in a tropical species of filamentous ulva.

The green seaweed Ulva is a major fouling organism but also an edible aquaculture product in Asia. This study quantified for the first time the effect of key factors on the reproduction of a tropical species of filamentous Ulva (Ulva sp. 3). The controlled timing of release of swarmers (motile reproductive bodies) was achieved when experiments were initiated in the early afternoon by exposing the thalli to a temperature shock (4°C) for 10 min and subsequently placing them into autoclaved filtered seawater under a 12 h light: 12 h dark photoperiod at 25°C. The release of swarmers then peaked two days after initiation. In contrast, segmentation, dehydration, salinity or time of initiation of experiments had no effect of any magnitude on reproduction. The released swarmers were predominantly biflagellate (95%), negatively phototactic and germinated without complementary gametes. This indicates that Ulva sp. 3 has a simple asexual life history dominated by biflagellate zoids.

Isolation and identification of oedogonium species and strains for biomass applications.

Freshwater macroalgae from the genus Oedogonium have recently been targeted for biomass applications; however, strains of Oedogonium for domestication have not yet been identified. Therefore, the objective of this study was to compare the performance of isolates of Oedogonium collected from multiple geographic locations under varying environmental conditions. We collected and identified wild-type isolates of Oedogonium from three geographic locations in Eastern Australia, then measured the growth of these isolates under a range of temperature treatments corresponding to ambient conditions in each geographic location. Our sampling identified 11 isolates of Oedogonium that could be successfully maintained under culture conditions. It was not possible to identify most isolates to species level using DNA barcoding techniques or taxonomic keys. However, there were considerable genetic and morphological differences between isolates, strongly supporting each being an identifiable species. Specific growth rates of species were high (>26% day-1) under 7 of the 9 temperature treatments (average tested temperature range: 20.9-27.7°C). However, the variable growth rates of species under lower temperature treatments demonstrated that some were better able to tolerate lower temperatures. There was evidence for local adaptation under lower temperature treatments (winter conditions), but not under higher temperature treatments (summer conditions). The high growth rates we recorded across multiple temperature treatments for the majority of species confirm the suitability of this diverse genus for biomass applications and the domestication of Oedogonium.

Partner- and planning-based interventions to reduce fat consumption: randomized controlled trial.

OBJECTIVE: The research tested the efficacy of partner- and planning-based interventions to reduce dietary fat intake over a 6-month period. DESIGN: Randomized controlled, blinded, parallel trial. METHODS: A computer randomization feature was used to allocate council employees (N = 427, of which 393 completed baseline measures) to one of four conditions (partner + implementation intentions, partner-only, implementation intentions, and control group) before they completed measures at baseline and follow-ups at 1, 3, and 6 months post-baseline. Outcome measures were comprised of validated self-report measures of dietary fat intake (saturated fat intake, fat intake, ratio of 'good' fats to 'bad' fats); psychosocial mediators (enjoyment, intention, self-efficacy, social influence, partner support); weight and waist size (baseline and 6 months only). RESULTS: Data from 393 participants were analysed in accordance with intention-to-treat analyses. All intervention groups reported greater reductions in fat intake than the control group at 3 months. The partner-based groups increased the ratio of 'good' fats to 'bad' fats at 3 and 6 months and lost more inches on their waist, versus the non-partner groups. The impacts of the partner-based manipulations on outcomes were partially mediated by greater perceived social influences, partner support, and enjoyment of avoiding high-fat foods. The partner-based interventions also increased intention and self-efficacy. However, the effects in this study were typically small and generally marginally significant. CONCLUSIONS: Partner-based interventions had some positive benefits on dietary-related outcomes at 3 and 6 months. Support for implementation intentions was more limited.

Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study.

INTRODUCTION: Patients represent an important and as yet untapped source of information about the factors that contribute to the safety of their care. The aim of the current study is to test the reliability and validity of the Patient Measure of Safety (PMOS), a brief patient-completed questionnaire that allows hospitals to proactively identify areas of safety concern and vulnerability, and to intervene before incidents occur. METHODS: 297 patients from 11 hospital wards completed the PMOS questionnaire during their stay; 25 completed a second 1 week later. The Agency for Healthcare Research and Quality (AHRQ) safety culture survey was completed by 190 staff on 10 of these wards. Factor structure, internal reliability, test-retest reliability, discriminant validity and convergent validity were assessed. RESULTS: Factor analyses revealed 8 key domains of safety (eg, communication and team work, access to resources, staff roles and responsibilities) explaining 58% variance of the original questionnaire. Cronbach's α (range 0.66-0.89) and test-retest reliability (r=0.75) were good. The PMOS positive index significantly correlated with staff reported 'perceptions of patient safety' (r=0.79) and 'patient safety grade' (r=-0.81) outcomes from the AHRQ (demonstrating convergent validity). A multivariate analysis of variance (MAMOVA) revealed that three PMOS factors and one retained single item discriminated significantly across the 11 wards. DISCUSSION: The PMOS is the first patient questionnaire used to assess factors contributing to safety in hospital settings from a patient perspective. It has demonstrated acceptable reliability and validity. Such information is useful to help hospitals/units proactively improve the safety of their care.