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Through technological innovations, patient cohorts can be examined from multiple views with high-dimensional, multiscale biomedical data to classify clinical phenotypes and predict outcomes. Here, we aim to present our approach for analyzing multimodal data using unsupervised and supervised sparse linear methods in a COVID-19 patient cohort. This prospective cohort study of 149 adult patients was conducted in a tertiary care academic center. First, we used sparse canonical correlation analysis (CCA) to identify and quantify relationships across different data modalities, including viral genome sequencing, imaging, clinical data, and laboratory results. Then, we used cooperative learning to predict the clinical outcome of COVID-19 patients: Intensive care unit admission. We show that serum biomarkers representing severe disease and acute phase response correlate with original and wavelet radiomics features in the LLL frequency channel (cor(Xu1, Zv1) = 0.596, p value < 0.001). Among radiomics features, histogram-based first-order features reporting the skewness, kurtosis, and uniformity have the lowest negative, whereas entropy-related features have the highest positive coefficients. Moreover, unsupervised analysis of clinical data and laboratory results gives insights into distinct clinical phenotypes. Leveraging the availability of global viral genome databases, we demonstrate that the Word2Vec natural language processing model can be used for viral genome encoding. It not only separates major SARS-CoV-2 variants but also allows the preservation of phylogenetic relationships among them. Our quadruple model using Word2Vec encoding achieves better prediction results in the supervised task. The model yields area under the curve (AUC) and accuracy values of 0.87 and 0.77, respectively. Our study illustrates that sparse CCA analysis and cooperative learning are powerful techniques for handling high-dimensional, multimodal data to investigate multivariate associations in unsupervised and supervised tasks. [ABSTRACT FROM AUTHOR]

Background Pulmonary hypertension is a rare, chronic and life-threatening group of diseases. Recent advances in pulmonary hypertension management prolong survival and improve quality-of-life. However, highly complex drug therapy enhances the risk of drug-related problems. Objective To assess the impact of involving clinical pharmacists in the collaborative care of pulmonary hypertension patients. Setting Ten French University Hospital Pneumology departments, all members of the French Network for Pulmonary Hypertension. Methods This prospective multicenter randomized controlled trial included incident pulmonary hypertension patients who were followed-up for 18 months. Randomization using an adapted Zelen method allocated patients to collaborative care (n = 41) or usual care groups (n = 51). A collaborative care program involving clinical pharmacists was developed through a close partnership between with physicians, nurses and pharmacists. Besides usual care, the program includes regular one-to-one interviews between the pharmacist and the patient. These interviews had following objectives: to perform an exhaustive medication history review; to identify the patient' needs, knowledge and skills; to define educational objectives and to provide patients with relevant information when needed. Following each interview, a standardized report form containing the pharmacist's recommendations was provided to physicians and nurses and discussed collaboratively. An ancillary economic analysis was performed. Main outcome measure Number of drug-related problems and their outcomes. Results The number of drug-related problems was not significantly different between groups (1.6 ± 1.5 vs. 1.9 ± 2.4; p = 0.41). More problems were resolved in the collaborative care group than in the usual care group (86.5% vs. 66.7%, p = 0.01). Time to clinical worsening, therapeutic adherence, satisfaction or quality-of-life were not statistically different between groups. Collaborative care decreased costs of drug-related hospitalizations. Conclusion Including clinical pharmacists in the multidisciplinary care of hospitalized patients with pulmonary hypertension improved the outcome of drug-related problems and reduced the costs of related hospitalization. However, we observed no efficacy on medication errors, clinical outcomes or medication adherence. Clinical Trial Registration ClinicalTrials.gov Identifier NCT01038284. [ABSTRACT FROM AUTHOR]

Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care. [ABSTRACT FROM AUTHOR]

International collaborative training programs for graduate students are widespread, but studies on their educational impact are limited. As an advanced cancer institute in China, Cancer Hospital Chinese Academy of Medical Science (CHCAMS) attaches great importance to international exchanges and cooperation within graduate education. The Department of Epidemiology of CHCAMS has been involved in several existing international training programs and has also launched a short-term training program in cooperation with foreign universities and institutes from 2008. Fogarty International Clinical Research Scholars and Fellows (FICRS-F) Program and the Fulbright-Fogarty Fellowship Program are the most typical examples of our practice in international cooperation on graduate education over these years. Our department has gained substantial experience in graduate-level international collaborative training, focused on cancer epidemiology. This paper is a brief introduction to the practice of different programs in our department and students' achievements during and after training. Moreover, we attempt to serve as a reference and help promote the training of graduate students pursuing careers in cancer research or global health by other universities or research institutes. [ABSTRACT FROM AUTHOR]

Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting. [ABSTRACT FROM AUTHOR]

The importance of basing public policy on sound scientific evidence is increasingly being recognized, yet many barriers continue to slow the translation of prevention research into legislative action. This work reports on the feasibility of a model for overcoming these barriers-known as the Research-to-Policy Collaboration (RPC). The RPC employs strategic legislative needs assessments and a rapid response researcher network to accelerate the translation of research findings into usable knowledge for policymakers. Evaluation findings revealed that this model can successfully mobilize prevention scientists, engage legislative offices, connect policymakers and experts in prevention, and elicit congressional requests for evidence on effective prevention strategies. On average, the RPC model costs $3510 to implement per legislative office. The RPC can elicit requests for evidence at an average cost of $444 per request. The implications of this work, opportunities for optimizing project elements, and plans for future work are discussed. Ultimately, this project signals that the use of scientific knowledge of prevention in policymaking can be greatly augmented through strategic investment in translational efforts. [ABSTRACT FROM AUTHOR]

The PROSPER model uses a three-tiered community partnership, university researcher, and Cooperative Extension-based technical assistance system to support the delivery of evidence-based interventions in communities. This study examines the trajectory and predictors of the collaborative relationship between technical assistance providers and community teams across the three phases of organization, implementation, and sustainability. Members of 14 PROmoting School-university-community Partnerships to Enhance Resilience (PROSPER) community teams and directors of local agencies rated communities' levels of readiness and adolescent substance use norms. Technical assistance providers rated their collaborative relationship with their teams at 14 occasions across 4.5 years. Results from mixed models show that levels of collaboration were stable until the sustainability phase, when they increased significantly. Team differences in change were significant during the implementation phase. Community readiness predicted levels of the collaborative relationship over time: high community readiness was associated with a high level of collaboration during organization, but a decline in collaboration during implementation. These results provide a more nuanced understanding of the relationship between technical assistance provision and community prevention teams and lead to recommendations to improve dissemination models to achieve a greater public health impact. [ABSTRACT FROM AUTHOR]

Collaboration can be challenging; nevertheless, the emerging successes of large, multi-partner, multi-national cooperatives and research networks in the biomedical sector have sustained the appetite of academics and industry partners for developing and fostering new research consortia. This model has percolated down to national funding agencies across the globe, leading to funding for projects that aim to realise the true potential of genomic medicine in the 21st century and to reap the rewards of 'big data'. In this Perspectives article, the experiences of the RA-MAP consortium, a group of more than 140 individuals affiliated with 21 academic and industry organizations that are focused on making genomic medicine in rheumatoid arthritis a reality are described. The challenges of multi-partner collaboration in the UK are highlighted and wide-ranging solutions are offered that might benefit large research consortia around the world. [ABSTRACT FROM AUTHOR]

Effective healthcare requires both competent individuals and competent teams. With this recognition, health professions education is grappling with how to factor team competence into training and assessment strategies. These efforts are impeded, however, by the absence of a sophisticated understanding of the the relationship between competent individuals and competent teams . Using data from a constructivist grounded theory study of team-based healthcare for patients with advanced heart failure, this paper explores the relationship between individual team members' perceived goals, understandings, values and routines and the collective competence of the team. Individual interviews with index patients and their healthcare team members formed Team Sampling Units (TSUs). Thirty-seven TSUs consisting of 183 interviews were iteratively analysed for patterns of convergence and divergence in an inductive process informed by complex adaptive systems theory. Convergence and divergence were identifiable on all teams, regularly co-occurred on the same team, and involved recurring themes. Convergence and divergence had nonlinear relationships to the team's collective functioning. Convergence could foster either shared action or collective paralysis; divergence could foster problematic incoherence or productive disruption. These findings advance our understanding of the complex relationship between the individual and the collective on a healthcare team, and they challenge conventional narratives of healthcare teamwork which derive largely from acute care settings and emphasize the importance of common goals and shared mental models. Complex adaptive systems theory helps us to understand the implications of these insights for healthcare teams' delivery of care for the complex, chronically ill. [ABSTRACT FROM AUTHOR]

This paper discusses how social network analyses and graph theory can be implemented in team sports performance analyses to evaluate individual (micro) and collective (macro) performance data, and how to use this information for designing practice tasks. Moreover, we briefly outline possible limitations of social network studies and provide suggestions for future research. Instead of cataloguing discrete events or player actions, it has been argued that researchers need to consider the synergistic interpersonal processes emerging between teammates in competitive performance environments. Theoretical assumptions on team coordination prompted the emergence of innovative, theoretically driven methods for assessing collective team sport behaviours. Here, we contribute to this theoretical and practical debate by re-conceptualising sports teams as complex social networks. From this perspective, players are viewed as network nodes, connected through relevant information variables (e.g. a ball-passing action), sustaining complex patterns of interaction between teammates (e.g. a ball-passing network). Specialised tools and metrics related to graph theory could be applied to evaluate structural and topological properties of interpersonal interactions of teammates, complementing more traditional analysis methods. This innovative methodology moves beyond the use of common notation analysis methods, providing a richer understanding of the complexity of interpersonal interactions sustaining collective team sports performance. The proposed approach provides practical applications for coaches, performance analysts, practitioners and researchers by establishing social network analyses as a useful approach for capturing the emergent properties of interactions between players in sports teams. [ABSTRACT FROM AUTHOR]

Purpose: Despite the quantity of research on child and adolescent mental health being done in schools, little output has focused on the practical aspects of recruiting schools and students into a study. Furthermore, there is limited knowledge on how to develop and sustain productive and mutually beneficial partnerships with schools after the project finishes.Methods: A large study examining prevalence of mental health problems in young people involving nine schools is used as an example for the procedure of recruitment and carrying out a research project, while developing and sustaining partnerships with schools.Results: While recruiting the schools, a three-stage model was developed that corresponded closely to the school's needs and existing demands. The suggested procedure for the study, thus, closely reflected the varying existing cultures of participating schools. Partnerships, developed as a result of the project, were used in developing further projects and interventions for promoting good mental health in schools.Conclusions: Rather than a blanket research recruitment and procedural approach with an end to school involvement at the end of the project, the paper advocates for a deeper understanding of the schools' internal culture for improved recruitment and study outcomes. Developed partnerships, when sustained past the completion of research, prove to be a useful tool in applying the findings in promoting good mental health in schools and continuing research further. [ABSTRACT FROM AUTHOR]

Anxiety disorders are characterized by hyperactivity in both the amygdala and the anterior insula. Interventions that normalize activity in these areas may therefore be effective in treating anxiety disorders. Recently, there has been significant interest in the potential use of oxytocin (OT), as well as vasopressin (AVP) antagonists, as treatments for anxiety disorders. In this double-blind, placebo-controlled, pharmaco- fMRI study, 153 men and 151 women were randomized to treatment with either 24 IU intranasal OT, 20 IU intranasal AVP, or placebo and imaged with fMRI as they played the iterated Prisoner's Dilemma game with same-sex human and computer partners. In men, OT attenuated the fMRI response to unreciprocated cooperation (CD), a negative social interaction, within the amygdala and anterior insula. This effect was specific to interactions with human partners. In contrast, among women, OT unexpectedly attenuated the amygdala and anterior insula response to unreciprocated cooperation from computer but not human partners. Among women, AVP did not significantly modulate the response to unreciprocated cooperation in either the amygdala or the anterior insula. However, among men, AVP attenuated the BOLD response to CD outcomes with human partners across a relatively large cluster including the amygdala and the anterior insula, which was contrary to expectations. Our results suggest that OT may decrease the stress of negative social interactions among men, whereas these effects were not found in women interacting with human partners. These findings support continued investigation into the possible efficacy of OT as a treatment for anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs).Objective: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM).Design: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year.Participants: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD.Main Measures: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months.Key Results: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7% for PCM patients and 60.6% for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14% higher (p < 0.01) and mental health medication prescription rates that were 15.2% higher (p < 0.01) than patients with no engagement.Conclusions: A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs. [ABSTRACT FROM AUTHOR]

Purpose: Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals' experiences with the scheme. The purpose of this study was to examine health professionals' experiences with patients subject to outpatient commitment.Methods: This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis.Results: The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients' lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient.Conclusion: Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients' need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients' autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the bidirectional relationship between youth behaviours, more specifically opposition and aggression, and the types of interventions used by staff within a child welfare residential setting. Intervention forms were completed by staff after their interventions with youth. A total of 278 micro-interactions between staff and youth were coded from 84 forms. Generalised estimating equations were conducted controlling for past aggression during the intervention. Reminding youth of rules and using constraining methods were the interventions used with greater frequency when youth were oppositional or aggressive. These two interventions were also found to increase the odds of opposition and aggression among youth. [ABSTRACT FROM AUTHOR]

There is a consensus about the benefits of community-based participatory research and the important role it can play in reducing cancer health disparities. Although every community-based participatory research project is unique in many ways, several fundamental issues deserve consideration. We discuss issues concerning community representation, possible tensions within community-based participatory research (CBPR) projects, and staffing CBPR projects. Flexibility, open-mindedness, transparency, and above all, caring, are characteristics that best ensure successful and rewarding outcomes. [ABSTRACT FROM AUTHOR]

The study was a randomized controlled trial evaluating the efficacy of a brief and preventatively-focused parenting discussion group for dealing with disobedient behavior in preschool-aged children. Eighty-five parents with children aged between 3 and 5 years who were concerned about the noncompliant behavior of their child were recruited from Auckland, New Zealand and Brisbane, Australia. Compared to the waitlist control group (n = 40), parents in the intervention group (n = 45) reported greater improvements in disruptive child behavior, ineffective parenting practices and parenting confidence, as well as clinically significant improvements in child behavior and parenting. All of these effects were maintained at 6-month follow up. No group differences were found for parental wellbeing, inter-parental conflict and general relationship quality, although intervention parents reported improvements in parental wellbeing and inter-parental conflict at 6-month follow-up. The findings are discussed in terms of the implications for making brief and effective parenting support available to parents. [ABSTRACT FROM AUTHOR]

Background: During the last decades, pharmaceutical care services have been developed and implemented to optimize drug therapies and ensure medication safety. To investigate the need for pharmaceutical care services, drug-related problems can be measured.Objective: Thus, the aim of this study was to analyse number, type and occurrence of drug-related problems in different clinical departments.Setting: A pharmaceutical care service was established on general wards in Urology, Neurology and Gastroenterology at the University Hospital RWTH Aachen, Germany.Method: For each of a total of 306 patients, a pharmacist conducted an extended medication history, performed medication reconciliation, conducted medication safety checks and if drug-related problems were discovered, gave valid recommendations to the attending healthcare team. Drug-related problems were classified using the APS-Doc system. For statistical analyses, SAS(®) 9.1.3, SAS Institute, Cary NC, USA was applied. The project was approved by the local ethics committee.Main Outcome Measure: Type, occurrence and frequency of DRP in different medical departments.Results: On average, 2.3 drug-related problems per patient were documented for all three departments. Drug-related problems were found in each category of the APS-Doc system. The most pronounced drug-related problems found were drug-drug interactions (34.6 %). 37 % of the identified drug-related problems occurred before hospital admission, 27 % during transitional care, and 36 % on the ward. Subgroup analysis revealed specific drug-related problem patterns for each clinical department. The number of drug-related problems was found to be associated with the number of drugs and age.Conclusion: Drug-related problems frequently occur in all investigated clinical departments. A holistic pharmaceutical care service could be an option to address this issue. In case of limited resources, individual drug-related problem patterns can be used as a basis for a tailored pharmaceutical care service. As number of drugs and age have been shown to be significant risk factors, it is crucial that the healthcare team including the pharmacist pays special attention to elderly patients and those with polymedication. [ABSTRACT FROM AUTHOR]

Background: As traditional roles of pharmacists and physicians seem nowadays insufficient to ensure patient safety and therapy effectiveness, interprofessional collaboration has been suggested to improve health outcomes.Objective: To assess and compare the attitudes of physicians and pharmacists, as well as medical and pharmacy students in Croatia, toward interprofessional collaboration in primary health care.Methods: The study included 513 pharmacists and physicians, and 365 students of pharmacy and medicine from Croatia. The validated questionnaire, Scale of Attitudes Toward Physician–Pharmacist Collaboration, was translated in Croatian and completed, anonymously and voluntarily, by all participants. Results Pharmacists showed a more positive attitude toward collaboration than physicians (53.8 ± 4.8 vs. 50.7 ± 5.0). Pharmacy students expressed the most positive attitude (56.2 ± 4.9), while medical students showed the remarkably lowest attitude toward collaboration (44.6 ± 6.2).Conclusion: Pharmacists and physicians in Croatia expressed a relatively positive attitude toward their collaboration, comparable with their colleges in the USA. On the other hand, medical students expressed a 21 % less positive attitude than pharmacy students which could have an effect on interprofessional collaboration in the future when those students start working as health care professionals. Future studies, focusing on the promotion of this collaboration, on both under-graduated and post-graduated level, are warranted. [ABSTRACT FROM AUTHOR]

Recent research has examined the effects of oxytocin (OT) and vasopressin (AVP) on human social behavior and brain function. However, most participants have been male, while previous research in our lab demonstrated sexually differentiated effects of OT and AVP on the neural response to reciprocated cooperation. Here we extend our previous work by significantly increasing the number of participants to enable the use of more stringent statistical thresholds that permit more precise localization of OT and AVP effects in the brain. In a double-blind, placebo-controlled study, 153 men and 151 women were randomized to receive 24 IU intranasal OT, 20 IU intranasal AVP or placebo. Afterwards, they were imaged with fMRI while playing an iterated Prisoner's Dilemma Game with same-sex partners. Sex differences were observed for effects of OT on the neural response to reciprocated cooperation, such that OT increased the caduate/putamen response among males, whereas it decreased this response among females. Thus, 24 IU OT may increase the reward or salience of positive social interactions among men, while decreasing their reward or salience among women. Similar sex differences were also observed for AVP effects within bilateral insula and right supramarginal gyrus when a more liberal statistical threshold was employed. While our findings support previous suggestions that exogenous nonapeptides may be effective treatments for disorders such as depression and autism spectrum disorder, they caution against uniformly extending such treatments to men and women alike. [ABSTRACT FROM AUTHOR]

The widespread adoption of science-based prevention requires local infrastructures for prevention service delivery. Communities That Care (CTC) is a tested prevention service delivery system that enables a local coalition of community stakeholders to use a science-based approach to prevention and improve the behavioral health of young people. This paper uses data from the Community Youth Development Study (CYDS), a community-randomized trial of CTC, to examine the extent to which better internal team functioning of CTC coalitions increases the community-wide adoption of science-based prevention within 12 communities, relative to 12 matched comparison communities. Specifically, this paper examines the potential of both a direct relationship between coalition functioning and the community-wide adoption of science-based prevention and a direct relationship between functioning and the coalition capacities that ultimately enable the adoption of science-based prevention. Findings indicate no evidence of a direct relationship between four dimensions of coalition functioning and the community-wide adoption of a science-based approach to prevention, but suggest a relationship between coalition functioning and coalition capacities (building new member skills and establishing external linkages with existing community organizations) that enable science-based prevention. [ABSTRACT FROM AUTHOR]

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Introduction Stakeholder cooperation in return-to-work has been increasingly emphasized over the last years. However, there is a lack of empirical studies on the subject. This study explores different public stakeholders’ experiences of participating in Coordination Associations (CAs), a Swedish form of structured cooperation in return-to-work. The aim of the study is to determine the impact of stakeholder interests on the prerequisites for cooperation. Methods Thirty-five representatives from two CAs in eastern Sweden were interviewed regarding the aim, structure and strategies for their common work. Results Stakeholders’ actions are to a high degree determined by their institutional preferences and self-interest. In the CAs, the motives for cooperation differ, and although these differences supposedly could be overcome, they are in fact not. One of the stakeholders, the Public Employment Service, limit its interest to coordinating resources, while the other three wishes to engage in elaborated cooperative work forms, implying the crossing of organizational borders. This discrepancy can largely be attributed to the difficulties for representatives from state authorities in changing their priorities in order to make cooperation work. Conclusions Stakeholders’ interests have a high impact on the prerequisites for cooperation in return-to-work. By referring to organizational goals, stakeholders engage in non-cooperative behaviour, which threatens to spoil cooperative initiatives and to develop distrust in cooperative work forms. The results of this study expose the complexity of and threats to cooperation, and its conclusions may be used by return-to-work stakeholders in different jurisdictions to improve the possibilities for the development of cooperative structures. [ABSTRACT FROM AUTHOR]

Background: Effective collaboration and teamwork is essential in providing safe and effective hospital care. Prior research reveals deficiencies in collaboration on medical teaching units.Objective: The aim of this study was to assess the impact of an intervention, structured inter-disciplinary rounds (SIDR), on hospital care providers' ratings of collaboration and teamwork.Methods: The study was a controlled trial comparing an intervention medical teaching unit with a similar control unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We surveyed providers on each unit and asked them to rate the quality of communication and collaboration they had experienced with other disciplines using a five-point ordinal scale. We also assessed the teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost.Results: One hundred forty-seven of 159 (92%) eligible providers completed the survey. Although resident physicians on each unit rated the quality of communication and collaboration with nurses similarly, a greater percentage of nurses gave high ratings to the quality of collaboration with resident physicians on the intervention unit as compared to the control unit (74% vs. 44%; p = 0.02). Providers on the intervention unit rated the teamwork climate significantly higher as compared to the control unit (82.4 +/- 11.7 vs. 77.3 +/- 12.3; p = 0.01). The difference was explained by higher teamwork climate ratings on the part of nurses on the intervention unit (83.5 +/- 14.7 vs. 74.2 +/- 14.1; p = 0.005). Ratings of the safety climate were not significantly different between units. Adjusted LOS and hospital costs were not significantly different between units.Conclusions: SIDR had a positive effect on nurses' ratings of collaboration and teamwork on a medical teaching unit. Further study is required to assess the impact of SIDR on patient safety measures. [ABSTRACT FROM AUTHOR]

Background: Effective physician-nurse collaboration is an important, but incompletely understood determinant of patient and nurse satisfaction, and patient safety. Its impact on physicians has not been described. This study was undertaken to develop a fuller understanding of the collaboration experience and its outcomes.Methods: Twenty-five medical residents, 32 staff nurses, 5 physician and 5 nurse faculty wrote narratives about successful collaboration; the narratives were then qualitatively analyzed. Narrative analysis was the initial qualitative method iteratively employed to identify themes. A phenomenological approach was subsequently used to develop a framework for collaborative competence.Results: Collaboration triggers, facilitative behaviors, outcomes and collaborative competence were the themes identified. Affect was identified in the triggers leading to collaboration and in its outcomes. Practioners typically entered a care episode feeling worried, uncertain or inadequate and finished the interaction feeling satisfied, understood and grateful to their colleagues. The frequency of affective experience was not altered by gender, profession, or ethnicity. These experiences were particularly powerful for novice practioners of both disciplines and appear to have both formative and transformative potential. Collaborative competence was characterized by a series of graduated skills in clinical and relational domains. Many stories took place in the ICU and afterhours settings.Conclusions: Despite the prevailing wisdom that nursing and medicine are qualitatively different, the stories from this study illuminate surprising commonalities in the collaboration experience, regardless of gender, age, experience, or profession. Collaborative competence can be defined and its component skills identified. Contexts of care can be identified that offer particularly rich opportunities to foster interprofessional collaboration. [ABSTRACT FROM AUTHOR]

The author reflects on how the quality of hospital language services has been improved and measured. In relation to this, a program called Speaking Together: National Language Services Network has been launched by the Robert Wood Johnson Foundation. This is designed to improve the quality and availability of language services at hospitals in the U.S.

Background: To assess team collaboration in the context of laparoscopic surgery, laparoscopic cutting tasks performed by single operators and dyad teams were observed. Our previous work suggested that the anticipatory movement performed by a teammate may lead to a shorter total task time than for a single bimanual operator. This report further explores this phenomenon by quantifying the frequency of anticipatory movements and discussing their significance to team collaboration.Methods: Subjects were required to reach, grasp, and cut a piece of thread using a laparoscopic grasper and scissors. The task was performed by either 8 individual subjects bimanually or 16 paired subjects unimanually (using their preferred hands). The performances were video recorded. The total task time, the time used for thread grasping and cutting, and the number of anticipatory movements were computed and compared between the single operator and the dyad team group. In this report, anticipatory movement is defined as movements of the scissors before the completion of grasping and holding the thread.Results: Shorter durations of total task time were shown for the dyad than for the bimanual group. Anticipatory movements were counted significantly more often when the scissors were controlled by a teammate on the dyad team (96%) than when they were controlled by the preferred hand of the operator (45%). The number of anticipatory movements increased with practice, but no significant difference was shown among practice phases.Conclusion: Higher frequency of anticipatory movement was observed in the dyad team, which led to superior performance for team collaboration, as compared with that of the single operator. Performance of anticipatory movements in the dyad team was explained by a shared mental model, which postulates combined capacity for information processing among team members. Results have implications for surgical education, team training, and error prevention in the performance of laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes.Objective: We examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes.Design: Controlled pre- and postintervention study.Patients/participants: Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites.Measurements and Main Results: Ten-year risk of cardiovascular disease; determined using a modified United Kingdom Prospective Diabetes Study risk engine score. A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria. The baseline mean 10-year risk of cardiovascular disease was 31% for both the intervention group and the control group. Participants in both groups had improved blood pressure, lipid levels, and HbA1c levels during the observation period. Random intercept hierarchical regression models showed that the intervention group had a 2.1% (95% CI -3.7%, -0.5%) greater reduction in predicted risk for future cardiovascular events when compared to the control group. This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention.Conclusions: Over a 1-year interval, this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization's settings. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction. [ABSTRACT FROM AUTHOR]

Goals Of the Work: To identify possible effects of an interprofessional breaking bad news course for medical and nursing students on perceived key communication skills and to elicit the views of participants on interprofessional aspects of breaking bad news.Participants and Methods: Medical and nursing students attending an optional course on breaking bad news received a structured questionnaire on self-perceived communication skills and views on interprofessional aspects at the beginning and end of the course.Main Results: Forty-seven out of 54 students completed the evaluation questionnaires (response rate=87%). Medical students and nursing students rated their key communication skills after the course as significantly better compared with the beginning of the course. Medical students and nursing students disagreed with the statement that a course format for only one of the professional groups would have been more effective than the interprofessional course concept.Conclusions: Students valued the concept of the interprofessional course positively. The improvement of self-perceived communication skills may be interpreted as a positive effect of the teaching session. Further research is necessary to develop strategies to implement a collaborative approach in breaking bad news in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications.Objective: To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications.Design: The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications.Patients: Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan.Measurements: Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records.Results: The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care.Conclusion: Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems. [ABSTRACT FROM AUTHOR]

In this Perspective article, I consider ways in which the contemporary arts and sciences can interact with each other, and I outline the current opportunities for funding in the United Kingdom. I examine the view that, in an art-science collaboration, it is the artist who benefits most, and I cautiously suggest that this is an oversimplification. Evidence from interviews with scientists who have been involved in these collaborations shows that artistic experience and skills are of value in the scientific research process. [ABSTRACT FROM AUTHOR]

Objectives: Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant).Design: Stratified case-controlled study.Patients/participants: Twenty family medicine and internal medicine physicians and 135 patients.Measurements: Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation.Main Results: Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation.Conclusions: Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that increases in one often lead to increases in the other. [ABSTRACT FROM AUTHOR]

This study analyzed the relationship between social network dynamics and initial help-seeking behaviors. The primary social network was reconstructed for the period beginning with initial observation of unusual behavior and ending with first psychiatric hospitalization. The social network's influence was analyzed based on the concept of social network cohesion, considering both structure and content of social ties. The results demonstrate that networks succeed in referring the family member to services and in maintaining a clinical follow-up to the degree that they are cohesive. When a network lacks cohesiveness, the onset and development of problem behaviors are less easily recognized. These findings confirm the importance of social and interactional contexts in decision-making processes leading to use of psychiatric services and specify the roles they play. [ABSTRACT FROM AUTHOR]

New and emerging collaborative responses to sex offender management are challenging traditional notions about how treatment providers and probation and parole officers (POs) deliver services to this difficult population. Typically, sex offender treatment professionals provide community-based services to offenders who are supervised by POs. Yet, no comprehensive survey has investigated how treatment providers and POs collaborate and view their relationships with each other. This national random survey examined the beliefs and behaviors of community-based adult sex-offender treatment providers concerning various types of provider and PO interactions and collaborative models. Overall, treatment providers reported that they value frequent and substantive communication with POs concerning mutual clients. There was, however, considerable diversity in practice and opinion among providers with regard to POs leading, coleading, and observing sex offender treatment groups. Treatment providers' opinions about various clinical, ethical, and legal issues evident in these collaborative approaches are examined. [ABSTRACT FROM AUTHOR]

Child noncompliance is a core maladjustment factor in current clinical models of aggression and antisocial development. However, little is known about the relations among qualitative aspects of child noncompliance and aggressive maladjustment. The authors developed the Response Style Questionnaire, an instrument designed to measure the multidimensional qualities of child noncompliance, and tested its validity and reliability. Tests of internal validity provided a five-factor solution, featuring distinctions in noncompliance quality between and among skilled noncompliance (verbally skilled and emotionally regulated) and unskilled noncompliance (overt/confrontational, covert/sneaky, and emotionally labile). Theory-driven tests of external validity using peer-adjustment variables as criteria provided discriminant prediction (a) among qualitatively distinct aspects of noncompliance and (b) between noncompliance qualities and rate. Discussion focuses on a modified view of the nature and role of noncompliance in aggressive and antisocial development. [ABSTRACT FROM AUTHOR]

Compliance with the consultant's recommendations is one measure of the effectiveness of a consultation. A previous study showed that compliance was better when fewer recommendations were made. In the subsequent year, consultants were encouraged to limit their recommendations to five or fewer. Despite a significant decrease in the number of recommendations, compliance rates remained essentially unchanged (72%). Multivariate analysis demonstrated that the clinical severity of the patient's disease and the number of associated problems, as well as the types of recommendations, were significant predictors of compliance. Compliance was best for recommendations involving medications (84%) and worst for recommendations involving diagnostic tests (62%). Compliance was also evaluated in the context of a surgeon's view of the appropriateness of the recommendations. For recommendations felt to be essential to patient care the compliance rate was 75%, but it was only 44% for recommendations judged nonessential (p less than 0.001). The consulting internist should be aware that the surgeon's view of the relevance of the recommendations to patient care needs may have an important effect on compliance. [ABSTRACT FROM AUTHOR]

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Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)