Multidisciplinary Tumor Board Smart Virtual Assistant in Locally Advanced Cervical Cancer: A Proof of Concept

AimThe first prototype of the “Multidisciplinary Tumor Board Smart Virtual Assistant” is presented, aimed to (i) Automated classification of clinical stage starting from different free-text diagnostic reports; (ii) Resolution of inconsistencies by identifying controversial cases drawing the clinician’s attention to particular cases worthy for multi-disciplinary discussion; (iii) Support environment for education and knowledge transfer to junior staff; (iv) Integrated data-driven decision making and standardized language and interpretation.Patients and MethodData from patients affected by Locally Advanced Cervical Cancer (LACC), FIGO stage IB2-IVa, treated between 2015 and 2018 were extracted. Magnetic Resonance (MR), Gynecologic examination under general anesthesia (EAU), and Positron Emission Tomography–Computed Tomography (PET-CT) performed at the time of diagnosis were the items from the Electronic Health Records (eHRs) considered for analysis. An automated extraction of eHR that capture the patient’s data before the diagnosis and then, through Natural Language Processing (NLP), analysis and categorization of all data to transform source information into structured data has been performed.ResultsIn the first round, the system has been used to retrieve all the eHR for the 96 patients with LACC. The system has been able to classify all patients belonging to the training set and - through the NLP procedures - the clinical features were analyzed and classified for each patient. A second important result was the setup of a predictive model to evaluate the patient’s staging (accuracy of 94%). Lastly, we created a user-oriented operational tool targeting the MTB who are confronted with the challenge of large volumes of patients to be diagnosed in the most accurate way.ConclusionThis is the first proof of concept concerning the possibility of creating a smart virtual assistant for the MTB. A significant benefit could come from the integration of these automated methods in the collaborative, crucial decision stages.

CAUSES OF ORGANISATIONAL CONFLICT IN PUBLIC INSTITUTIONS IN GHANA: A STUDY IN TAMALE HIGH COURT

Organizational conflicts are generally inevitable in public institutions. However, there seems to be paucity of studies on the causes of organisational conflict in public institutions in Ghana in general and Tamale High Court in particular. This article seeks to bridge this knowledge gap by determining the causal factors of organizational conflicts in the Tamale High Court. The research gathered data from both primary and secondary sources and used the case study approach. The key instruments used for the data collection were interview guides. A total of fifteen (15) participants; eight (8) senior staff and seven (7) junior staff who took part in this study were purposively selected. The study found out that ineffective organisational system, unpredictable policies, tribalism, incompatible goals, poor communication, distribution of duties, lack of benefits, varying views on accountability, poor relations between senior and junior staff, disagreement between employees and employers, clashing of one’s role, selfishness among employers and employees, politics and difference in educational background, personal experiences, religion and gender are the factors causing conflict at Tamale High Court. It is recommended that the staff of Tamale High Court should be cordial and work harmoniously towards the administration of Justice in Ghana. It is further recommended that the management of Judicial Service in the Northern Region of Ghana apart from the Complaint Unit design a system where grievances can be tackled easily when there are conflicts. Keywords: Causes, Organizational Conflict, Public Institutions, Tamale High Court, Northern Region, Ghana.

Differences in Coping Strategies and Help-Seeking Behaviours among Australian Junior and Senior Doctors during the COVID-19 Pandemic

Background: Throughout the COVID-19 pandemic, hospital medical staff (HMS) have faced significant personal, workplace, and financial disruption. Many have experienced psychosocial burden, exceeding already concerning baseline levels. This study examines the types and predictors of coping strategies and help-seeking behaviours utilised by Australian junior and senior HMS during the first year of the pandemic. Methods: A cross-sectional online survey of Australian frontline healthcare workers was conducted between 27 August and 23 October 2020. Data collected included demographics, personal and workplace disruptions, self-reported and validated mental health symptoms, coping strategies, and help-seeking. Results: The 9518 participants included 1966 hospital medical staff (62.1% senior, 37.9% junior). Both groups experienced a high burden of anxiety, depression, post-traumatic stress disorder, and burnout. Coping strategies varied by seniority, with maintaining exercise the most common strategy for both groups. Adverse mental health was associated with increased alcohol consumption. Engagement with professional support, although more frequent among junior staff, was uncommon in both groups. Conclusions: Junior and senior staff utilised different coping and help-seeking behaviours. Despite recognition of symptoms, very few HMS engaged formal support. The varied predictors of coping and help-seeking identified may inform targeted interventions to support these cohorts in current and future crises.

Hand Motion Analysis Illustrates Differences When Drilling Cadaveric and Printed Temporal Bone

Objective: Temporal bone simulation is now commonly used to augment cadaveric education. Assessment of these tools is ongoing, with haptic modeling illustrating dissimilar motion patterns compared to cadaveric opportunities. This has the potential to result in maladaptive skill development. It is hypothesized that trainee drill motion patterns during printed model dissection may likewise demonstrate dissimilar hand motion patterns. Methods: Resident surgeons dissected 3D-printed temporal bones generated from microCT data and cadaveric simulations. A magnetic position tracking system (TrakSTAR Ascension, Yarraville, Australia) captured drill position and orientation. Skill assessment included cortical mastoidectomy, thinning procedures (sigmoid sinus, dural plate, posterior canal wall) and facial recess development. Dissection was performed by 8 trainees (n = 5 < PGY3 > n = 3) using k-cos metrics to analyze drill strokes within position recordings. K-cos metrics define strokes by change in direction, providing metrics for stroke duration, curvature, and length. Results: T-tests between models showed no significant difference in drill stroke frequency (cadaveric = 1.36/s, printed = 1.50/s, P < .40) but demonstrate significantly shorter duration (cadaveric = 0.37 s, printed = 0.16 s, P < .01) and a higher percentage of curved strokes (cadaveric = 31, printed = 67, P < .01) employed in printed bone dissection. Junior staff used a higher number of short strokes (junior = 0.54, senior = 0.38, P < .01) and higher percentage of curved strokes (junior = 35%, senior = 21%, P < .01). Conclusions: Significant differences in hand motions were present between simulations, however the significance is unclear. This may indicate that printed bone is not best positioned to be the principal training schema.

Differences in Coping Strategies and Help-Seeking Behaviours among Australian Junior and Senior Doctors during the COVID-19 Pandemic

Background: Throughout the COVID-19 pandemic, hospital medical staff (HMS) have faced significant personal, workplace, and financial disruption. Many have experienced psychosocial burden, exceeding already concerning baseline levels. This study examines the types and predictors of coping strategies and help-seeking behaviours utilised by Australian junior and senior HMS during the first year of the pandemic. Methods: A cross-sectional online survey of Australian frontline healthcare workers was conducted between 27th August and 23rd October 2020. Data collected included demographics, personal and workplace disruptions, self-reported and validated mental health symptoms, coping strategies, and help-seeking. Results: The 9518 participants included 1966 hospital medical staff (62.1% senior, 37.9% junior). Both groups experienced a high burden of anxiety, depression, post-traumatic stress disorder, and burnout. Coping strategies varied by seniority, with maintaining exercise the most common strategy for both groups. Adverse mental health was associated with increased alcohol consumption. Engagement with professional support, although more frequent among junior staff, was uncommon in both groups. Conclusions: Junior and senior staff utilised different coping and help-seeking behaviours. Despite recognition of symptoms, very few HMS engaged formal support. The varied predictors of coping and help-seeking identified may inform targeted interventions to support these cohorts in current and future crises.

The effect of a company's innovation orientation culture on employee turnover among selected non-governmental organizations in Samburu, Kenya

This paper examines the effect of a company's innovation orientation culture on employee turnover among selected non-governmental organizations in Samburu, Kenya. A stratified random sampling technique was used to select 78 NGOs operating in Samburu County for the analysis, the study population comprised 11 senior management teams, 14 technical teams and 78 junior staff in 24 selected and active NGOs in Samburu. The analysis gathered both qualitative and quantitative data. A structured questionnaire was used to collect quantitative data and an interview guide was used to collect qualitative data. Thematic data analysis was used to interpret qualitative data, which included common terms, phrases, themes, and patterns. Quantitative data were analyzed using descriptive statistics which includes frequencies, means, and standard deviation. Findings Results showed that innovation orientation is positively correlated with employee turnover (r=0.375, P=0.01). This supports Chow et al’s (2001) study which revealed that innovation orientation as part of an organization's culture has a significant effect on employee turnover. This study also discovered that an innovation orientation culture embedded in an NGO's ideology will help to reduce turnover because workers feel valued when their work is recognized for creativity and innovation.

Validation of the Occupational Self-Efficacy Scale in a Sample of Chinese Employees

Occupational self-efficacy, which refers to the belief that one is competent to fulfill work-related tasks or activities, has attracted increasing attention in recent years. The six-item version of the Occupational Self-Efficacy Scale (OSS-6) is an excellent tool for evaluating occupational self-efficacy; however, there is currently no report of the reliability and validity of the OSS-6 among Chinese people. This study aimed to translate the OSS-6 into Chinese and evaluate its reliability and validity in a sample of Chinese employees. A total of 433 junior staff at several firms completed the Chinese version of the OSS-6, the General Self-Efficacy Scale, the Rosenberg Self-Esteem Scale, the Minnesota Job Satisfaction Questionnaire, the in-role performance scale, and the career calling scale. Four weeks later, 94 participants were recalled and were retested using the OSS-6. Factor analysis results supported the one-factor model of the OSS-6. Excellent internal consistency was obtained with the OSS-6. Additionally, the OSS-6 results were significantly correlated with general self-efficacy, self-esteem, job satisfaction, in-role performance, and career calling. Furthermore, occupational self-efficacy was found to partially mediate the effects of career calling on job satisfaction and in-role performance. The results of this study supported the cross-cultural consistency of the structure of the OSS-6 and showed that the Chinese version of the OSS-6 demonstrated excellent validity and reliability. Therefore, the Chinese version of the OSS-6 can be used as an assessment tool for evaluating occupational self-efficacy in future studies.

Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care

Background: There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED). Aim: A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service. Method: Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis. Findings: This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure. Conclusion: PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.

Improving mental health care transitions through information capture during admission to inpatient mental health services: a quality improvement study

Background Many interventions aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. We aimed to develop a novel information capture tool during admission that facilitates and accelerates discharge. Methods A quality improvement study to develop, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. We developed the tool by synthesising existing evidence and working with multi-agency and multi-disciplinary professionals in two co-design workshops. During implementation the tool was piloted on three wards. Ethnographic observations (145 h) and interviews (45) were used to evaluate the implementation of the tool across the three wards. Thematic synthesis was used to consolidate the findings. Results The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to hospital to facilitate discharge planning to community settings. Reported advantages of the tool were: (1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward (2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and (3) collecting information from the services/agencies to which patients will eventually be discharged. Conclusions Improving the quality of information at admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems. However, the introduction of the tool exacerbated complex, fragile distributed team dynamics, highlighting the importance of sociocultural context in information flow transitional interventions within distributed teams.

Bolgoda chat, crossing the borders in his own way: An interview with Emeritus Professor P A De Silva

IPT gained university status in 1972. However, in 1966 we had received a status equivalent to a university, under the name “Ceylon College of Technology”. I remember one interesting incident from that time. The first vice chancellor was Dr. Upali Kuruppu. I was responsible for selecting Junior Technical Officers (JTO), and these were highly capable students who had missed engineering by a narrow margin. There were around 80 deserving candidates, and we were only admitting 40. Late Prof. Patuwathawithana and I (we were both young and junior staff members at that time), approached the administration to request an increase in the intake. Indeed, we had space to accommodate. There was a fear that, if we produced more, there will be no demand. The University of Ceylon was thus unwilling to increase the intake beyond 25 students. Finally, we managed to increase the JTO intake from 40 to 60. The JTO students were very capable. Prof. Patuwathawithana and I started to teach IMechE part II subjects to them. While I taught Heat Engines and Materials, he used to teach Thermo-machines etc. Some of them went on to become chartered engineers, and that too paved the way for the Ceylon College of Technology.