X+Why? A Qualitative Approach to Understanding Pediatric Resident and Faculty Preferences for the X+Y Scheduling Change.

The impact of cancer on adult survivors of aggressive non-Hodgkin's Lymphoma (NHL) is understudied. We examined positive and negative life changes (health behaviors, relationships, financial situation) experienced by survivors of NHL and their association with physical and mental function. Using the Los Angeles County Cancer Surveillance Program, 744 questionnaires were mailed to adult survivors of NHL: 308 provided complete data for analyses (M age=59.8, SD=14.9). Perceptions of positive and negative life changes were common in our sample, with 77.9% of NHL survivors reporting at least one positive change and 78.6% reporting at least one negative change. Cancer had the greatest positive change on relationships and the most negative change on survivors' financial situation. There was an equal distribution of survivors classified as having experienced positive change and negative change on health behaviors. Regardless of whether positive and negative life change were entered into separate regression models or the same model, an increase in negative life change in each of the domains was significantly associated with a decrease in physical and mental functioning. Positive change was significantly associated only with physical functioning when examining overall change (p=.018) and health behaviors (p=.013), and the inclusion of negative change attenuated these associations. In designing interventions to improve the mental and physical function of NHL survivors, the greatest benefit may likely be achieved by reducing the negative effects of cancer. Perhaps positive life changes are related in more specific ways to other indexes of adjustment, but our findings failed to show a positive relationship with mental and physical function.

Background and objectives: Despite a generally good prognosis, testicular cancer can be a life-altering event. We explored perceived positive and negative life changes after testicular cancer in terms of frequency, demographic and disease-related predictors, and associations with depression and anxiety. Materials and methods: All testicular cancer survivors receiving follow-up care at two specialized outpatient treatment facilities were approached at follow-up visits or via mail. We assessed a total of N = 164 patients (66% participation rate, mean time since diagnosis: 11.6 years, SD = 7.4) by the Posttraumatic Growth Inventory (PTGI, modified version assessing positive and negative changes for each of 21 items), Patient-Health-Questionnaire-9 (PHQ-9), and Generalized-Anxiety-Disorder-Scale-7 (GAD-7). We conducted controlled multivariate regression analyses. Results: Most survivors (87%) reported at least one positive change (mean number: 7.2, SD = 5.0, possible range: 0–21). The most frequent perceived positive changes were greater appreciation of life (62%), changed priorities in life (62%), and ability rely on others (51%). At least one negative change was perceived by 33% (mean number of changes: 1.1, SD = 2.5). Negative changes were most frequent for decreases in self-reliance (14%), personal strength (11%), and ability to express emotions (9%). A higher socioeconomic status was associated with more positive changes (β = 0.25, 95% CI 0.08 to 0.42); no other association with demographic and disease-related predictors emerged. While positive life changes were not associated with depression (β = −0.05, 95% CI −0.17 to 0.07) and anxiety (β = 0.00, 95% CI −0.13 to 0.13), more negative life changes were significantly associated with higher depression (β = 0.15, 95% CI −0.03 to 0.27) and anxiety (β = 0.23, 95% CI 0.11 to 0.36). There was no significant interaction of positive and negative changes on depression or anxiety. Conclusions: Although positive life changes after testicular cancer are common, a significant number of survivors perceive negative changes in life domains that have been primarily investigated in terms of personal growth. Early identification of and psychosocial support for patients who perceive predominantly negative changes may contribute to prevention of prolonged symptoms of anxiety and depression.

2. IMPACT OF X+Y SCHEDULING ON FACULTY PERCEPTIONS OF RESIDENT EDUCATION - RESULTS FROM THE PEDIATRIC X+Y SCHEDULING COLLABORATIVE

ABSTRACTAlthough women predominantly report negative premenstrual changes, a substantial portion of women also reports positive changes. Little is known about factors related to report of positive and negative premenstrual changes. The aim of this experimental study at the Philipps-University of Marburg from January and February 2015 was to investigate the effect of manipulated information about premenstrual changes on the retrospective report of premenstrual changes. A total of 241 healthy women were randomly assigned either to an experimental group (EG) reading: (1) text focusing on negative and positive premenstrual changes (EG1 (+/−)); (2) text focusing on negative changes (EG2 (−)); or (3) control group (CG) text. At least one positive premenstrual change was reported by the majority of the participating women. The results of the MANOVA and discriminant analysis showed that, after having read the text, EG2 (−) reported more negative and fewer positive premenstrual changes in a retrospective screening compared to EG1 (+/−) and CG. No significant difference was observed between EG1 (+/−) and CG. The results show the negative influence of information focusing on negative premenstrual changes on the retrospective report of both negative and positive premenstrual changes.

How asymmetric is the response of CO2 emissions to economic restructuring in China? Evidence from NARDL approach

Depending on the prevailing global or local economic situations, the instability in income from crude oil sales dictate the state of oil exporting economy, such as Nigeria. This is anchored to the fact that considerable proportion of the country’s total revenue comes from the oil sector. Thus, rise (positive change) and fall (negative change) in oil revenue may exert unequal influence on the Nigeria’s economic performance. Based on the foregoing, this research work investigates the asymmetric effect of income from oil on Nigeria’s economic performance between the period 1981 and 2020. The objective is to examine how economic performance reacts severally to rise and fall in oil revenue. Using time series analysis methodology, the study utilizes datasets on real GDP (a proxy for economic performance), oil revenue, exchange rate and inflation rate. The data were sourced from CBN Statistical Bulletin and World Development Indicators. The data analysis process includes stationarity test (using ADF test), bounds cointegration test, technique of estimation, using non-linear autoregressive distributed lag (NADRL) and post estimation tests. The findings reveal that positive change (increase) and negative change (decrease) in oil revenue exert the same direction (positive) but different magnitudes of impact on Nigerian economic performance in the long run. In other words, positive oil revenue change exerts positive impact on economic performance while negative oil revenue change exerts negative impact on economic performance. Essentially, both positive and negative oil revenue changes are real GDP inelastic, however, economic performance responds more to negative change (decrease) in oil revenue than the positive change (increase) in the long-run. Therefore, the study submits that the Nigerian government, through its concerned agencies in the oil sector, should design necessary strategies to curb oil theft such as adopting proactive measures against vandalism. Also, massive diversification into other sectors of the economy must be the government’s paramount consideration.

Introduction Surgical advances attempt to alleviate lumbar spinal stenosis, which burdens many people in our aging population. One goal of pedicle screw and spinous process distraction is to decompress the neural foramina of the affected segment. The objective of this study is to evaluate the change in the foraminal size adjacent to the distracted level. Materials and Methods The lumbar spine of a prone cadaveric specimen was exposed. Titanium pedicle screws were placed from L1-L5. A titanium rod spanning only two levels on either side of the spine was fastened down at the caudal end and secured at the cephalad end. The screws were distracted until maximal resistance on the left side was reached and then the cephalad set screw was secured. The same amount of distraction was applied to the right side and secured in the same fashion. A second prone cadaveric specimen was exposed. Titanium screws were instead inserted into the spinous processes at levels L1-L4. The distraction technique described above was used with two predetermined distances (3 mm and 6 mm). A CT scan was obtained before and after distraction at each level. Foraminal openings at the level of distraction as well as the adjacent above and below foramina were measured and analyzed. Results In the pedicle-distraction specimen, there was an overall positive percent change at the level of distraction and an overall negative percent change in the levels above and below. The level of L3-L4 on the right revealed the largest percent change (11.09%) in foramen distraction. The foramen superior to the L2-L3 distraction demonstrated the least amount of change (−9.71%). The spinous process-distraction specimen demonstrated an overall positive percent change at the level of the distraction but not an overall negative change at the adjacent levels. The L1-L2 superior adjacent foramina had negative percent changes at the 3 mm and 6 mm of −2.80% R, −12.52% L and −4.20% R,−15.46% L, respectively. Only the right, 3 mm distraction of the inferior adjacent of L1-L2 showed a negative percent change, the rest were positive changes. The L3-L4 distractions including above and below foramina were positive percent changes. The greatest percent change at L3-L4 for the 6 mm distraction was 43.1% at the level of distraction and 6.35% at the above adjacent level. Conclusion Distraction of the lumbar spine at any level does increase foramen size at that level, but adjacent levels are affected differently depending on the type of distraction. Distraction at the spinous process may be more beneficial particularly in the lower lumbar area. Further studies are necessary to reproduce these results to provide a basis for determining an optimal method for foraminal distraction which minimizes adjacent level stenosis. Disclosure of Interest None declared

Both positive and negative changes are commonly reported by cancer survivors, and both may impact quality of life. Yet few studies have directly compared the associations of positive and negative changes across multiple life domains with multiple aspects of well-being. This study examined positive and negative changes and their conjoint relation to a range of well-being indices. We used correlational and regression analyses of data from 237 young to middle aged (X = 45.3 years) cancer survivors, several years after treatment. Measures included demographic and medical variables, medical post-cancer positive and negative changes on multiple life domains, and a range of positive and negative adjustment indices. Demographic factors, especially income, related to both positive and negative outcomes. On average, participants reported no change on most life domains, although modest amounts of both positive and negative changes were reported. Negative change, rather than positive change, was closely associated with cancer survivors’ adjustment. Detailed measurement of both positive and negative changes – as well as lack of change – is important to advance understanding of cancer's impact on survivors.

BackgroundIn-situ simulation occurs in the workplace involving the inter-professional team caring for patients in that clinical area. Latent threats and system issues that potentially compromise patient safety can be identified...

It is unknown how hospital- and systems-level factors have impacted patient safety in the intensive care unit (ICU) during the COVID-19 pandemic. We sought to understand how the pandemic has exacerbated preexisting patient safety issues and created novel patient safety challenges in ICUs in the United States. We performed a national, multi-institutional, mixed-methods survey of critical care clinicians to elicit experiences related to patient safety during the pandemic. The survey was disseminated via email through the Society of Critical Care Medicine listserv. Data were reported as valid percentages, compared by COVID caseload and peak of the pandemic; free-text responses were analyzed and coded for themes. We received 335 survey responses. On general patient safety, 61% felt that conditions were more hazardous when compared with the prepandemic period. Those who took care of mostly COVID-19 patients were more likely to perceive that care was more hazardous (odds ratio, 4.89; 95% CI, 2.49-9.59) compared with those who took care of mostly non-COVID-19 or no COVID-19 patients. In free-text responses, providers identified patient safety risks related to pandemic adaptations, such as ventilator-related lung injury, medication and diagnostic errors, oversedation, oxygen device removal, and falls. Increased COVID-19 case burden was significantly associated with perceptions of a less safe patient care environment by frontline ICU clinicians. Results of the qualitative analysis identified specific patient safety hazards in ICUs across the United States as downstream consequences of hospital and provider strain during periods of the COVID-19 pandemic.

Introduction Safety culture is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation’s health and safety management.(1) Community pharmacists play a vital role in ensuring optimum medication safety however the study of patient safety culture in this setting is less developed than in secondary care. Aim The study aim was to measure patient safety culture in Irish community pharmacies using the validated Community Pharmacy Survey on Patient Safety Culture (PSOPSC).(2) Methods The survey consisted of 39 questions based on a 5-point Likert scale, within 11 dimensions. Demographic questions were asked including the pharmacist’s role within the pharmacy. A free-text box allowed respondents to give comments on the survey topic. The online questionnaire, hosted on Microsoft Forms, was emailed to all 3943 community pharmacists registered with the Pharmaceutical Society of Ireland in November 2021. A reminder email was sent 14 days later. Data were analysed in Microsoft Excel. Categorical data were presented as frequencies (%). The positive rate response (PRR) of each survey question and dimension was calculated.(2) The PRR is the mean percentage of positive Likert scale responses to each item and each dimension of the survey. A PRR >75% indicated a strong safety culture, while a PRR <50% indicated a dimension that may be improved upon. Free-text responses were explored by thematic analysis. Results The survey was completed by 173 pharmacists, response rate 4.5%. Of these, 33 (19.1%) were superintendent pharmacist, 65 (37.6%) supervising pharmacist, 53 (30.6%) staff pharmacist and 22 (12.7%) locum pharmacist. The mean %PRR across the 11 survey dimensions was 72.3%. Individual statements with highest PRR were “Our pharmacists tell patients important information about their new prescriptions” (PRR=91.3%) and “Staff are treated fairly when they make mistakes” (PRR=87.3%). Individual statements with lowest PRR were “Interruptions/distractions in this pharmacy (from phone calls, faxes, customers, etc.) make it difficult for staff to work accurately” (PRR=6.4%) and “We feel rushed when processing prescriptions” (PRR=8.1%). The dimension of “Organizational Learning-Continuous Improvement” demonstrated the highest PRR (81.6%), followed by “Response to Mistakes” (PRR=81.2%). The dimension of “Staffing, work pressure and pace” demonstrated the lowest PRR (35.6%). Respondents rated overall patient safety in their pharmacy as excellent/very good/good (88.4%). Differences in perception of patient safety emerged between pharmacists with different levels of responsibility. Patient safety rating was described as fair/poor by 0.0% of superintendent pharmacists, 6.3% of supervising pharmacists, 17.0% of staff pharmacists and 31.8% of locum pharmacists. Fifty-one (29.0%) respondents provided free-text comments. Emergent themes were impact on safety culture of staffing issues; staff training; dispensary workload; and dispensary work pressures. Conclusion The study was limited by low response rate. This may reflect its timing during the COVID-19 pandemic and pharmacists’ prioritisation of clinical roles at that time. Respondents reported a broadly positive patient safety culture in the pharmacy in which they work. Differences in perception of safety culture were observed between those with differing levels of responsibility in community pharmacy practice.

Background In-situ simulation occurs in the workplace involving the inter-professional team caring for patients in that clinical area. Latent threats and system issues that potentially compromise patient safety can be identified through this method.1 Learning is promoted through team-based approaches as part of the normal working day. Our aims are to make our services as safe as possible for patients and staff and create a positive learning environment, reflecting our Trust values. Educational Programme The Simulation-Based Education National Standards guide our approach to designing, delivering and evaluating our in-situ programme.2 Regular inter-professional, in-situ simulation sessions have been introduced throughout the Trust. The challenge is to incorporate deliberate learning into everyone’s working day. We undertake regular planned hospital-wide sessions and combine high and low fidelity simulation to deliver clinical scenarios. We have been running this programme since 2014 which is now established in 11 different departments across primary and secondary care. The uniqueness of our programme is driven by Trust-wide commitment from the Consultant body and Senior Nursing staff. Good relationships have been cultivated over time with managers, ensuring senior support. There is a collaborative effort between the education team and clinical staff at all levels. As active members of the hospital patient safety committee, we contribute towards newly-identified learning needs from incidents that occur. This influences scenario design, delivery and debrief. We have invested in nurturing a multidisciplinary faculty of various grades and specialities in order to deliver the programme. A standardised tool has been adopted to evaluate all in-situ simulation activity from 2016 in order to gather quantitative and qualitative data about the impact of our programme. Free text responses were thematically analysed. Results Since September 2016, 422 responses from 55 simulated scenarios have been recorded. A summary of quantitative data from these responses is summarised in Table 1. Since the programme inception in November 2014 we have gathered 734 responses from all feedback modalities. Learning was themed around technical skills acquisition and recognition of the importance of non-technical skills to enhance patient safety. Word maps were produced to inform further evolution of the programme. Conclusions We have developed this trust-wide learning initiative that has now become embedded into daily practice. Our programme continues to improve with the introduction of latent error identification forms. We are pre-empting potential errors and through deliberate intervention can improve patient safety. Our team has fostered a positive cultural change within the Trust. References . Patterson MD, Blike GT, Nadkarni VM. In situ simulation: Challenges and results. In K Henriksen, JB Battles, MA Keyes, ML Grady (Eds.), Advances in patient safety: New directions and alternative approaches (Performance and Tools) 2008;Vol. 3. Rockville, MD: Agency for Healthcare Research and Quality. . Association for Simulated Practice in Healthcare (ASPiH). Standards for simulation based healthcare in education 2016. Available at: http://www.aspih.org.uk/standards/consultation/

This qualitative follow up of long-term (>5 years) cancer survivor and spouse participants from a large, previous study of quality of life after blood and marrow transplantation (BMT) was designed to gain a deeper understanding of lasting life changes they experienced. Thirty spouse-survivor pairs, an average of 13 years post-BMT, were individually interviewed to identify lasting life changes. Participants were asked about their most significant long-lasting change since cancer/BMT, most significant positive change and negative change, and whether the experience had affected them and their spouse differently. Spouses and survivors spontaneously identified both positive and negative changes. Spouses reported a higher proportion of negative changes (24%) than did survivors (15%), and survivors a higher proportion of positive changes (85%) than spouses (76%). For both groups, the most frequent positive change was in 'perspective/outlook on life' and negative change was 'lingering health effects,' although survivors mentioned the latter twice as often as did spouses. Spouses were more likely to talk about changes in the first-person plural (we, us) that were largely emotional or in relation to the survivor, whereas survivors spoke of changes in the first-person singular (I, me) that occurred to them directly and were largely physical. Although both spouses and survivors described similar negative and positive long-lasting changes that continued an average of 13 years post-BMT, they reported differences in the ways they were impacted by the experience, which was reflected in the language they used. Implications for future studies, family education, and couples-based interventions are discussed.

Delphi methods are mostly used in the health sciences to reach agreement among experts on unclear issues. Generally, consensus is reached after several rounds of Delphi using standardized items. Additional open-ended questions offer respondents the opportunity to provide reasons for judgments. Although these free-text responses contribute substantially to the steering and result generation of the Delphi process, so far no analytical strategy has been established which takes into account the context and methodological principles of the Delphi procedure. Moreover, in already published Delphi studies the analysis of qualitative data is often not sufficiently disclosed.•We provide an overview of analytical strategies for free-text responses. We critically reflect on them with regard to their use and suitability in the context of Delphi procedures.•Following established qualitative methods of qualitative content analysis according to Mayring and thematic analysis according to Braun & Clarke, we developed the Argument-based QUalitative Analysis strategy (AQUA) for Delphi studies in the health sciences and presented it using a concrete project example.•This newly developed strategy can significantly support the rule-governed and intersubjective evaluation of free-text responses in Delphi processes, the integration of the results into the feedback design, and thereby also the quality of the results.

A longitudinal study was conducted to investigate (a) the timing and course of posttraumatic growth and (b) the relations between positive and negative life changes and posttraumatic distress among recent female sexual assault survivors (N = 171). Most survivors reported positive change even at 2 weeks postassault. Positive changes generally increased over time and negative changes decreased, although change in different domains followed different courses and there was significant individual variability in change patterns. Both positive and negative changes were associated with distress in expected ways, although the relations with negative changes were stronger. The least distress at 12 months was reported by those who noted positive life changes at both 2 weeks and 12 months postassault. Implications for theory and research on posttraumatic growth are discussed.