Hawthorne Effect Research Articles

A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19.

Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design. We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression. We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was -8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls (p = 0.126). There were no significant changes to anxiety or depression. Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways. ClinicalTrials.gov: NCT04455360.

Advancing Publicly Engaged Sociology1

This article is a version of Professor Smith's Presidential Address as delivered at the annual meetings of the Eastern Sociological Society in Boston, March 2022. Most sociologists go into the field hoping our work will help address the inequalities or injustices we study, but academic institutions and careers strongly guide most of our work away from the engagement needed to have such impacts. With others, I argue for changes in academic careers and institutions to better recognize, promote, and reward publicly engaged sociology, which would help academia honor its social contract. I briefly engage Burawoy's concept of public sociology, then propose types of publicly engaged sociology that align with how many sociologists do such work: Reframing/Debunking Sociology, Institutionally Engaged Sociology, and Community Engaged Sociology. Next, I analyze several obstacles to publicly engaged—and especially community engaged—sociology, including epistemic assumptions and evaluative practices stemming from instrumental positivism, belief in a canonical Hawthorne effect as a clean experimental finding, and a bias against research that helps research participants or partners. Finally, I offer advice and strategies to younger sociologists wishing to do such work and recommend ways academic institutions and practices could better support publicly engaged sociology, including by training students and faculty in how to do it, creating a Journal of Publicly Engaged Sociology, and amending ASA's Code of Ethics.

Medication safety in the perioperative setting: A comparison of methods for detecting medication errors and adverse medication events.

The purpose of this study was to evaluate perioperative medication-related incidents (medication errors (MEs) and/or adverse medication events (AMEs)) identified by 2 different reporting methods (self-report and direct observation), and to compare the types and severity of incidents identified by each method. We compared perioperative medication-related incidents identified by direct observation in Nanji et al's 2016 study[1] to those identified by self-report via a facilitated incident reporting system at the same 1046-bed tertiary care academic medical center during the same 8-month period. Incidents, including MEs and AMEs were classified by type and severity. In 277 operations involving 3671 medication administrations, 193 MEs and/or AMEs were observed (5.3% incident rate). While none of the observed incidents were self-reported, 10 separate medication-related incidents were self-reported from different (unobserved) operations that occurred during the same time period, which involved a total of 21,576 operations and approximately 280,488 medication administrations (0.004% self-reported incident rate). The distribution of incidents (ME, AME, or both) did not differ by direct observation versus self-report methodology. The types of MEs identified by direct observation differed from those identified by self-report (P = .005). Specifically, the most frequent types of MEs identified by direct observation were labeling errors (N = 37; 24.2%), wrong dose errors (N = 35; 22.9%) and errors of omission (N = 27; 17.6%). The most frequent types of MEs identified by self-report were wrong dose (N = 5; 50%) and wrong medication (N = 4; 40%). The severity of incidents identified by direct observation and self-report differed, with self-reported incidents having a higher average severity (P < .001). The procedure types associated with medication-related incidents did not differ by direct observation versus self-report methodology. Direct observation captured many more perioperative medication-related incidents than self-report. The ME types identified and their severity differed between the 2 methods, with a higher average incident severity in the self-reported data.

Investigation of the improving effect of raw and charred hawthorn on functional dyspepsia based on interstitial cells of Cajal

BackgroundRaw hawthorn (RH) is a traditional Chinese medicine commonly used to treat indigestion. Charred hawthorn (CH) is obtained from RH by charring. It is reported that the effect of CH treatment on dyspepsia is stronger than RH. However, this has not been fully proven. The purpose of this study was to compare the effects of RH and CH on functional dyspepsia (FD) model rats. And contribute to the development of dietary therapy for dyspepsia.MethodsSPF-grade male SD rats were divided into 5 groups: the control group, the model group, the Mos group, the RH group, and the CH group. The FD rat model was established by using the methods of water restriction, fasting, tilting cage restraint, day and night upside down, swimming, and tail damping. The body weight of rats in each group was recorded. And the gastric emptying rate, intestinal propulsive rate, and the levels of motilin (MTL), gastrin (GAS), and 5-HT in serum were compared in each group. The expression of C-kit in the stomach and small intestine of each group was compared by immunofluorescence and PCR.ResultsRH and CH could increase weight, improve the gastric emptying rate and intestinal propulsive rate, and promote the secretion of motilin (MTL), gastrin (GAS), and 5-HT in the serum of FD rats. RH and CH can upregulate the expression of the characteristic protein c-kit of ICC in the stomach and small intestine of FD model rats, and the effect of CH is stronger than RH.ConclusionRH and CH may increase the number of interstitial cells of Cajal (ICC) in the gastrointestinal tract by upregulating c-kit expression, thus improving gastrointestinal motility in FD model rats. And compared with RH, CH has certain advantages.

Prospective trial of efficiency and safety of fibrin sealant criofit after autologous breast reconstruction in stages I–III breast cancer

Introduction. Breast cancer is the most common cancer. Success in early diagnostic and system treatment is achieved. All the same mastectomy with reconstruction is the best option for some patients. Seroma is common complication after reconstructive plastic surgery.Aim. To analyze efficiency of using fibrin sealant criofit at donor zone after autologous breast reconstruction in decreasing seroma incidences.Materials and methods. This is randomised controlled clinical trial of fibrin sealant criofit effect on assessing of seroma incidences, timing of drain removal at donor zone after autologous breast reconstruction in comparison with control group. Surgical technic, drains removal criteria and patients characteristics were identical in both groups.Results. Average drain fluid volume on the first day (150.9 ± 40.7 ml vs 190.6 ± 60.7 ml; p &lt;0.001) and second day (152.6 ± 53.3 ml vs 184.9 ± 90.3 ml; p = 0.04) after surgery was significantly lower in experimental group. Average number of days of drainage in criofit group was significantly lower (6.3 ± 1.1 days vs 7.4 ± 2.1 days; p = 0.01). Seroma incidences in experimental group was lower in comparison with control group (10 % vs 23 %). It was statistically significant.Conclusion. We aimed to asses the efficiency of fibrin sealant criofit at donor zone after autologous breast reconstruction. Criofit decrese the volume of serous draining in first days after surgery, number of days of drainage and seroma incidences significantly. But more powerful clinical trials are needed. Study limitations are small sample, changes in surgery team, small observation period.

The Outcomes Measured and Reported in Meningioma Clinical Effectiveness Trials Are Heterogeneous and Preclude Comparative Analysis of Results: A Systematic Review

Abstract AIMS Meningioma clinical trials have assessed interventions including surgery, radiotherapy, and pharmacotherapy, but heterogeneity of outcome measurement and reporting often precludes comparative analysis of trial results. This systematic review aimed to summarise the outcomes measured and reported in such trials. METHOD Systematic literature and trial registry searches were performed to identify published and ongoing intracranial meningioma clinical effectiveness trials. Reported outcomes were extracted verbatim, along with an associated definition and method of measurement if provided. Deduplication, grouping, and classification of verbatim outcomes was performed to identify unique outcomes reported in the literature. RESULTS Thirty published articles and 18 ongoing studies were included, describing 47 unique studies: phase II n=33, phase III n=14. Common interventions included: surgery n=13, radiotherapy n=8, and pharmacotherapy n=20. 660 verbatim outcomes were reported, of which 85 were defined. Following deduplication, 416 unique verbatim outcomes remained and were grouped into 119 unique ‘non-verbatim’ outcomes. Those reported most frequently included: blood loss n=15, need for blood transfusion n=12, radiographic response to treatment n=19, eye toxicity after radiotherapy, gastrointestinal toxicity from pharmacotherapy n=40, haematological toxicity from pharmacotherapy n=31, metabolic and nutrition toxicity from pharmacotherapy n=42, progression-free survival n=46, and overall survival n=37. CONCLUSION Outcome measurement and reporting across meningioma clinical trials is heterogeneous and may preclude comparative analysis of trial results. The unique outcomes identified from this systematic literature review will be prioritised through an eDelphi survey and consensus meeting of key stakeholders (including patients), in order to develop a Core Outcome Set (COS) for use in future meningioma clinical trials.

Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds

Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds

The Impact of Dietary Fiber as a Prebiotic on Inflammation in Children with Obesity.

Background: Obesity is associated with dysbiosis, contributing to inflammation and insulin resistance. Inulin might reduce inflammation by manipulating intestinal microbiota. Objective: We aimed to determine the effects of inulin supplementation on inflammation and assess the relationships of inflammatory cytokines with adiposity and insulin resistance in obese Thai children. Design: Obese Thai children ages 7–15 years were randomly assigned to inulin (intervention), maltodextrin (placebo), and dietary fiber advice groups. All participants received monthly follow-up and identical advice on lifestyle modification for six visits. Body composition was evaluated using bioelectrical impedance analysis. IL-1β, IL-6, TNF-α, and fecal calprotectin were analyzed by ELISA technique at baseline and the final visit. Spearman correlation was used to assess the associations between inflammation and other clinical outcome variables. Results: A total of 155 obese children completed the study (mean age: 10.4 ± 2.2 years, 59% male). All groups showed a significant decrease in BMI z-score, fat mass index (FMI), percent body fat, and trunk FMI. A generalized estimating equation (GEE) model showed significantly decreased IL-1β and TNF-α of 34.8% and 25.8%, (p < 0.0001) but increased IL-6 (21.5%, p = 0.006) in all groups. There were no significant differences in inflammatory cytokines and fecal calprotectin between groups. Mean IL-6 was higher in obese children with acanthosis nigricans (p = 0.048). Only IL-6 was positively correlated with body fat percentage and FMI (r = 0.29, p = 0.008 and r = 0.25, p = 0.049, respectively). Conclusions: Intensive behavioral modification and frequent follow-up visits were effective methods to reduce BMI and adiposity leading to decreased inflammatory cytokines. The additional benefits of inulin on inflammation could not be demonstrated due to the Hawthorne effect. Among the three cytokines, IL-6 was the most likely mediator relating FM and insulin resistance at baseline; therefore, it could be used as a surrogate marker of inflammation in obese children who are at risk for insulin resistance and metabolic syndrome.

Abstract P304: Persistent Use Of Aktiia 24/7 Blood Pressure Monitor Is Associated With Lower Blood Pressure In Hypertensive Patients

Introduction: Cuffless blood pressure (BP) monitors are a promising innovation for hypertension diagnosis and monitoring. Aktiia (Aktiia 24/7 BP Monitor, Aktiia, Switzerland) is a CE-marked, commercially available BP monitor that passively and continually collects BP waveforms via optical sensors at the wrist. After initial cuff calibration, the app displays BP estimates on a smartphone. No data exist on the impact of persistently showing a person their BP data with this device. Hypothesis: If people with hypertension persistently use Aktiia and are exposed to their BP data, there will be a change in behavior resulting in measurably lower BP. Methods: We analyzed the systolic BP (SBP) trends of 838 real-world users (Age 57±11, 14% female) who consistently used Aktiia for 6 months (375±287 app interactions, 3646±1417 cuffless readings per user, and 9±7 cuff readings per user). Users were grouped by the mean monthly SBP (&lt;140 and &gt;140 mmHg) calculated over 6 months. Then, cuff SBP averages were calculated monthly and compared to the SBP average of the first month. A t-test analysis was used to detect the difference in SBP between the first and successive months. Results: Hypertensive users (SBP &gt; 140 mmHg) saw a reduction in SBP of -3.2 mmHg (CI: -0.70, -5.59, p&lt;0.02), beginning at 3 months and sustained through 6 months. For users with SBP &lt; 140 mm Hg, the mean SBP remained unchanged (Fig. 1). Conclusion: Persistent BP monitoring with Aktiia’s cuffless device is associated with a significant, sustained reduction in SBP for hypertensive patients at 6 months. Possible explanations include the Hawthorne effect or intensified treatment.

Hawthorne Effect in Gait Analysis of Children with In-Toeing Caused by Increased Femoral Anteversion.

In-toeing is one of the main reasons children are applying to the orthopedics clinic. In the clinical settings, during in-toeing gait assessment parents often define that their child does not walk same at the clinic as at home, linked possibly to Hawthorne effect. How does the in-toeing angle differ when children are aware, versus when they are not aware of their gait inspection? This single center, clinical, cross-sectional, observational study looked into the variation in gait pattern of twelve children with in-toeing, with and without their awareness. Two videos for each child was recorded with a smart phone, once at the clinic while aware and once by the family without awareness, and uploaded into Kinovea software for gait analysis. The angle of foot in-toeing was measured and analyzed using SPSS comparison of means and correlations. The gait pattern evaluated with the angle of in-toeing showed a significant difference between the two videos of the same child. The angle difference returned a p value of 0.000 using paired sample t test and a Cohen's d value of 1.4, representing the large significance between clinic and family recorded videos. The initial foot in-toeing angle showed a moderate positive Pearson's correlation of 0.031 when compared with the angle difference in both settings. These results highlight the importance of including family recorded videos in gait pattern analysis without the patient's awareness. The study not only shows the significant difference found which can be explained by Hawthorne Effect but also suggests a clearer path of understanding the child's condition with the family.

Impaired insight in schizophrenia: impact on patient-reported and physician-reported outcome measures in a randomized controlled trial

BackgroundImpaired insight poses a challenge in the treatment of patients with schizophrenia because of its potential to jeopardize therapeutic engagement and medication adherence. This study explored how insight impairment, graded from none to extreme, is related to patient-reported mental health status, depression, and neurocognition in schizophrenia.MethodsIn a post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study (NCT00014001), insight was measured using the Positive and Negative Syndrome Scale (PANSS) Item G12 (lack of insight). Additional assessments for this analysis included the 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS), physician- and patient-reported Clinical Global Impression–Severity (CGI-S), MATRICS Consensus Cognitive Battery, and Calgary Depression Scale for Schizophrenia. Relationships between patient-reported outcomes and PANSS total and Item G12 ratings were evaluated.ResultsAmong 1431 CATIE study participants in this analysis, increasingly impaired insight at baseline was significantly associated with better patient-reported quality of life (QoL), lower baseline depression, and greater divergence between physician- and patient-reported illness severity. Patients with more severely impaired insight reported milder illness compared with physician reports, particularly those with moderate-severe to extreme impairment (PANSS Item G12 rating ≥ 5), approximately 10% (138/1431) of CATIE participants. For the 90% of patients with PANSS Item G12 ratings < 5, patient-reported QoL decreased with increasing symptoms. SF-12 MCS scores were linearly related to baseline PANSS total score only in patients with PANSS total score < 90 (moderately ill or better), and better symptom scores were associated with higher QoL. No significant relationship between insight and neurocognition was observed.ConclusionsIn the small subgroup (10%) of CATIE study patients with schizophrenia and PANSS Item G12 ratings ≥5, moderate-severe–severe/extreme insight impairment was associated with significantly more positive perception of QoL and illness severity by the patient versus the treating physician. This was not observed in the remaining 90% of patients with normal to moderately impaired insight, suggesting that poor insight as a threat to the validity of self-report is uncommon.

Effects of hawthorn seed oil on plasma cholesterol and gut microbiota

BackgroundHypercholesterolemia and gut microbiota dysbiosis are associated with the risk of cardiovascular diseases. Hawthorn fruits has shown to be cardioprotective and hypocholesterolemic. However, no studies to date have studied the biological activity of hawthorn seed oil (HSO). The present study was to investigate if HSO could favourably reduce plasma cholesterol and modulate gut microbiota in hypercholesterolemia hamsters.MethodsGolden Syrian hamsters (age, 8 weeks) were randomly divided into five groups (n = 8, each) and fed one of the following five diets, namely a non-cholesterol diet, a high cholesterol diet containing 0.15% cholesterol (HCD); a HCD diet with addition of 4.75% HSO (LHSO), a HCD diet with addition of 9.5% HSO (HHSO), a HCD diet with addition of 0.50% cholestyramine as positive control diet. After 6-week dietary intervention, plasma lipids, inflammatory markers, atherosclerosis plaque, hepatic and fecal lipids were quantified. Microbiota in fresh feces were analysed by sequencing 16S rRNA genes, while RT-PCR and Western blot analyses were employed to quantify the expression of genes involved in cholesterol homeostasis.ResultsHSO at a dose of 9.5% HSO could decrease plasma cholesterol and non-HDL-cholesterol by 15%. Additionally, both HSO experimental groups also suppressed mRNA of 3-Hydroxy-3-Methylglutaryl-CoA Reductase (HMG-CoA-R). Supplementation of HSO at 4.75% could significantly increase the excretion of fecal acidic sterols, accompanied by elevation of short-chain fatty acid levels in feces. The analyses of gut microbiome indicated that HSO supplementation could selectively alter the genera abundance of gut bacteria that were correlated with cholesterol metabolism including unclassified_f__Christensenellaceae, Ruminococcaceae_NK4A214_ group, norank_o_Gastranaerophilales, Faecalibaculum, Peptococcus, norank_f__Clostridiales_vadinBB60_group and Ruminococcus_2.ConclusionsHSO supplementation was able to decrease plasma cholesterol by favourably modulating gut microbiota composition and gut-derived metabolites associated with cholesterol regulation.Graphical

TU6.5 Motivation in the Surgical Workforce

Abstract Aims To investigate the motivational spectrum amongst those choosing to work in the theatre environment according to Deci and Ryan's Organismic Integration Theory. Methods The Survey of Current Regulation of Behaviour In Theatres (SCRUB-IT) was adapted from the Behavioural Regulation in Exercise Questionnaire (BREQ-3) and administered to theatre staff at a UK university hospital in April 2019. Results 48 staff members (surgical consultant n=6, surgical trainee n=9, nurse n=24, healthcare assistant n=9, male(%) 15(31.3), mean age 34 (27–59) years) completed the survey. Respondents had been working in theatres for an average of 11 (2–39) years. The degree of self-motivation to work in the theatre environment was higher in the surgeon group (p=0.037) but there was no significant difference by age (p=0.119) or duration of theatre experience (p=0.227). Conclusion Theatre staff demonstrated a high degree of self-motivation and explanations are likely multifactorial (personal fulfilment, sense of duty, team dynamics, technical challenge) although the Hawthorne effect may bias results. These data could inform targeted recruitment and retainment of staff, whilst further work could compare findings with other medical specialties.

LC-MS-based lipidomic analysis of liver tissue sample from spontaneously hypertensive rats treated with extract hawthorn fruits.

At present, many experiments provide support for the cardiovascular protective effect of hawthorn (Crataegus oxyacantha) flower, leaf and fruit extracts. The aim of this study was to investigate the intervention mechanism of hawthorn fruit extract on spontaneously hypertensive rats (SHR) and its effect on their lipid metabolic pattern. After SHR was intervened by hawthorn extract (1.08 g/kg/d) for 6 weeks, the blood pressure and liver histopathology of rats were evaluated. An UHPLC-Q Extractive metabolomics approach was used to collect information on rat liver lipid metabolites, combined with multivariate data analysis to identify significantly different substances and potential biomarkers through mass spectrometry and database searches. Histomorphology of the liver was partially restored in the hawthorn-treated group. Hawthorn extract interferes with sphingolipid metabolism, glycerophospholipid metabolism and glycerolipids metabolism, improving partially disturbed metabolic pathways. This study showed that hawthorn could partially restore liver histomorphology and has anti-hypertensive effect by regulating lipid metabolism.

Core outcome measures for clinical effectiveness trials of nutritional and metabolic interventions in critical illness: an international modified Delphi consensus study evaluation (CONCISE)

BackgroundClinical research on nutritional and metabolic interventions in critically ill patients is heterogenous regarding time points, outcomes and measurement instruments used, impeding intervention development and data syntheses, and ultimately worsening clinical outcomes. We aimed to identify and develop a set of core outcome domains and associated measurement instruments to include in all research in critically ill patients.MethodsAn updated systematic review informed a two-stage modified Delphi consensus process (domains followed by instruments). Measurement instruments for domains considered ‘essential’ were taken through the second stage of the Delphi and a subsequent consensus meeting.ResultsIn total, 213 participants (41 patients/caregivers, 50 clinical researchers and 122 healthcare professionals) from 24 countries contributed. Consensus was reached on time points (30 and 90 days post-randomisation). Three domains were considered ‘essential’ at 30 days (survival, physical function and Infection) and five at 90 days (survival, physical function, activities of daily living, nutritional status and muscle/nerve function). Core ‘essential’ measurement instruments reached consensus for survival and activities of daily living, and ‘recommended’ measurement instruments for physical function, nutritional status and muscle/nerve function. No consensus was reached for a measurement instrument for Infection. Four further domains met criteria for ‘recommended,’ but not ‘essential,’ to measure at 30 days post-randomisation (organ dysfunction, muscle/nerve function, nutritional status and wound healing) and three at 90 days (frailty, body composition and organ dysfunction).ConclusionThe CONCISE core outcome set is an internationally agreed minimum set of outcomes for use at 30 and 90 days post-randomisation, in nutritional and metabolic clinical research in critically ill adults.

A Game of Two-Halves: World War II and the Institutionalization of Human Relations in the U.S.

Much has been made about the enduring legacy of the human relations movement, especially how it shed new light on tensions between labor and management in industry. Histories of human relations have played a game of ‘two halves.’ On the on hand, scholars have furnished our understanding of the Hawthorne Studies and their numerous implications on management and organization. However, on the other, this plethora of research has not yet fully considered the impact of World War II and its contribution to the institutionalization of early human relations. What we set out to address in this paper is how the War formed a specific historic context from which leading voices such as Elton Mayo and Chester Barnard helped institutionalize the nascent human relations movement as a focal of management and industrial relations research. We reassemble archival material from four archives that help trace the influence and impact of the War on human relations theorizing in the United States during the early 1940s. We conclude by suggesting the war brought about new thinking on the importance (and attention) of social relations at work.

What do expectations change? Optimistic expectations, job crafting, job satisfaction and a new theoretical model

PurposeThe purpose of this study is to determine the effect of optimistic expectations on job satisfaction at work and whether job crafting behaviour plays a mediating role in this effect. At the same time, this model presents the need for “expectation management” in the context of work psychology to the attention of all academics and practitioners.Design/methodology/approachTo test the hypotheses of the study, data were obtained from 475 health-care workers in a public hospital. Hypotheses were tested using Process Macro Model of Hayes (2018).FindingsThe result of the analyses determined that the optimistic expectations for the organization as a whole have a positive effect on job satisfaction, both directly and indirectly, and that job crafting behaviour has a partial mediating role in this effect.Research limitations/implicationsThe first limitation is that the data were obtained only by a cross-sectional method. The second is that among the various workplace behaviours and workplace psychologies job crafting and job satisfaction were examined in the study. The partial mediation effect between the research variables reveals the existence of many other variables and constitutes the third limitation. The fourth is that only optimistic expectations effects on positive behaviours and positive psychological states were evaluated in this study. Finally, a fifth limitation of this study is that the sample is limited to those working in the health sector and public hospitals.Practical implicationsFirst, the data were obtained only by a cross-sectional method, and the longitudinal method was not implemented in how the study was designed. Second, among the workplace behaviours, only job crafting behaviour and only job satisfaction as a workplace psychology were analysed. Third, partial mediation effect was found to be among the other variables might indicate the role of additional variables that could be uncovered by further research. Fourth, only optimistic expectations and their effects on positive behaviours and positive psychological states at the workplace were evaluated. Fifth, the sample is limited to those working in the health sector and public hospitals.Social implicationsThis study draws attention to “Expectation Management” as a management activity worth exploring and its potential in terms of social and working relations.Originality/valueThis study provides versatile answers to the question of why individuals perform differently despite working under the same conditions. The model suggested in the study takes the conventional way of thinking in the literature one step further by offering an alternative answer to this critical question, whose answers we have been discovering step by step since the Hawthorne studies. In addition, the proposed model draws attention to the need for “expectation management” in the context of business psychology in theory and practice.

Understanding approaches to continence care for people living with dementia in acute hospital settings: an ethnographic study

Background The acute hospital setting has become a key site of care for people living with dementia. People living with dementia are one of the largest populations in our hospitals, with the Department of Health and Social Care recognising that 25–50% of all acute hospital admissions are people who are also living with dementia. However, people living with dementia are a highly vulnerable group in the hospital setting and, following an acute admission, their functional abilities can deteriorate quickly and significantly. Detailed research is required to explore what constitutes ‘good care’. Objectives This study’s focus was a common, but poorly understood, aspect of everyday care for people living with dementia during an acute admission, that is continence care. We asked the following questions: what caring practices are observable when interacting with this patient group? How do ward teams respond to and manage continence needs? What informs these approaches? What are staff doing and why? Design This ethnography was informed by the symbolic interactionist research tradition, focusing on understanding how action and meaning are constructed within a setting. In-depth evidence-based analysis of everyday care enabled us to examine how ward staff responded to the continence care needs of people living with dementia and to follow the consequences of their actions. We carried out a mixed-methods systematic narrative review to refine our approach to fieldwork and analysis. Setting This ethnography was carried out for 180 days, across 12 months, in six wards in three hospitals across England and Wales that were purposefully selected to represent a range of hospital types, geographies and socioeconomic catchments. Participants In addition to general observations, 108 individuals participated directly in this study, contributing to 562 ethnographic interviews. Ten detailed case studies were also undertaken with people living with dementia. Results This study identified ‘pad cultures’ as an embedded practice on these acute wards. The routine use of continence pads among people living with dementia (regardless of continence and independence) was widespread. The use of continence pads was viewed as a precautionary strategy, the rationale being to provide safeguards, ensure containment and prevent ‘accidents’ or incontinence episodes, with an expectation that patients living with dementia not only will wear pads, but will use them. Conclusions These ‘pad cultures’ enabled the number of unscheduled interruptions to the institutionally mandated timetabled work of these wards to be reduced, but had significant impacts on people living with dementia and, in turn, wider consequences for these individuals and their identities. Ward staff described feeling abandoned with the responsibility of caring for large numbers of people living with dementia, believing that it was impossible to work in other ways to support their patient’s continence. Limitations The limitations identified included the potential for the Hawthorne effect to influence data collection. Future work In collaboration with a specialist dementia care and continence teams, the findings are informing the development of education and training at the interactional and organisational level. Study registration This study is registered as PROSPERO CRD42018119495. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.

Tocilizumab fails survival benefit in severe COVID-19 – A retrospective cohort study

Objectives: Anti-interleukin-6 monoclonal antibody, tocilizumab, has produced mixed results in clinical trials for effectiveness against coronavirus disease 2019 (COVID-19). We conducted a retrospective cohort study to compare outcomes at 28 days of a cohort of patients with severe COVID-19 treated with tocilizumab and standard care, with those receiving standard care only. Materials and Methods: In this record-based retrospective cohort study, patients hospitalised with COVID-19 were classified into non-severe and severe disease as per institutional protocol. One cohort received tocilizumab with standard care and the second cohort received only standard care. Few patients also received high-dose steroids as ‘pulse’ steroids on initial clinical deterioration. Data were collected for the treatment given including oxygen interface, steroids, antimicrobials, duration of hospital stay in survivors, requirement of mechanical ventilation, and day of intubation from symptom onset. The primary outcome was to compare the all-cause mortality between the two groups. The effect of pulse steroid therapy on all-cause mortality was studied in the secondary outcome. Results: There was statistically significant mortality in the tocilizumab cohort as compared to standard care alone (HR 2.43, 95% CI 1.54–3.89). The need for mechanical ventilation was more in the tocilizumab cohort (85% vs. 18%, P &lt; 0.001). Tocilizumab cohort had a delay in the day of intubation by a mean of 2.29 days from the day of symptom onset (P &lt; 0.05). Pulse steroid administration showed increased all-cause mortality (HR 1.94, 95% CI 1.18–3.20) and risk of mechanical ventilation. Conclusion: Tocilizumab cohort showed higher mortality and need for mechanical ventilation in our study which contrasts the result of a few previous trials. Our study warrants the need for future clinical trials on this subject to ensure better treatment strategies in upcoming COVID-19 waves.

Adherence to oral anticoagulation in a Belgium atrial fibrillation population measured by a medical event monitoring system

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N). The AF-EduApp study is supported by an BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) grant. Background Treatment with oral anticoagulation (OAC) is one of the main pillars in the management of atrial fibrillation (AF). Therapy adherence to both VKA and NOAC is important. Education and intake monitoring are recommended to improve therapy adherence. Purpose The main purpose of this project was to evaluate the effect of personalized follow-up strategies on therapy adherence to OAC in AF patients. Methods In a multicentre, Belgian randomized controlled trial, the AF-EduCare/AF-EduApp study, the effect of different personalized education strategies (i.e. in-person, online or app-based education) is evaluated on clinical outcome parameters of AF patients compared to standard care (SC). One of the outcome parameters is therapy adherence to OAC. During the first 3 months of the trial, patients’ adherence to NOAC or VKA was measured with the Electronic Medication Event Monitoring System (MEMS). The MEMS cap fits on a medication bottle and registers the date and time of every bottle opening. Regimen adherence was defined as the the number of days with the correct number of openings according to the specific OAC regimen divided by the total number of monitored days. As dabigatran has to be stored in the original package to protect it from moisture and VKAs have a variable scheme between patients, a proxy-medication (i.e. another oral drug that needed to be taken once or twice daily and on the same moment of the day as dabigatran or VKA) was chosen to measure medication adherence. Patients in the education groups received a MEMS cap with LCD screen providing direct feedback by showing the number of openings within 24h. A small sample of the SC group also received a MEMS cap as controls, but without LCD screen to minimally trigger these patients. Results A total of 593 AF patients underwent adherence monitoring, of which 514 (86.7%) in the intervention group and 79 (13.3%) in the SC group. The mean age was 70.1±7.7 years, mean time since AF diagnosis was 5.8±6.9 years, and mean CHA2DS2-VASc score was 3.2±1.5. Overall adherence was high: 94.8% of the patients had an adherence &amp;gt;80% and 80.9% had an adherence &amp;gt;90%. A small but significant difference in adherence was observed between the intervention groups and the standard care group (intervention group 97% (5-100); SC 96%(24-100); p=0.024; Figure1). Also between the four study groups a significant difference was seen (in-person 97% (93.5-99); online 98% (94-100); app-based 98% (92-99); p=0.049) driven by a significant difference between the online and SC group (p=0.009). Conclusion Overall adherence to OAC in all study groups and even in SC was high. The high adherence percentage in the SC group could be related to the Hawthorne effect of using the MEMS. Nevertheless, electronic monitoring and targeted education slightly improved therapy adherence further in the intervention groups.