Staff Acceptance Research Articles

A pilot study exploring staff acceptability of a socially assistive robot in a residential care facility that accommodates people under 65 years old.

ABSTRACTSocially assistive robots have successfully been trialed in residential care facilities (RCFs) for older adults. These robots may have potential for younger adults (i.e. under 65 years old) who also live in RCFs. However, it is important to investigate staff acceptability and ease-of-use of these robots. This pilot study used the Technology Acceptance Model to investigate how staff working in a specialized RCF for younger adults accept Betty, a socially assistive robot who was introduced in the facility for 12 weeks. Twenty-four staff completed pre-questionnaires, reporting that they thought Betty would have the ability to engage and entertain the residents they cared for. While there were only eight staff who completed the post-questionnaires, there were significant improvements compared to the pre-questionnaire results in areas such as residents enjoying the contact and activities. Impacting on ease-of use were technical difficulties. Although this study had limitations and could be improved by a better response rate and investigating the residents' acceptability of Betty, this study is one of the first to report that this novel technology may have much potential for engaging adults in RCFs.

40 ED crowding: the acceptability of dysfunction

BackgroundCrowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay,...

Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial

BackgroundCentral venous access device (CVAD) associated complications are a preventable source of patient harm, frequently resulting in morbidity and delays to vital treatment. Dressing and securement products are used to prevent infectious and mechanical complications, however current complication rates suggest customary practices are inadequate. The aim of this study was to evaluate the feasibility of launching a full-scale randomized controlled efficacy trial of innovative dressing and securement products for pediatric tunneled CVAD to prevent complication and failure.MethodsAn external, pilot, four-group randomized controlled trial of standard care (bordered polyurethane dressing and suture), in comparison to integrated securement-dressing, suture-less securement device, and tissue adhesive was undertaken across two large, tertiary referral pediatric hospitals in Australia. Forty-eight pediatric participants with newly inserted tunneled CVADs were consecutively recruited. The primary outcome of study feasibility was established by elements of eligibility, recruitment, attrition, protocol adherence, missing data, parent and healthcare staff satisfaction and acceptability, and effect size estimates for CVAD failure (cessation of function prior to completion of treatment) and complication (associated bloodstream infection, thrombosis, breakage, dislodgement or occlusion). Dressing integrity, product costs and site complications were also examined.ResultsProtocol feasibility was established. CVAD failure was: 17% (2/12) integrated securement-dressing; 8% (1/13) suture-less securement device; 0% tissue adhesive (0/12); and, 0% standard care (0/11). CVAD complications were: 15% (2/13) suture-less securement device (CVAD associated bloodstream infection, and occlusion and partial dislodgement); 8% (1/12) integrated securement-dressing (partial dislodgement); 0% tissue adhesive (0/12); and, 0% standard care (0/11). One CVAD-associated bloodstream infection occurred, within the suture-less securement device group. Overall satisfaction was highest in the integrated securement-dressing (mean 8.5/10; standard deviation 1.2). Improved dressing integrity was evident in the intervention arms, with the integrated securement-dressing associated with prolonged time to first dressing change (mean days 3.5).ConclusionsImproving the security and dressing integrity of tunneled CVADs is likely to improve outcomes for pediatric patients. Further research is necessary to identify novel, effective CVAD securement to reduce complications, and provide reliable vascular access for children.Trial registrationACTRN12614000280606; prospectively registered on 17/03/2014.

Creating space for relationships.

Sexuality is a key component of personality and behavior, encompassing basic human needs for touch, intimacy, love, affection, and sexual behavior. The design of long-term care facilities makes it almost impossible for a resident to be sexually intimate, to share romantic moments, or to have a meal in a private setting. This case study describes the rationale and process used to establish a private guestroom called the Family Room at Patriots Place, the specialized dementia unit in the Veterans Affairs (VA) Maine Healthcare System Community Living Center (CLC). As part of an overall commitment to culture change at VA Maine, the Family Room addresses needs for privacy and sexual intimacy as expressed by residents and their partners. Supporting the dignity and independence of individuals with dementia provided the basis for the policies established to support this project. Despite potential challenges, (e.g., staff acceptance, nursing coverage, facility space needs) residents, partners, and health care staff at VA Maine have expressed positive support for the Family Room. This resource is a way to accommodate the ongoing needs for privacy, intimacy, relational continuity, and sexual expression of long-term care residents with dementia and to support their autonomy and dignity. (PsycINFO Database Record

Level of acceptance of islet cell and kidney xenotransplants by personnel of hospitals with and without experience in clinical xenotransplantation.

Recently, significant progress in both safety and efficacy has been achieved in the field of xenotransplantation, as exemplified by results from the first clinical trials of porcine islet transplantation. It would be of interest to learn whether the attitude of the clinical staff involved in such trials changes as the trials are carried out in their own hospital. One hundred and four clinical staff members from the Eva Peron Hospital of San Martin (Buenos Aires, Argentina) where clinical trials of islet xenotransplantation have been performed and 92 similar staff members from the Diego Thompson Hospital (Buenos Aires, Argentina) where no such xenotransplantation has been carried out participated in the study. Data were collected anonymously using questionnaires. Statistically significant differences between the acceptance of xenotransplantation by clinical personnel in a hospital that had carried out clinical xenotransplantation trials were observed when compared with the acceptance of a similar staff from the hospital that had not carried out such trials. This study shows that involvement in clinical xenotransplantation trials significantly changes the attitude of the clinical staff towards this technology and suggests that better information given to the society may increase acceptance of the xenotransplantation.

How to implement live video recording in the clinical environment: A practical guide for clinical services.

The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. To provide a practical guide for clinical services to embed live video recording. Using Kotter's 8-step process for leading change, we provide a 'how to' guide to navigate the challenges required to implement a continuous video-audit system based on our experience of video recording in our emergency department resuscitation rooms. The most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. Clinicians are faced with considerable ethical, legal and data protection challenges which are the primary barriers for services that pursue video recording of patient care. Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. This article outlines core implementation issues that need to be addressed if video is to become part of routine care delivery. By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care.

Improving Glycemic Control Safely in Critical Care Patients: A Collaborative Systems Approach in Nine Hospitals

Safely improve glycemic control in the critical care units of nine hospitals. Critical care adult inpatients from nine hospitals with ≥4 point-of-care blood glucose (BG) readings over ≥2 days were targeted by collaborative improvement efforts to reduce hyper- and hypoglycemia. Balanced glucometric goals for each hospital were set targeting improvement from baseline or goals deemed desirable from Society of Hospital Medicine (SHM) benchmarking data. Collaborative interventions included standardized insulin infusion protocols, hypoglycemia prevention bundles, audit and feedback, education, and measure-vention (coupling measurement of patients "off protocol" with concurrent interventions to correct suboptimal care). All sites improved glycemic control. Six reached prespecified levels of improvement of the day-weighted mean BG. The day-weighted mean BG for the cohort decreased by 7.7 mg/dL (95% confidence interval [CI], 7.0 mg/dL to 8.4 mg/dL) to 151.3 mg/dL. Six of nine sites showed improvement in the percent intensive care unit (ICU) days with severe hyperglycemia (any BG >299 mg/dL). ICU severe hyperglycemic days declined from 8.6 to 7.2% for the cohort (relative risk, 0.84; 95% CI, 0.80 to 0.88). Patient days with any BG <70 mg/dL were reduced by 0.4% (95% CI, 0.06% to 0.6%), from 4.5 to 4.1%, for a small but statistically significant reduction in hypoglycemia. Seven of nine sites showed improvement. Multihospital improvements in ICU glycemic control, severe hyperglycemia, and hypoglycemia are feasible. Balanced goals for glycemic control and hypoglycemia in the ICU using SHM benchmarks and metrics enhanced successful improvement efforts with good staff acceptance and sustainability. BG = blood glucose CMI = case-mix index CY = calendar year DKA = diabetic ketoacidosis EMR = electronic medical record GBMF = Gordon and Betty Moore Foundation ICU = intensive care unit IIP = insulin infusion protocol SHM = Society of z Hospital Medicine.

1192 ADAPTATION OF A BRIEF MOTIVATIONAL ENHANCEMENT EDUCATION PROGRAM DURING CPAP INITIATION TO AN ACADEMIC PUBLIC SLEEP CLINIC

A brief motivational enhancement education program (BMEEP) developed in Hong Kong is a pragmatic intervention that may improve CPAP adherence (Lai, CHEST 2014). We adapted BMEEP to a Los Angeles County public sleep clinic (BMEEP-LA) and evaluated implementation and effectiveness. Our hypotheses: 1) Patient and staff acceptance of BMEEP-LA would be high; 2) Patients who received BMEEP-LA would achieve greater CPAP adherence compared to usual care. BMEEP-LA was adapted to accommodate staffing, appointment availability, workflow and language/cultural factors, while maintaining core features of video education, motivation interviewing and negative message framing. BMEEP-LA encounters were provided by a Sleep NP-specialist trained in motivational interviewing. During 3/15/2016 - 7/15/2016, 78 newly-diagnosed patients completed BMEEP-LA. Acceptance was evaluated qualitatively by semi-structured patient and staff interviews. Electronic CPAP adherence data at 1 and 3 months were collected and compared to: 1) a case-matched control group that received usual care during 1/1/2014 - 12/31/2015 (informal education during CPAP set-up); and 2) published data from the BMEEP trial. Comparisons among groups were tested by student’s t-test and binomial approximation. The BMEEP-LA and control groups were equivalent by age, gender, racial/ethnic, BMI, Epworth score, subjective sleepiness and AHI. Compared to the BMEEP trial, BMEEP-LA had similar age and AHI ranges, but lower proportion of men (50% vs 84%), dissimilar racial/ethnic composition (70% Hispanics/0% Chinese vs 100% Chinese) and higher mean BMI (37.4 vs 28.6). Interviews with patients and staff indicated high acceptance of BMEEP-LA. Adherence indicators were similar to the BMEEP trial at 1 and 3 months. Compared to controls, BMEEP-LA adherence indicators were similar at 1 month, but higher at 3 months (82 +/- 23% vs 66 +/- 33% days used (p=0.003), 4hr 47min vs 3 hr 36 min daily use (p=0.003), 63 +/- 23 vs 49 +/- 33% days with >4 hr use (p=0.016), and 36 vs 23% patients with >70% days of >4hr use (p=0.072)). Despite having been developed for Chinese patients, BMEEP was successfully adopted in a Los Angeles County sleep clinic with disparate demographic/social-cultural characteristics and engendered long-term CPAP adherence improvement over usual care. none

An investigation of residential facility staff usage of touchscreen technology.

Older adults may become more familiar and interested in using touchscreen technology (TT). TT can be used to engage older adults living in residential aged care facilities (RACFs) and staff there can play an important role in supporting residents to use TT. However, before these are introduced, it is crucial to investigate their opinions in using TT with residents. A questionnaire based on the Technology Acceptance Model was administered to assess staff usage and confidence in using TT, their perceptions in TT ease-of-use and usefulness in helping them care for their residents. Perhaps unsurprisingly, results found that respondents were familiar using TT. More importantly, staff reported that they were interested in engaging residents with TT and nominated different training methods to support them such as group in-services. This project provides information about staff experience and acceptance of the use of TT for residents in RACFs.

Improving emergency department medical clinical handover: Barriers at the bedside.

The present paper describes our experience of developing and piloting a best practice model of medical clinical handover. Secondary aims were to improve reliability of communication, identify negative effects on patient care and assess staff adherence and acceptance of the process. We described existing handover practice. We designed and implemented a process incorporating bedside handover, the Identification, Situation, Background, Assessment, Requirements and Requests (ISBAR) tool and handover documentation. We audited the process and surveyed doctors before and after the intervention regarding their practice and preferences. Existing handover practice was remote from the patient, neither standardised nor documented. The new process resulted in a median 87% (95% CI 70.4-92.1) of handovers in the presence of the patient. ISBAR elements were consistently communicated, median 100% (95% CI 91.8-100). Risk events were directly identified in a median 8.3% (95% CI 0.0-13.8) of bedside handovers. Handover documentation did not improve. FACEM and registrar perception that bedside handover improves patient care fell from 71%, 80% to 56%, 58%, respectively. Preference for bedside handover fell from 79% and 80%, respectively, to being evenly divided between bedside and centralised models; 80.9% of respondents reported that ISBAR improved communication. Bedside handover using ISBAR resulted in improved patient involvement, communication and a non-significant trend to improved patient safety. Despite a majority of doctors acknowledging these findings, preference remained for a centralised handover using ISBAR. Gaining staff acceptance of a process change is essential to its success. A barrier to acceptance could be that staff are time-poor. We suggest handover processes can be strengthened by adequate staffing and small, incremental improvements to existing models combined with auditing of outcomes.

Physician and Staff Acceptance of Care Managers in Primary Care Offices.

Embedded care managers are increasingly implemented as part of the care team within primary care practices, yet previous studies have indicated variability in acceptance by physicians and staff. This study assesses the acceptability of care managers among staff and physicians within the Michigan Primary Care Transformation (MiPCT) demonstration. Care manager acceptance was measured using a web-based survey distributed to practices participating in the MiPCT demonstration. Both physicians and staff reported high levels of care manager acceptance. Longer length of care manager employment at the practice, higher care manager FTE dedicated to care management, and care manager employed by practice were all significantly associated with care manager acceptance. The MiPCT demonstration found high care manager acceptance across all care team members. The high level of acceptance may be due to the structures and processes developed by MiPCT to support implementation of care managers and the length of the intervention period. The MiPCT demonstration confirms that following three years of implementation, embedded care managers are acceptable to both physicians and staff within primary care practices. Importantly, embeddedness, or the amount of time care managers are located within practices, is associated with increased acceptance.

A Long-Term Autonomous Robot at a Care Hospital: A Mixed Methods Study on Social Acceptance and Experiences of Staff and Older Adults

Robot technology could be a future means to ameliorate predicted staff shortage in elder care due to the current demographic change. This study focuses on the evaluation of a long-term autonomous robot that was deployed in a real-world scenario at a care facility for older adults with severe multimorbidity and dementia. Social acceptance and user experience were assessed using a mixed-method design consisting of observations (12 h), ten interviews and 70 questionnaires with members of staff. Findings show that the interacting modalities have to meet the very needs of specific end-user groups and that the perceived utility of a robot is very much tied to its tasks and proper functioning. Social acceptance was ambivalent. On one hand the robot was integrated into daily routines, but on the other hand staff was not willing to share their work space with a robotic aid and saw the introduction of robots in eldercare as an inevitable development. Findings on user experience showed that staff and older adults were interested in and excited about the robot. Still it is necessary to equip the robot with meaningful communication abilities as well as cues that enhance the predictability of its behavior.

Major problems and solutions in the health care system of specialist physicians working in hospitalsHastanelerde çalışan uzman hekimlerin sağlık sistemindeki başlıca sorunları ve çözüm önerileri

Transformation project in health which started to be implemented in 2003, has been implemented by the ministry of health quickly, this system which includes a very different point of view from the previous period and implementation in health, has been realized sometimes despite everybody, by means of the approval and acceptance of health staff in high percent. However, current implemantation mistakes and and lacks at the accepted speed, even getting worse in the system have created a dissatisfaction feeling at the each step and rank of the health staff. World Health Organization has described the health as not having an illness and weakness and having a well-being in physical, in soul and in social completely (WHO 1946 ). Health system is the general name of health service which has been given to life which is the most precious thing in universe and to the human being who is the most valuable within all the living creatures. As versatile matrix structure is very technical and needs expertise, the lack at the each point of this structure and the value of the served living creatures, chaos is a complex system which can lead to a crise. At our research, a questionnare has been implemented for specialist doctors working at the second rank state institutions (Hospitals). In this study, a survey of specialist physicians working for government agencies in hospitals has been applied. In this survey, the major issues of concern Specialist Physicians as a summary of the study 1) Additional payment distribution in the Injustice 2) One physician on call of thread and care of Emergency Medicine out of shift hours. 3) Physicians pensions 4) Health personnel carried out actual attacks have been evaluated and their proposed solutions and rational solutions compiled suggestions and it discussed. This survey of major problems existing in our health system, for example, comprise the solution. This article is the first research study conducted in Turkey in its field, it is considered the most versatile and comprehensive study will encourage other. Özet2003 yılı itibarıyla uygulamaya konulan Sağlıkta Dönüşüm Projesi, Sağlık Bakanlığınca hızla yürürlüğe konulmuş, önceki dönemden çok farklı bir bakış açısı ve sağlıkta uygulama içeren bu sistem, bazen herkese rağmen, önemli oranda da sağlık personelinin vicdanen tasdiki ve kabulüyle gerçekleşmiştir. Ancak sistem içerisinde mevcut uygulama hataları, mevzuat eksiklikleri ve bu eksikliklerin ve hataların beklenen hızda düzeltilemeyip adeta müzminleşmesi, sağlık personeli içerisinde her basamak ve kademede memnuniyetsizlik hissi oluşturmuştur. Dünya Sağlık Örgütü, sağlığı herhangi bir hastalık ve güçsüzlük halinin olmaması ve bedenen, ruhen ve sosyal bakımdan tam bir iyi olma durumudur olarak tanımlamaktadır (WHO 1946). Sağlık sistemi, evrende en kıymetli şey olan hayata ve hayat sahibi canlılar içinde en kıymetlisi insana verilen sağlık hizmetinin genel adıdır. Çok yönlü matrix yapısı, çok teknik oluşu ile uzmanlık gerektirmesi ve bu yapının her bir noktasındaki eksikliklerin hizmet verilen canlının kıymeti nedeniyle, kaos, kriz oluşturabildiği kompleks bir sistemdir. Bu çalışmamızda 2.basamak devlet kurumlarında çalışan uzman hekimlere yönelik bir anket çalışması uygulanmıştır. Bu anket çalışmasında özet olarak uzman hekimleri ilgilendiren başlıca sorunlar olan 1) Ek Ödeme dağıtımında ki adaletsizlikler 2) Tek hekim icapçılığı konusu ve icap hekimliği 3) Hekim emekli maaşları 4) Sağlık personeline yapılan fiili Saldırılar değerlendirilmiş ve onların önerdiği çözüm yolları ve rasyonel çözüm önerileri derlenmiş ve tartışılmıştır. Bu anket çalışması sağlık sistemimizde mevcut önemli sorunların, örnek çözümlerini içermektedir.

Acceptance of primary practitioner physiotherapists in an emergency department: A qualitative study of interprofessional collaboration within workforce reform

ABSTRACTPrimary contact practitioner physiotherapists (PPs) are increasingly common in emergency departments (EDs) and provide targeted care to people with uncomplicated musculoskeletal conditions such as sprains, strains, and simple fractures. Workforce redesign can be challenging and success is influenced by staff attitude and opinion. The current study aimed to explore the experiences and perceptions of ED team members about a recently introduced PP service on existing staff and services in a large regional ED. Forty-two staff from eight professional groups participated in semi-structured interviews or focus groups which were audio recorded and field notes were taken. Data were transcribed verbatim and subsequently underwent thematic analysis. Acceptance emerged as one key theme. Acceptance of the PP service by ED staff was not automatic, unconditional, or implied and represented a continuum from PPs being tolerated as transient visitors to being subsumed as integrated members of the ED team. Acceptance of the service and its members was contingent upon the PPs demonstrating three interdependent qualities: being trustworthy, valuing learning, and complementing (not competing with) ED practices to achieve ED goals. Given that staff acceptance was crucial for the successful integration and performance of the service, understanding and manipulating the factors that influence acceptance might increase the likelihood of successfully implementing PP services in EDs. The results might also be applied to facilitate workforce reform in other settings.

Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka

BackgroundMultidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka.MethodsThis is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist’s recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period.ResultsA total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist’s recommendations by doctors was 73.5% (200/272) (95% CI 67.9 – 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses’ rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey.ConclusionsThere was high acceptance and implementation of clinical pharmacist’s recommendations regarding DRPs by the healthcare team. The doctors’ views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff.Trial registrationSri Lanka Clinical Trials Registry SLCTR/2013/029 Date: 13 September 2013; retrospectively registered.

University-Private Hospital clinical education partnerships: opportunities, benefits and barriers for medical student clinical training in private hospitals

Introduction: Private hospitals in Australia have the potential to offer rich clinical training opportunities for medical students. This study aimed to identify benefits and barriers to private hospitals engaging with medical schools to provide clinical learning opportunities, as perceived by staff and visiting clinicians at private hospitals. Methods: Visiting clinicians and staff at four private hospitals in Adelaide (South Australia) were surveyed, using open-ended questions, to determine attitudes to medical student training in private hospitals. Responses were analysed using inductive content analysis to determine dominant themes in relation to perceived benefits, perceived barriers, and factors that might facilitate clinical teaching in private hospitals. Results: A total of 59 participants completed the survey: 38 secondary care specialists; 4 general practitioners; 6 senior administrative staff; 6 hospital volunteers, medical students or registered nurses; and 5 not specified. There were three dominant themes related to perceived benefits of teaching: the breadth and diversity of clinical exposure for students, opportunities for students to understand private and community health systems, and the high quality of learning available. There were three dominant themes related to barriers: time constraints, patient unwillingness and limitations of learning opportunities. Factors that might facilitate medical education in private hospitals included senior staff acceptance and provision of clear support structures, faculty clinical academic support, administration and facilitation. Conclusions: Attention to the issues raised, correction of the misunderstanding regarding patient acceptance of students and minimisation of disruption to clinical service provision should allow further development of training placements in private hospitals.

Communication Skills Assessment Using Human Avatars: Piloting a Virtual World Objective Structured Clinical Examination

IntroductionProficiency in communication skills is a core competency of residency training. We evaluated the feasibility, acceptability and applicability of a virtual world objective structured clinical examination that enables practice based learning and assessment of resident communication skills. MethodsA virtual clinical encounter situated in 2 practice settings was developed that uses a human avatar physician and a standardized patient. Following an online tutorial house staff participated in 4 communication tasks, including shared decision making, delivering bad news, obtaining informed consent and disclosing a medical error. Validated instruments and semistructured interviews were used to assess house staff acceptability and applicability of the platform. Three faculty members used ACS (Affective Competency Scale) and communication specific assessment instruments to evaluate house staff performance. ResultsA total of 12 urology house staff completed the simulation. Direct costs were approximately $1,000. The virtual world was easy to use and immersive. Applicability directly correlated with presence (Pearson r = 0.67, p = 0.01) and co-presence (Pearson r = 0.8, p = 0.002). House staff identified problems with 1) limited nonverbal cues, 2) too much information presented and 3) a lack of immediate feedback. The ICC (intraclass correlation) of faculty assessments was high for ACS at 0.53 (95% CI 0.36–0.69) for single measures, 0.77 (95% CI 0.63–0.86) for average measures and less for other assessment instruments. ConclusionsA virtual world objective structured clinical examination is a feasible, acceptable and applicable method of communication skills assessment. Improving nonverbal cues, focusing on individual skill sets and providing immediate feedback are measures to be adopted in future iterations of this platform.

Constant Observation of Suicidal Patients: The Intervention We Love to Hate.

Constant observation (CO) of psychiatric inpatients at risk for suicidal behavior has been criticized in the literature because of the absence of demonstrable effectiveness, associated costs, staff and patient acceptance, and related issues. Our inability to demonstrate effectiveness, however, is an ethical conundrum that cannot readily be solved. Frequent and often vociferous references in the literature to the absence of an evidence base for this intervention carries the risk that CO may be underutilized in particular clinical circumstances with untoward results. A case is made for shifting focus from the lack of evidence supporting CO to agreement on an observation protocol that achieves the desired goal of maximizing patient safety. A sample protocol is presented.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China.

ObjectiveDual practice is defined as a physician’s performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people’s perception.MethodsA cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis.ResultsThe study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals’ human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients.ConclusionThis study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals’ human resource would promote physicians’ willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.

Feasibility of Pulse Oximetry Pre-discharge Screening Implementation for detecting Critical Congenital heart Lesions in newborns in a secondary level maternity hospital in the Western Cape, South Africa: The 'POPSICLe' study.

Early detection of critical congenital heart disease (CCHD) through newborn pulse oximetry (POx) screening is an effective strategy for reducing paediatric morbidity and mortality rates and has been adopted by much of the developed world. To document the feasibility of implementing pre-discharge POx screening in well babies born at Mowbray Maternity Hospital, a busy government hospital in Cape Town, South Africa. Parent and staff acceptance was assessed. We conducted a prospective study of predischarge POx screening in one postnatal ward, following informed parental consent. During the 4-month study period, 1 017 of 2 256 babies discharged (45.1%) were offered POx screening and 1 001 were screened; 94.0%of tests took &lt;3 minutes to perform, 4.3% 3 - 5 minutes and 1.7% &gt;5 minutes. Eighteen patients needed second screens and three required thirdscreens. Only 3.1% protocol errors were made, all without consequence. The vast majority (91.6%) of nursing staff reported insufficient time toperform the study screening in addition to their daily tasks, but ~75% felt that with a full nursing staff complement and if done routinely (not partof a study), pre-discharge POx screening could be successfully instituted at our facility. Over 98% of the mothers had positive comments. Twobabies failed screening and required echocardiograms; one was diagnosed with CCHD and the other with neonatal sepsis. The sensitivity andspecificity were 50% (95% confidence interval (CI) 1.3 - 98.7%) and 99.9% (95% CI 99.4 - 100%), respectively, with a percentage correct of 99.8%. POx screening was supported and accepted by staff and parents. If there are no nursing staff shortages and if it is doneroutinely before discharge, not as part of a study, we conclude that POx screening could be implemented successfully without excessive falsepositives or errors, or any additional burden to cardiology services.