Interpersonal Antecedents to Selective Disclosure of Lesbian and Gay Identities at Work

Lesbian, gay, and bisexual (LGB) employees’ sexual identitymay be considered a concealable stigmatised identity. Disclosing it to others at work could potentially lead to discrimination and rejection, hence threatening their inclusion. Therefore, they may hide their sexual identity instead, which may then come at the cost of, e.g., guilt for not living authentically. However, disclosure is a continuum—rather than a dichotomy—meaning that LGB workers may decide to disclose selectively, i.e., telling some, but not all co‐workers. Most literature on disclosure focuses on the interplay between intrapersonal (e.g., psychological) and contextual (e.g., organisational) characteristics, thereby somewhat overlooking the role of interpersonal (e.g., relational) characteristics. In this article, we present findings from semi‐structured, in‐depth interviews with nine Dutch lesbian and gay employees, conducted in early 2020, to gain a better understanding of interpersonal antecedents to disclosure decisions at work. Through our thematic analysis, we find that LGB workers may adopt a proactive or reactive approach to disclosure, which relates to the salience of their sexual identity at work (high/low) and their concern for anticipated acceptance. Other themes facilitating disclosure include an affective dimension, being in a relationship, and associating with the employee resource group. We demonstrate the importance of studying disclosure at the interpersonal level and reflect on how our findings relate to literature on disclosure, authenticity, belonging, and social inclusion of LGB individuals at work.

Use of professional practice guidance resources in pharmacy: a cross-sectional nationwide survey of pharmacists, intern pharmacists, and pharmacy students

Background Variations in practice are commonplace in healthcare where health professionals, such as pharmacists act as autonomous practitioners. This is evident in simulated patient studies, where pharmacists practice does not meet widely accepted standards for medicines supply or treatment of an ailment. To promote best pharmacy practice a myriad of guidance resources including practice guidelines, codes and standards are produced by professional organisations. These resources provide a framework for pharmacy practice and endeavour to facilitate consistency in provision of pharmacy-based services to consumers. Despite their role in specifying essential pharmacist behaviours, there is limited research exploring if and how these resources are used in practice. Objective To characterise Australian pharmacists’ use of the Pharmaceutical Society of Australia’s Code of Ethics, Professional Practice Guidelines and Professional Practice Standards. Methods A cross-sectional, self-administered, electronic survey of registered pharmacists, intern pharmacists and pharmacy students living in Australia was conducted in July 2020. Questions considered use of professional practice resources (by resource group) in the preceding 12 months. Data were analysed descriptively. Results Of 601 responses included in the analysis 462 (76.9%) of respondents were registered pharmacists, 88 (14.6%) pharmacy students and 51 (8.5%) intern pharmacists. Interns and students accessed overarching practice resources, such as the Professional Practice Standards, Code of Ethics and Dispensing Practice Guidelines more frequently than practising pharmacists. Pharmacists accessed professional practice guidelines, such as Practice Guidelines for the Provision of Immunisation Services Within Pharmacy, more often than students. More pharmacists than interns and students indicated that they would access guidelines to resolve practice and patient care issues. All resources except the Professional Practice Standards for Pharmacists (67.4%) were accessed by less than 50% of respondents in the preceding 12-month period. Reasons for not accessing resources varied between participant and resource groups, and generally were due to a lack of awareness of the resource or not considering them necessary for the individual’s practice. Conclusion(s) Access and use patterns for professional practice guidance resources change with experience. Professional organisations responsible for developing resources should consider these patterns when designing and reviewing resources and related policies. To ensure resources are meeting the needs of the profession, students, interns, and pharmacists should be involved in the review of and design of further resources.

What are the financial implications of an open right hemicolectomy to hospital trusts within NHS England? A cost analysis

ObjectiveThis study aimed to quantify the actual costs to National Health Service (NHS) England of open right/extended right hemicolectomy (ORH) patient episodes compared with national tariffs to determine whether the total cost of care for these patients is adequately reimbursed to NHS Trusts.Design2017–2018 NHS Improvement reference cost data for elective and non-elective ORH Healthcare Resource Group 4+ (HRG4+)-coded procedures were used to calculate the actual mean initial admission costs of ORH and compare with corresponding 2017–2018 national tariffs. Costs of postoperative complications were estimated based on 2017–2018 Hospital Episode Statistics (intensive care unit (ICU)/high-dependency unit (HDU) stay and surgical site infection (SSI)) or further associated HRG4+-coded procedures (anastomotic leakage, SSI or hernia).Setting and patient cohortData were analysed for all ORH inpatients reported as treated at 140 secondary care Hospital Trusts in England during the 2017–2018 financial year.Results9812 ORH HRG4+-coded procedures were reported across 140 Hospital Trusts (74.0% elective; 26.0% non-elective). A total 1-year deficit of £993 335 was estimated between actual initial admission costs incurred and tariffs reimbursed for all patient episodes, 93.7% of which was associated with elective admissions. The cost of the average length of stay (LoS) in ICU/HDU after an ORH was £6818. The additional cost of an extended LoS in ICU/HDU due to an SSI was £45 316.ConclusionThe total cost of delivering care for these patients declared by NHS England was far higher than the tariff provided, which may be significantly underestimating the true cost of an ORH, leading to inadequate national tariff-setting by NHS Improvement.

Identification of Finely Mapped Quantitative Trait Locus and Candidate Gene Mining for the Three-Seeded Pod Trait in Soybean

The three-seeded pod number is an important trait that positively influences soybean yield. Soybean variety with increased three-seeded pod number contributes to the seed number/plant and higher yield. The candidate genes of the three-seeded pod may be the key for improving soybean yield. In this study, identification and validation of candidate genes for three-seeded pod has been carried out. First, a total of 36 quantitative trait locus (QTL) were detected from the investigation of recombinant inbred lines including 147 individuals derived from a cross between Charleston and Dongning 594 cultivars. Five consensus QTLs were integrated. Second, an introgressed line CSSL-182 carrying the target segment for the trait from the donor parent was selected to verify the consensus QTL based on its phenotype. Third, a secondary group was constructed by backcrossing with CSSL-182, and two QTLs were confirmed. There were a total of 162 genes in the two QTLs. The mining of candidate genes resulted in the annotation of eight genes with functions related to pod and seed sets. Finally, haplotype analysis and quantitative reverse transcriptase real-time PCR were carried to verify the candidate genes. Four of these genes had different haplotypes in the resource group, and the differences in the phenotype were highly significant. Moreover, the differences in the expression of the four genes during pod and seed development were also significant. These four genes were probably related to the development process underlying the three-seeded pod in soybean. Herein, we discuss the past and present studies related to the three-seeded pod trait in soybean.

Learner Motivation and Engagement in Virtual EFL Classes at the Tertiary Level in Bangladesh during the Pandemic

In the face of the ongoing pandemic crisis in the country, the tertiary level education context of Bangladesh has predominantly resorted to online and distance learning modules. While such virtual English as Foreign Language (EFL) classes have undoubtedly played a pivotal role to ensure continuation of tertiary level teaching and learning even amidst the closure of educational institutions in the country, however, some contemporary research and news in this regard have reported on tertiary level learners’ dissatisfaction and reduced performances in such EFL classes. As such, to assess the learners’ perceived motivation and engagement in virtual EFL classes, the current research uses a mixed method approach. Here, the researcher uses questionnaire survey, interview and FGD guidelines, constructed based on Vroom’s expectancy theory of motivation and instruments to assess attitude orientation, to collect data from both the “target” group, i.e. the learners, and the “resource” group, i.e. the teachers and the parents, from 5 tertiary level institutes of the country. Here, the data highlights negative attitude and reduced motivation orientation of the learners towards certain aspects in online EFL classes. The findings also manifest some imperial causal factors, which leads to reduced motivation and engagement of learners in such online modules. It unravels how online education has exacerbated the digital divide among the learners amidst the pandemic crisis. Moreover, the study also presents some pedagogic participant-centric suggestions to promote motivation and engagement of the learners in online EFL classes in a developing country context like Bangladesh.

546 QUALITY IMPROVEMENT PROJECT: IMPROVING CONTENT IN DISCHARGE SUMMARIES FOR CODING

Introduction Hospital coding provides a pivotal service, integral to data collection, national statistics and hospital finances. The system of accurately coding depends almost entirely on the information put into Electronic Discharge Letters (EDLs). This project aims to up skill doctors with the expertise of the coding department, so that the EDLs reflect more accurately the experiences of the patient in hospital. Method Cycle 1; A member from the coding department was invited to the ward once a week to join with junior doctors writing their discharge letter. The coding from the discharge letters produced during this time were compared to those immediately prior to the coding department’s involvement. Cycle 2; The lead author and a member from the coding team took a sample of 12 notes from the Ambulatory Emergency Clinic (AEC), for patients presenting in January and February of 2020. Results Cycle 1; there was no significant difference in the number of co-morbidities or revenue gained from EDLs written with the support of the coding team compared to doctors writing ELDs independently Cycle 2; For 9 of the 12 patients (75%), co-morbidities were added. This changed the Healthcare Resource Group coded of 5 patients, resulting in an increasing the revenue to the hospital by £757 on average. For the number of patients seen in AEC in January, this could represent £218,271 of lost revenue, in addition to other benefits of accurate record keeping. Conclusion The role of the physician cannot increase indefinitely, and there is a wealth of knowledge and experience to be gained from our colleagues in the coding department. This collaboration in assiduously improving the service that our patients receive brings the possibility of large financial gains as well as more accurate health care records.

Feasibility of using data collected through the St. Jude Pediatric Oncology Facility integrated local evaluation (PrOFILE) tool to determine previously defined levels of pediatric hematology-oncology care.

e13530 Background: Pediatric hematology and oncology (PHO) facilities are not all equally equipped to diagnose and treat the full range of childhood cancers. Proposed facility tier models have been published to facilitate the context-based adaptation of PHO diagnostic and treatment guidelines. However, a tool to assist facilities in identifying their level of PHO care does not exist. We assessed the feasibility of using the St. Jude Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool to identify (1) facility levels as defined by the International Society of Pediatric Oncology (SIOP) and the Lancet Oncology Commission (LOC) for sustainable care for children with cancer, and (2) treatment strata in the Adapted Resource and Implementation Application (ARIA) Guide. Methods: This study employed a multi-step mapping approach. We mapped the 1,279 PrOFILE tool variables to the nine SIOP service lines, ten LOC domains, and ten ARIA resource groups. Mapping was performed by two teams and carried out in two different rounds. The first round aimed to define if an indicator was fully or partially covered by PrOFILE. Multiple PrOFILE variables could be assigned to each concept to meet its content specificity. Various cut-offs were applied when necessary to assign mutually exclusive responses to each tier. The second round consisted of expert validation for each indicator previously identified. Results: Most (97%) of SIOP’s indicators were partially or fully covered in the PrOFILE tool (Table). Radiation therapy tools and appointment scheduling and call back system could not be mapped. Of the LOC indicators, 89% were covered (Table). Pathology technical staff, chemotherapy complexity (low, moderate, and high), lymph node biopsy, organ preservation, liver transplantation, intensity-modulated radiotherapy, and research infrastructure could not be mapped. Finally, 77% of the indicators used by the ARIA Guide were covered (Table). The ophthalmology resource group could not be fully mapped. Conclusions: This exercise demonstrates the feasibility of using PrOFILE tool variables to identify facility PHO care levels as defined by SIOP and LOC. The tool also contains most of the variables necessary to apply the ARIA Guide to diagnose, treat, and manage childhood cancer. Future PrOFILE versions will address concepts that are not covered or are partially covered in its current version.[Table: see text]

Employee Resource Groups (ERGs) – An Under-Utilized and Under-Organized Way of Developing New Staff, Management and Organizational Culture

We evaluated impact of employees’ participation in an employee resource group (ERG) on their soft skills learning and development and proposed a tool for assessing competence development that is often difficult to quantify.ERG has a positive effect on soft skills development, however certain soft skills do not develop in the interaction between management and new employees. Some soft skills require focused and organized learning.The role of ERG stretches beyond integration of new employees only. We propose a multidimensional paradigm where the management and organizational culture are considered as the object of development and new employees facilitate this process.