Specific Suggestions For Improvement Research Articles

Engagement and Adoption of Person-Centered Care: Participant Experiences in the Kansas PEAK 2.0 Program.

The Promoting Excellent Alternatives in Kansas (PEAK) 2.0 program provides training, evaluation, and support in person-centered care (PCC) for nursing homes across Kansas. To represent the participant voice, nursing home employees (N = 141) provided feedback on their experiences and their home's level of engagement in PEAK 2.0 as well as achievement of PCC adoption. Analyses were conducted to capture the positive/negative valence and specificity of their comments and examine how engagement in PEAK 2.0 relates to the process and outcome of PEAK 2.0. Qualitatively, staff participants demonstrated that PEAK 2.0 is viewed positively overall, with approximately twice as many participants with more positive (e.g., community support, satisfaction with resources) than negative (e.g., over-regulation, too structured) comments. Employees reporting moderate engagement in PCC provided the majority of specific suggestions for improvement. In addition, higher levels of engagement were significantly associated with higher levels of PCC achievement. Based on these results, suggestions are offered to enhance nursing staff experiences and engagement that will help support PCC adoption. [Journal of Gerontological Nursing, 45(11), 5-10.].

Diverse diagnostic profiles associated with prescription opioid use disorder in a nationwide sample: One crisis, multiple needs.

The opioid crisis has had devastating effects on individuals and communities, and it has rapidly increased in severity. However, we still lack nationally representative information on the diversity of comorbidity patterns among prescription opioid use disorder (P-OUD), other substance use disorders (SUDs), and psychopathology using the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This impedes planning for multiple aspects of intervention, including society-wide allocation of treatment resources, program design at individual treatment centers, and personalized care to individual patients. To address this critical gap in information, we evaluated clinical profiles of American adults via latent class analysis in a large, recently collected epidemiological dataset that uses structured diagnostic assessment for DSM-5 psychopathology (National Epidemiologic Survey on Alcohol and Related Conditions-III; N = 36,309). Variables considered for profiles included lifetime diagnosis for multiple SUDs, various externalizing and internalizing conditions, and demographic variables. We then associated clinical profiles with demographic variables and functional impairment. Comorbid psychopathology and other SUDs were common in latent classes with elevated and very high rates of P-OUD. To illustrate, alcohol use disorder rates were greater than 45%, and posttraumatic stress disorder rates were greater than 28% in classes with higher P-OUD rates. Higher P-OUD rates were associated with White/non-Hispanic and American Indian/Alaska Native populations. Relationships between P-OUD rates and functional impairment were inconsistent. Many current treatment delivery systems are not designed to accommodate the heterogeneous profiles associated with high P-OUD rates. We provide specific suggestions for improvements to the mental health service system, individual clinical care programs, and future research approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understanding and evaluating visual guidance quality inside passenger terminals - a cognitive and quantified approach

ABSTRACTUsing the findings from visual cognitive psychology and computer vision, this study proposes a method that can predict how passenger visual attention to indoor visual guidance elements will affect the visual guidance quality inside passenger terminals. A saliency model is used to simulate the human visual attention, so as to understand how the visual guidance elements and visual noise are cognitively perceived by passengers. For every possible origin and destination node combination, the length and probability of the path that passengers are most likely to take (LP) are compared with the respective shortest path (SP). The overall evaluation of the terminal’s visual guidance quality can be expressed by the Extra Walking Index. The validity of the developed evaluation method is verified and it is then applied in a case study. The method can be used as a supporting tool for architects to identify relevant architectural features in the design phase and optimize them accordingly; in addition, it can also provide existing passenger terminals with specific improvement suggestions.

FEEDBK: a novel approach for providing feedback.

High-quality feedback is fundamental to students' learning. We describe and evaluate FEEDBK, a novel feedback tool that encompasses the focus of learning, student self-evaluation (reflection), the encounter with the patient (professionalism), one task that the student should continue to do (reinforcement), one task that they could do better (improvement) and a key take-home message for self-directed learning. Medical students received regular bedside teaching and feedback during a 9-week clinical placement at a teaching hospital. Teaching fellows gave feedback in their usual style during weeks1-3 and then used the FEEDBK tool during weeks4-9. Questionnaires and focus groups were used to evaluate the students' experience of feedback before and after the introduction of FEEDBK. FEEDBK significantly enhanced the feedback experience across six domains: identifying learning objectives, chance to reflect, feedback on communication skills/professionalism, specific suggestions for improvement, clear take-home message and personalised feedback. The analysis of the feedback from focus groups yielded four categories: (i) FEEDBK influenced the feedback process (delivering timely feedback); (ii) the nature of the feedback (enhancing both the quantity and the quality of the feedback received); (iii) the structure of the feedback; and (iv) the evolution of teaching and learning. FEEDBK may enhance both the quantity and the quality of feedback and has the potential to improve the quality of teaching. It provides teachers with a quick and easy-to-follow framework to signpost curriculum-aligned feedback.

Say, What Is on Your Mind? Surgeons' Evaluations of Realism and Usability of a Virtual Reality Vertebroplasty Simulator.

Virtual reality (VR)-based simulations offer rich opportunities for surgical skill training and assessment of surgical novices and experts. A structured evaluation and validation process of such training and assessment tools is necessary for effective surgical learning environments. To develop and apply a classification system of surgeon-reported experience during operation of a VR vertebroplasty simulator. A group of orthopedic, trauma surgeons and neurosurgeons (n = 13) with various levels of expertise performed on a VR vertebroplasty simulator. We established a mixed-methods design using think-aloud protocols, senior surgical expert evaluations, performance metrics, and a post-simulation questionnaire. Verbal content was systematically analyzed using structured qualitative content analysis. We established a category system for classification of surgeons' verbal evaluations during the simulation. Furthermore, we evaluated intraoperative performance metrics and explored potential associations with surgeons' characteristics and simulator evaluation. Overall, 244 comments on realism and usability of the vertebroplasty simulator were collected. This included positive and negative remarks, questions, and specific suggestions for improvement. Further findings included surgeons' approval of the realism and usability of the simulator and the observation that the haptic feedback of the VR patient's anatomy requires further improvement. Surgeon-reported evaluations were not associated with performance decrements. This study is the first to apply think-aloud protocols for evaluation of a surgical VR-based simulator. A novel classification approach is introduced that can be used to classify surgeons' verbalized experiences during simulator use. Our lessons learned may be valuable for future research with similar methodological approach.

Electronic decision support for treatment of hospitalized smokers: A qualitative analysis of physicians’ knowledge, attitudes, and practices

BackgroundWe recently demonstrated the ability of a suite of tools embedded in an electronic medical record (EMR) to improve tobacco cessation treatment for adult smokers admitted to the hospital. A randomized controlled trial conducted by our group demonstrated the ability of an EMR-embedded tobacco use disorder treatment tool, the Electronic Support Tool and Orders for the Prevention of Smoking (E-STOPS), to increase the identification and treatment of smokers, but its uptake varied among 126 physicians randomized to the intervention arm. The purpose of this study was to identify facilitators and barriers to using E-STOPS. MethodsSemi-structured individual interviews from a purposive sample of 12 hospitalist attending physicians and nine internal medicine residents who were randomized to the E-STOPS intervention were analyzed thematically. ResultsThree themes shaped E-STOPS use: the inpatient environment, prescriber attitudes and beliefs, and information needs. Overall, participants were pleased with E-STOPS, but had specific suggestions for improvements regarding the timing of the intervention, suppression logic, and additional decision support and training. A few had concerns about the clinical appropriateness of beginning treatment for tobacco dependence during a hospitalization and the proper role of the inpatient team in that treatment. ConclusionsTobacco dependence treatment for hospitalized smokers and facilitated by the EMR is generally acceptable to hospitalists and resident physicians. Improvements in provider training and feedback as well as the timing and content of the electronic tools may increase their utilization by inpatient physicians.

Effect of individual structured and qualified feedback on improving clinical performance of dental students in clinical courses-randomised controlled study.

Analysis of the effect of individual structured and qualified feedback (FB) on practical skills development of dental students during clinical courses. Fifty-three final-year dental students at Jena University Hospital participated in this prospective randomised controlled interventional study. Two calibrated assessors evaluated 128 pre- and post-assessments of 4 different dental treatment steps performed by dental students during the integrated clinical course in restorative dentistry and prosthodontics and the clinical course paediatric dentistry. The assessment included direct observation, graded and non-grading evaluation and was documented with a specific FB assessment tool. Dental students in the intervention group (IG) received an elaborated, structured and qualified FB after the pre-assessment that focussed on individual strengths and weaknesses, providing specific suggestions for improvement and establishing a personal learning goal. Participants were randomly allocated to the IG and the control group (CG). In both groups, dental students significantly enhanced their performance, but the difference was higher in the IG than in the CG. Large effect sizes (ES) were observed in all observed items, but FB had largest effect size in improving technical skills (ES=1.6), followed by management (ES=1.3) and communication skills (ES=0.8). Factors with the highest influence on FB in enhancing dental students' clinical performance were their insight into their own mistakes or omissions, the observed dental treatment step and the duration of FB. Individual structured and qualified FB is an effective method to enhance dental students' professional performances and to individually guide the learning process.

Need Assessment of Consultation Liaison Psychiatry amongst the Clinical Faculty

Nearly 20-40% of patients with medico-surgical illnesses in general hospitals have a co morbid psychiatric illness or psychosocial issues, which interfere in improvement of the primary illness. It is important to assess the attitudes and awareness of non-psychiatrist clinicians about the co-existing psychiatric morbidity in their patients and their felt needs, which can help in mitigating this morbidity. The present study attempts to gauge the non-psychiatrist clinician's perception, felt needs and barriers to referral/ intervention in a tertiary care teaching hospital. A cross-sectional, descriptive, online questionnaire-based method was used. Of the 239 clinical faculty members, only 45 responded. Responses indicated that clinicians were aware of the existence and significance of psychological problems in their patients, but could do with further increased levels of awareness and more specific training in evaluation and intervention. Stigma, lack of awareness of available services, and lack of detailed understanding regarding psychological problems were the important barriers to referral/ intervention. Better teamwork, training and more manpower were the specific suggestions for improvement in the future.

Integrated Evaluation System for the Strategic Management of Innovation Initiatives in Manufacturing Industries

The innovation capability of industrial organizations is an essential prerequisite to stay ahead of the global competition by adapting flexible to the rapidly changing customer requirements. However, the success of innovation initiatives is often at risk, due to short-sighted, unsystematic planning-, implementation- and evaluation activities. For this purpose an integrated evaluation approach has been developed by Fraunhofer IPK to manage the lifecycle of an innovation initiative in terms of implementation progress and operational performance in a sustainable way. The Evaluation System follows a multi-perspective approach that involves internal and external stakeholders by applying a combination of evaluation instruments including key performance indicators, self-assessment- and audit procedures as well as monitoring- and reporting tools. As a main output of the Evaluation System, specific improvement suggestions and action plans can be derived to react agile on potential challenges.

“Compassion, pleasantry, and hope”: A process evaluation of a volunteer-based nonprofit

As funders continue to emphasize the importance of documented results, nonprofit organizations must work to complete program evaluations that are both valuable and feasible. The purpose of this paper is to document a practical process evaluation of a southeastern nonprofit, a local Meals on Wheels. Using a mixed methods approach, we sought to answer four evaluation questions: (1) What are the essential program components, as identified by key stakeholders; (2) To what extent are volunteers implementing the identified essential components as intended; (3) What is the level of volunteer satisfaction with the program; and (4) What suggestions do stakeholders have for improving the program? Our findings indicate that most aspects of the program were implemented as intended, but inconsistencies occurred when volunteers were unsure of their assigned duties. In addition, volunteers had high levels of satisfaction and specific suggestions for improvement. From these results, we developed a conceptual model of factors contributing to quality of implementation and volunteer satisfaction that may be generalizable to other volunteer-based nonprofits. Specifically, we identified three factors that helped to facilitate satisfaction and performance: leadership, social contact, and fulfillment. Finally, this process evaluation demonstrates the feasibility of developing and implementing evaluation tools in similar organizations.

Problems and Optimization Recommendations Exist in Manufacturing Logistics Cost Accounting

logistics management system is a new thing in China, the logistics cost accounting method can be also used some be inopportune or inappropriate, and therefore have a very negative impact on the operation of enterprises. The current or on the accrual basis of accounting, and have set up a special accounting system to the operation mechanism of logistics, lead to the definition of logistics cost according to the comprehensive accounting. The following describes the logistics cost accounting method of manufacturing enterprises, discusses the reasons for the logistics cost accounting, research on some problems in current logistics cost accounting, and gives specific suggestions for improvement.

The Doing Business Indicators in Investor Protection: The Case of Singapore

The World Bank’s Ease of Doing Business index has significantly impacted regulations and policies regarding corporate matters around the world, and yet there has been scant academic attempt examining the use and implication of the Doing Business indicators, especially in the area of investor protection, an essential element in doing business. In this paper, we examine in depth the research methodologies employed by the Doing Business project in measuring the strength of investor protection, especially in light of the recent renaming of the index to Protecting Minority Investors index in Doing Business 2015. Using Singapore as a case study, we argue that, notwithstanding the positive changes brought in the latest round of changes, the variables and components chosen in the index essentially fail to capture salient features of minority protection. We argue that minority protection is an area which is inherently too context-specific to be evaluated based on a unified business assumption or by pure quantitative methods. Lastly, we also provide specific suggestions for improvements of the Protecting Minority Investors index.

From the Editors: How to write a high-quality review

The peer review process is widely used by academic journals, including the Journal of International Business Studies (JIBS), to evaluate the quality of manuscript submissions relative to the journals’ scholarly goals. Our overview suggests that the best reviews also facilitate the introduction of new and important ideas to the field. Content analysis of 156 past JIBS reviews found that the best reviews (highly rated reviews written by reviewers who won the JIBS best reviewer award in 2011 and 2012) shared many key features, including a focus on the overall contribution (potential impact) of the manuscript, a positive tone and specific suggestions for improvement. We also surveyed current JIBS action editors and found that, despite the importance of high-quality reviews for the advancement of the field, few recalled being formally trained or mentored on how to write them. To better understand the features of a good review, the editors rated the various features of the peer reviews on helpfulness, and they also rated how often these features are present in the reviews they receive. Based on the survey of action editors and the content analysis of previous reviews, this editorial offers detailed guidance for current and future reviewers on how to write helpful, developmental and possibly even award-winning peer reviews.

Attribution, Legal Causation and Preventive Effects on Causal Imputation from a Psychological Perspective and its Possible Consequences for the Preventive Effects of Tort Law

The aim of this paper is to describe how private law rules on causal imputation fit the actual conduct of people, given the existence of attribution as a psychological phenomenon. Which behavioural presumptions are hidden behind the rules on causation in our civil codes and case law and does the image stemming thereof correspond with what psychologists have concluded regarding causal relationships? If not, is it possible to align these concepts? The conclusion is that both concepts cannot be made compliant easily. Accordingly, when examining causation issues we should take account of the lessons from psychology, most notably attribution theory. In addition to a number of specific suggestions for improvements, I conclude that, generally speaking, thinking harder and longer about legal causation issues will usually lead to better answers, which implies that decionion maker should be allowed time and space to reach a decision. A more general lesson is that (some of) the supposed preventive effects of tort law appear to be unachievable because imputation mechanisms (which lead to people making external imputations for some events) stand in the way.

Service Blueprinting as a Failure Elimination Tool in the Case of Outsourcing Services

This paper applies the service blueprinting method as a tool that can produce a systematic description and analysis of an industrial outsourcing service process. The key objective is to characterise critical incidents and potential failure situations from the service provider’s perspective. The main benefit of the service blueprinting technique is that it makes the service provision process, failure situations, and relevant actors systematically visible. In this regard, it facilitates more detailed analysis and reveals opportunities for service improvements in the context of industrial outsourcing services. Suggested improvements can facilitate service process improvements that strengthen businesses competitiveness in the marketplace. The analysis also yields more specific suggestions for improvements.

Professional development of school leaders in Cyprus: is it working?

School heads and assistant headteachers in Cyprus attend in‐service training programmes as part of their professional development, after they are promoted to their new leadership post. A review of the literature highlights the significance of a needs analysis when designing and/or reforming in‐service training programmes. Nevertheless, there seems to be a lack of studies focusing on the leaders’ views regarding their own professional development and needs. The present study investigates school leaders’ views regarding the in‐service training programmes they formally attend in Cyprus (both with regards to content as well as organizational aspects of the courses), and whether specific personal characteristics of school leaders are associated with their views. The research was based on both interviews with school leaders (assistant heads and school heads) and also a semi‐structured questionnaire. Content and statistical analysis of the participants’ views revealed that they prefer specific training, especially designed for their needs and according to their specific leadership post. The study contributes to the fields of educational leadership and professional development, since it provides insights into the perceptions of school leaders about the continuing professional development they receive and offers useful information for the organization of professional development programmes for school leaders. Finally, some specific suggestions for improvement in the field of training for school leaders are provided.

Evaluation of Safety in a Radiation Oncology Setting Using Failure Mode and Effects Analysis

Failure mode and effects analysis (FMEA) is a widely used tool for prospectively evaluating safety and reliability. We report our experiences in applying FMEA in the setting of radiation oncology. We performed an FMEA analysis for our external beam radiation therapy service, which consisted of the following tasks: (1) create a visual map of the process, (2) identify possible failure modes; assign risk probability numbers (RPN) to each failure mode based on tabulated scores for the severity, frequency of occurrence, and detectability, each on a scale of 1 to 10; and (3) identify improvements that are both feasible and effective. The RPN scores can span a range of 1 to 1000, with higher scores indicating the relative importance of a given failure mode. Our process map consisted of 269 different nodes. We identified 127 possible failure modes with RPN scores ranging from 2 to 160. Fifteen of the top-ranked failure modes were considered for process improvements, representing RPN scores of 75 and more. These specific improvement suggestions were incorporated into our practice with a review and implementation by each department team responsible for the process. The FMEA technique provides a systematic method for finding vulnerabilities in a process before they result in an error. The FMEA framework can naturally incorporate further quantification and monitoring. A general-use system for incident and near miss reporting would be useful in this regard.

Meta-Analysis

Audit and feedback (A&F) has long been used to improve quality of care, albeit with variable results. This meta-analytic study tested whether Feedback Intervention Theory, a framework from industrial/organizational psychology, explains the observed variability in health care A&F research. studies cited by Jamtvedt's 2006 Cochrane systematic review of A&F, followed by database searches using the Cochrane review's search strategy to identify more recent studies. Cochrane review criteria, plus: presence of a treatment group receiving only A & F; a control group receiving no intervention; a quantitatively measurable outcome; minimum n of 10 per arm; sufficient statistics for effect size calculations. Moderators: presence of discouragement and praise; correct solution, attainment level, velocity, frequency, and normative information; feedback format (verbal, textual, graphic, public, computerized, group vs. individual); goal setting activity. meta-analytic procedures using the Hedges-Olkin method. Of 519 studies initially identified, 19 met all inclusion criteria. Studies were most often excluded due to the lack of a feedback-only arm. A&F has a modest, though significant positive effect on quality outcomes (d = 0.40, 95% confidence interval = +/-0.20); providing specific suggestions for improvement, written, and more frequent feedback strengthened this effect, whereas graphical and verbal feedback attenuated this effect. A&F effectiveness is improved when feedback is delivered with specific suggestions for improvement, in writing, and frequently. Other feedback characteristics could also potentially improve effectiveness; however, research with stricter experimental controls is needed to identify the specific feedback characteristics that maximize its effectiveness.

Evaluation of harmful algal bloom outreach activities.

With an apparent increase of harmful algal blooms (HABs) worldwide, healthcare providers, public health personnel and coastal managers are struggling to provide scientifically-based appropriately-targeted HAB outreach and education. Since 1998, the Florida Poison Information Center-Miami, with its 24 hour/365 day/year free Aquatic Toxins Hotline (1-888-232-8635) available in several languages, has received over 25,000 HAB-related calls. As part of HAB surveillance, all possible cases of HAB-related illness among callers are reported to the Florida Health Department. This pilot study evaluated an automated call processing menu system that allows callers to access bilingual HAB information, and to speak directly with a trained Poison Information Specialist. The majority (68%) of callers reported satisfaction with the information, and many provided specific suggestions for improvement. This pilot study, the first known evaluation of use and satisfaction with HAB educational outreach materials, demonstrated that the automated system provided useful HAB-related information for the majority of callers, and decreased the routine informational call workload for the Poison Information Specialists, allowing them to focus on callers needing immediate assistance and their healthcare providers. These results will lead to improvement of this valuable HAB outreach, education and surveillance tool. Formal evaluation is recommended for future HAB outreach and educational materials.

Surgical adverse outcomes and patients’ evaluation of quality of care: inherent risk or reduced quality of care?

Background:Previous research has shown that sicker patients are less satisfied with their healthcare, but specific effects of adverse health outcomes have not been investigated. The present study aimed to assess...