scholarly journals LO75: Does the Ottawa emergency department shift observation tool give more useful information – assessing the utility of transitioning to a novel, entrustability based assessment tool in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S34-S34
Author(s):  
S. Dewhirst ◽  
W. Cheung ◽  
N. Dudek ◽  
T. Wood ◽  
J. Frank
Keyword(s):  
Emergency Department ◽  
Assessment Tool ◽  
Reliable Estimate ◽  
Multiple Sources ◽  
Implementation Phase ◽  
Ottawa Hospital ◽  
Scale Scores ◽  
Generalizability Analysis ◽  
The Individual ◽  
Different Levels

Introduction: The Ottawa Emergency Department Shift Observation Tool (O-EDShOT) was recently developed to assess a resident's ability to safely run an ED shift and is supported by multiple sources of validity evidence. The O-EDShOT uses entrustability scales, which reflect the degree of supervision required for a given task. It was found to discriminate between learners of different levels, and to differentiate between residents who were rated as able to safely run the shift and those who were not. In June 2018 we replaced norm-based daily encounter cards (DECs) with the O-EDShOT. With the ideal assessment tool, most of the score variability would be explained by variability in learners’ performances. In reality, however, much of the observed variability is explained by other factors. The purpose of this study is to determine what proportion of total score variability is accounted for by learner variability when using norm-based DECs vs the O-EDShOT. Methods: This was a prospective pre-/post-implementation study, including all daily assessments completed between July 2017 and June 2019 at The Ottawa Hospital ED. A generalizability analysis (G study) was performed to determine what proportion of total score variability is accounted for by the various factors in this study (learner, rater, form, pgy level) for both the pre- and post- implementation phases. We collected 12 months of data for each phase, because we estimated that 6-12 months would be required to observe a measurable increase in entrustment scale scores within a learner. Results: A total of 3908 and 3679 assessments were completed by 99 and 116 assessors in the pre- and post- implementation phases respectively. Our G study revealed that 21% of total score variance was explained by a combination of post-graduate year (PGY) level and the individual learner in the pre-implementation phase, compared to 59% in the post-implementation phase. An average of 51 vs 27 forms/learner are required to achieve a reliability of 0.80 in the pre- and post-implementation phases respectively. Conclusion: A significantly greater proportion of total score variability is explained by variability in learners’ performances with the O-EDShOT compared to norm-based DECs. The O-EDShOT also requires fewer assessments to generate a reliable estimate of the learner's ability. This study suggests that the O-EDShOT is a more useful assessment tool than norm-based DECs, and could be adopted in other emergency medicine training programs.

Implications of Person Fluctuation for the Stability and Validity of Test Scores

Methodology ◽  
2006 ◽  
Vol 2 (4) ◽  
pp. 142-148 ◽  
Author(s):  
Pere J. Ferrando
Keyword(s):  
Item Response ◽  
Test Scores ◽  
Temporal Stability ◽  
Person Fit ◽  
Item Parameters ◽  
Individual Trait ◽  
The Stability ◽  
The Individual ◽  
Different Levels ◽  
Fluctuation Model

In the IRT person-fluctuation model, the individual trait levels fluctuate within a single test administration whereas the items have fixed locations. This article studies the relations between the person and item parameters of this model and two central properties of item and test scores: temporal stability and external validity. For temporal stability, formulas are derived for predicting and interpreting item response changes in a test-retest situation on the basis of the individual fluctuations. As for validity, formulas are derived for obtaining disattenuated estimates and for predicting changes in validity in groups with different levels of fluctuation. These latter formulas are related to previous research in the person-fit domain. The results obtained and the relations discussed are illustrated with an empirical example.

Value-driven issues throughout the development of sociological theory

2020 ◽  
pp. 147-160
Author(s):  
Gulbarshyn Chepurko ◽  
Valerii Pylypenko
Keyword(s):  
Social Interactions ◽  
Social System ◽  
Sociological Theory ◽  
Social Scientists ◽  
Social Sphere ◽  
Technological Advances ◽  
The Social ◽  
The Individual ◽  
Different Levels

The paper examines and compares how the major sociological theories treat axiological issues. Value-driven topics are analysed in view of their relevance to society in times of crisis, when both societal life and the very structure of society undergo dramatic change. Nowadays, social scientists around the world are also witnessing such a change due to the emergence of alternative schools of sociological thought (non-classical, interpretive, postmodern, etc.) and, subsequently, the necessity to revise the paradigms that have been existed in sociology so far. Since the above-mentioned approaches are often used to address value-related issues, building a solid theoretical framework for these studies takes on considerable significance. Furthermore, the paradigm revision has been prompted by technological advances changing all areas of people’s lives, especially social interactions. The global human community, integral in nature, is being formed, and production of human values now matters more than production of things; hence the “expansion” of value-focused perspectives in contemporary sociology. The authors give special attention to collectivities which are higher-order units of the social system. These units are described as well-organised action systems where each individual performs his/her specific role. Just as the role of an individual is distinct from that of the collectivity (because the individual and the collectivity are different as units), so too a distinction is drawn between the value and the norm — because they represent different levels of social relationships. Values are the main connecting element between the society’s cultural system and the social sphere while norms, for the most part, belong to the social system. Values serve primarily to maintain the pattern according to which the society is functioning at a given time; norms are essential to social integration. Apart from being the means of regulating social processes and relationships, norms embody the “principles” that can be applied beyond a particular social system. The authors underline that it is important for Ukrainian sociology to keep abreast of the latest developments in the field of axiology and make good use of those ideas because this is a prerequisite for its successful integration into the global sociological community.

Evidence-Based Social Sciences: A New Emerging Field

2018 ◽  
Vol 5 (2) ◽  
pp. 207-211
Author(s):  
Nazila Zarghi ◽  
Soheil Dastmalchian Khorasani
Keyword(s):  
Social Sciences ◽  
Critical Appraisal ◽  
State Of The Art ◽  
Internal Validity ◽  
Evidence Based ◽  
Multiple Sources ◽  
Social Settings ◽  
Research Findings ◽  
Academic Area ◽  
Different Levels

Abstract Evidence based social sciences, is one of the state-of- the-art area in this field. It is making decisions on the basis of conscientious, explicit and judicious use of the best available evidence from multiple sources. It also could be conducive to evidence based social work, i.e a kind of evidence based practice in some extent. In this new emerging field, the research findings help social workers in different levels of social sciences such as policy making, management, academic area, education, and social settings, etc.When using research in real setting, it is necessary to do critical appraisal, not only for trustingon internal validity or rigor methodology of the paper, but also for knowing in what extent research findings could be applied in real setting. Undoubtedly, the latter it is a kind of subjective judgment. As social sciences findings are highly context bound, it is necessary to pay more attention to this area. The present paper tries to introduce firstly evidence based social sciences and its importance and then propose criteria for critical appraisal of research findings for application in society.

scholarly journals Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 46
Author(s):  
Tina Hansen ◽  
Rikke Lundsgaard Nielsen ◽  
Morten Baltzer Houlind ◽  
Juliette Tavenier ◽  
Line Jee Hartmann Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cohort Study ◽  
Systemic Inflammation ◽  
Older Patients ◽  
Time Course ◽  
Assessment Tool ◽  
Handgrip Strength ◽  
Secondary Analysis ◽  
Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

Embodying the culture of achievement: Culture between illness and perfection is a ‘thin line’ – obtaining the ideal female body as an act of achievement

2021 ◽  
pp. 1354067X2110040
Author(s):  
Josefine Dilling ◽  
Anders Petersen
Keyword(s):  
Experimental Study ◽  
Human Body ◽  
Female Body ◽  
The Body ◽  
Thin Line ◽  
Complex Processes ◽  
The Individual ◽  
Different Levels ◽  
The Ideal ◽  
Body Ideals

In this article, we argue that certain behaviour connected to the attempt to attain contemporary female body ideals in Denmark can be understood as an act of achievement and, thus, as an embodiment of the culture of achievement, as it is characterised in Præstationssamfundet, written by the Danish sociologist Anders Petersen (2016) Hans Reitzels Forlag . Arguing from cultural psychological and sociological standpoints, this article examines how the human body functions as a mediational tool in different ways from which the individual communicates both moral and aesthetic sociocultural ideals and values. Complex processes of embodiment, we argue, can be described with different levels of internalisation, externalisation and materialisation, where the body functions as a central mediator. Analysing the findings from a qualitative experimental study on contemporary body ideals carried out by the Danish psychologists Josefine Dilling and Maja Trillingsgaard, this article seeks to anchor such theoretical claims in central empirical findings. The main conclusions from the study are used to structure the article and build arguments on how expectations and ideals expressed in an achievement society become embodied.

scholarly journals The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

2021 ◽  
pp. 084456212110144
Author(s):  
Behdin Nowrouzi-Kia ◽  
Mary T. Fox ◽  
Souraya Sidani ◽  
Sherry Dahlke ◽  
Deborah Tregunno
Keyword(s):  
Emergency Department ◽  
Role Conflict ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Medical Unit ◽  
Scale Scores ◽  
Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

scholarly journals Implementation of the Comprehensive Unit-Based Safety Program to Improve Hand Hygiene in Four NICUs in Pune, India

2020 ◽  
Vol 41 (S1) ◽  
pp. s8-s10
Author(s):  
Julia Johnson ◽  
Asad Latif ◽  
Bharat Randive ◽  
Abhay Kadam ◽  
Uday Rajput ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Safety Culture ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Infection Prevention And Control ◽  
Improvement Strategy ◽  
Implementation Phase ◽  
Healthcare Facilities ◽  
Safety Program

Background: In low- and middle-income country (LMIC) healthcare facilities, gaps in infection prevention and control (IPC) practices increase risk of healthcare-associated infections (HAIs) and mortality among hospitalized neonates. Method: In this quasi-experimental study, we implemented the Comprehensive Unit-based Safety Program (CUSP) to improve adherence to evidence-based IPC practices in neonatal intensive care units (NICUs) in 4 tertiary-care facilities in Pune, India. CUSP is a validated strategy to empower staff to improve unit-level patient safety. Baseline safety culture was measured using the Hospital Survey on Patient Safety Culture (HSOPS). Baseline IPC assessments using the Infection Control Assessment Tool (ICAT) were completed to describe existing IPC practices to identify focus areas, the first of which was hand hygiene (HH). Sites received training in CUSP methodology and formed multidisciplinary CUSP teams, which met monthly and were supported by monthly coaching calls. Staff safety assessments (SSAs) guided selection of multimodal interventions. HH compliance was measured by direct observation using trained external observers. The primary outcome was HH compliance, evaluated monthly during the implementation and maintenance phases. Secondary outcomes included CUSP meeting frequency and HH compliance by healthcare worker (HCW) role. Result: In March 2018, 144 HCWs and administrators participated in CUSP training. Site meetings occurred monthly. During the implementation phase (June 2018–January 2019), HH monitoring commenced, sites formed their teams, completed the SSA, and selected interventions to improve HH based on the WHO’s IPC multimodal improvement strategy: (1) system change; (2) training and education; (3) monitoring and feedback; (4) reminders and communication; and (5) a culture of safety (Fig. 1). During the maintenance phase (February–September 2019), HH was monitored monthly and sites adapted interventions as needed. HH compliance improved from 58% to 70% at participant sites from implementation to maintenance phases (Fig. 2), with an odds ratio (OR) of 1.66 (95% CI, 1.50–1.84; P < .001). HH compliance improved across all HCW roles: (1) physician compliance improved from 55% to 67% (OR, 1.69; 95% CI, 1.42–2.01; P < .001); (2) nurse compliance from 61% to 73% (OR, 1.68; 95% CI, 1.46–1.93; P < .001); and (3) other HCW compliance from 52% to 62% (OR, 1.48; 95% CI, 1.10–1.99; P = .010). Conclusion: CUSP was successfully adapted by 4 diverse tertiary-care NICUs in Pune, India, and it resulted in increased HH compliance at all sites. This multimodal strategy is a promising framework for LMIC healthcare facilities to sustainably address IPC gaps and reduce HAI and mortality in neonates.Funding: NoneDisclosures: Aaron Milstone, Johns Hopkins University, BD (consulting)

Identifying children at high risk for infection-related decompensation using a predictive emergency department-based electronic assessment tool

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Robert J. Sepanski ◽  
Arno L. Zaritsky ◽  
Sandip A. Godambe
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Positive Predictive Value ◽  
Firing Rate ◽  
Predictive Value ◽  
Assessment Tool ◽  
Predictive Tool ◽  
High Severity ◽  
Electronic Assessment ◽  
Ed Visits

AbstractObjectivesElectronic alert systems to identify potential sepsis in children presenting to the emergency department (ED) often either alert too frequently or fail to detect earlier stages of decompensation where timely treatment might prevent serious outcomes.MethodsWe created a predictive tool that continuously monitors our hospital’s electronic health record during ED visits. The tool incorporates new standards for normal/abnormal vital signs based on data from ∼1.2 million children at 169 hospitals. Eighty-two gold standard (GS) sepsis cases arising within 48 h were identified through retrospective chart review of cases sampled from 35,586 ED visits during 2012 and 2014–2015. An additional 1,027 cases with high severity of illness (SOI) based on 3 M’s All Patient Refined – Diagnosis-Related Groups (APR-DRG) were identified from these and 26,026 additional visits during 2017. An iterative process assigned weights to main factors and interactions significantly associated with GS cases, creating an overall “score” that maximized the sensitivity for GS cases and positive predictive value for high SOI outcomes.ResultsTool implementation began August 2017; subsequent improvements resulted in 77% sensitivity for identifying GS sepsis within 48 h, 22.5% positive predictive value for major/extreme SOI outcomes, and 2% overall firing rate of ED patients. The incidence of high-severity outcomes increased rapidly with tool score. Admitted alert positive patients were hospitalized nearly twice as long as alert negative patients.ConclusionsOur ED-based electronic tool combines high sensitivity in predicting GS sepsis, high predictive value for physiologic decompensation, and a low firing rate. The tool can help optimize critical treatments for these high-risk children.

The Entextualization of Ayurveda as Intellectual Property

2012 ◽  
Vol 19 (3) ◽  
pp. 313-343 ◽  
Author(s):  
Matthew Wolfgram
Keyword(s):  
Intellectual Property ◽  
Global Economy ◽  
Medical Knowledge ◽  
Linguistic Anthropology ◽  
Medical Discourse ◽  
Complex Nature ◽  
Multiple Sources ◽  
The Social ◽  
Rights Discourse ◽  
The Individual

AbstractThis article documents the practices of pharmaceutical creativity in Ayurveda, focusing in particular on how practitioners appropriate multiple sources to innovate medical knowledge. Drawing on research in linguistic anthropology on the social circulation of discourse—a process calledentextualization—I describe how the ways in which Ayurveda practitioners innovate medical knowledge confounds the dichotomous logic of intellectual property (IP) rights discourse, which opposes traditional collective knowledge and modern individual innovation. While it is clear that these categories do not comprehend the complex nature of creativity in Ayurveda, I also use the concept of entextualization to describe how recent historical shifts in the circulation of discourse have caused a partial entailment of this opposition between the individual and the collectivity. Ultimately, I argue that the method exemplified in this article of tracking the social circulation of medical discourse highlights both the empirical complexity of so-called traditional creativity, and the politics of imposing the categories of IP rights discourse upon that creativity, situated as it often is, at the margins of the global economy.

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