A multiple case study of data use practice in eight early childhood centres in the Republic of Trinidad and Tobago

ABSTRACT

Formative assessment and effective use of data to support student learning are key components of practice in early childhood (EC) centres. Although Trinidad and Tobago has developed an impressive EC care system, to decrease the achievement gap which international studies have shown to be significant in core subjects, educational planners must ensure that teachers make better use of data. This study explored data use practice in eight geographically diverse EC centres. Using maximum variation sampling, data were collected from focus group teacher interviews, observation and document analysis. Thematic analysis and constant comparison were used to identify differences across sites and to generate theory on practice. The theory identifies data use practice in an emerging Caribbean society lacking a robust data culture and with limited professional development opportunities. Implications for policy, professional sdevelopment and system reform of the EC sector in Trinidad and Tobago are included.     

Understanding how nurse practitioners estimate patients' risk for coronary heart disease: a judgment analysis

AIM: This paper is a report of a study to examine how nurse practitioners combine information when estimating patient risk of coronary heart disease. BACKGROUND: In the United States of America and other countries, nurse practitioners are increasingly working alongside physicians in primary healthcare settings. Given this role, nurse practitioners represent an important resource in early detection of numerous diseases. Understanding how nurse practitioners use patient characteristics (cues) to form estimates of patient risk for disease may improve general disease prevention efforts. METHOD: Social judgment theory and its lens model analysis are concerned with the correspondence between a person's judgments and the environment. This approach was applied to examine how 15 nurse practitioners weighted eight risk factors for coronary heart disease, how accurate practitioners were in assessing patient risk for coronary heart disease, and how much self-insight practitioners had into their own risk estimation processes. The data were collected in 2006. RESULTS: Nurse practitioners showed moderate to high accuracy and evinced a variety of cue-weighting strategies. Insight into their own judgment policies was modest. The lens model analysis revealed that most practitioners had lower values on knowledge of the ecology than they did on cognitive control. CONCLUSION: Educational efforts aimed at improving detection of patients at risk for diseases might do better to target increasing clinicians' understanding of cue-criteria relationships, than to stress themes of consistency in evaluating patients.     

Patient and Surgeon Risk-Taking Regarding Total Joint Arthroplasty

BackgroundDecisions regarding care for osteoarthritis involve physicians helping patients understand likely benefits and harms of treatment. Little work has directly compared patient and surgeon risk-taking attitudes, which may help inform strategies for shared decision-making and improve patient satisfaction.MethodsWe surveyed patients contemplating total joint arthroplasty visiting a high-volume specialty hospital regarding general questions about risk-taking, as well as willingness to undergo surgery under hypothetical likelihoods of moderate improvement and complications. We compared responses from surgeons answering similar questions about willingness to recommend surgery.ResultsAltogether 82% (162/197) of patients responded, as did 65% (30/46) of joint replacement surgeons. Mean age among patients was 66.4 years; 58% were female. Surgeons averaged 399 surgeries in 2019. Responses were similar between groups for general, health, career, financial, and sports/leisure risk-taking (P > .20); surgeons were marginally more risk-taking in driving (P = .05). For willingness to have or recommend surgery, as the chance of benefit decreased, or the chance of harm increased, the percentage willing to have or recommend surgery decreased. Between a 70% and 95% chance of moderate improvement (for a 2% complication risk), as well as between a 90% and 95% chance of moderate improvement (for 4% and 6% complication risks), the percentage willing to have or recommend surgery was indistinguishable between patients and surgeons. However, for lower likelihoods of improvement, a higher percentage of patients were willing to undergo surgery than surgeons recommended. Patients were also more often indifferent between complication risks.ConclusionAlthough patients and surgeons were often willing to have or recommend joint replacement surgery at similar rates, they diverged for lower-benefit higher-harm scenarios.     

Evolving Impact of COVID-19 on Transplant Center Practices and Policies in the United States

In our first survey of transplant centers in March 2020, >75% of kidney and liver programs were either suspended or operating under restrictions. To safely resume transplantation, we must understand the evolving impact of COVID-19 on transplant recipients and center-level practices. We therefore conducted a six-week follow-up survey May 7-15, 2020, and linked responses to the COVID-19 incidence map, with a response rate of 84%. Suspension of live donor transplantation decreased from 72% in March to 30% in May for kidneys and from 68% to 52% for livers. Restrictions/suspension of deceased donor transplantation decreased from 84% to 58% for kidneys and from 73% to 42% for livers. Resuming transplantation at normal capacity was envisioned by 83% of programs by August 2020. Exclusively using local recovery teams for deceased donor procurement was reported by 28%. Respondents reported caring for a total of 1166 COVID-19–positive transplant recipients; 25% were critically ill. Telemedicine challenges were reported by 81%. There was a lack of consensus regarding management of potential living donors or candidates with SARS-CoV-2. Our findings demonstrate persistent heterogeneity in center-level response to COVID-19 even as transplant activity resumes, making ongoing national data collection and real-time analysis critical to inform best practices.     

Factors influencing defensive medicine-based decision-making in primary care: A scoping review

Rationale, Aims and Objectives

Medical decision-making processes in primary care are influenced by defensive medical practice. This involves a high possibility for negative consequences on many levels, for example, patient's health, health care system costs and a crisis of trust in the patient−doctor relationship. Aim of this review was to identify factors of defensive medicine-based decision-making in primary care.

Methods

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) guidelines and included systematic research on MEDLINE, Google Scholar and two German databases for additional grey literature. References provided further literature. Articles in English and German published from 1 January 1982 to 15 June 2022 were assessed.

Results

From 911 publications screened, 13 publications [6 qualitative studies and 7 quantitative (3 cross-sectional) studies] were included. In these, four main categories of factors influencing defensive medical practice were identified: (social) media, patients adopting a consumer attitude, health care system based working conditions and physician's tolerance for uncertainty. Pressure deriving from these four different sources is exerted on the general practitioner and may result in a defensive medical decision behaviour.

Conclusions

Four categories on influencing factors of defensive medicine could be identified. Strategies to tolerate uncertainty should be trained in under- and postgraduate training.     

Dopaminergic Influences on Emotional Decision Making in Euthymic Bipolar Patients

We recently reported that the D2/D3 agonist pramipexole may have pro-cognitive effects in euthymic patients with bipolar disorder (BPD); however, the emergence of impulse-control disorders has been documented in Parkinson''s disease (PD) after pramipexole treatment. Performance on reward-based tasks is altered in healthy subjects after a single dose of pramipexole, but its potential to induce abnormalities in BPD patients is unknown. We assessed reward-dependent decision making in euthymic BPD patients pre- and post 8 weeks of treatment with pramipexole or placebo by using the Iowa Gambling Task (IGT). The IGT requires subjects to choose among four card decks (two risky and two conservative) and is designed to promote learning to make advantageous (conservative) choices over time. Thirty-four BPD patients completed both assessments (18 placebo and 16 pramipexole). Baseline performance did not differ by treatment group (F=0.63; p=0.64); however, at week 8, BPD patients on pramipexole demonstrated a significantly greater tendency to make increasingly high-risk, high-reward choices across the five blocks, whereas the placebo group''s pattern was similar to that reported in healthy individuals (treatment × time × block interaction, p<0.05). Analyses of choice strategy using the expectancy valence model revealed that after 8 weeks on pramipexole, BPD patients attended more readily to feedback related to gains than to losses, which could explain the impaired learning. There were no significant changes in mood symptoms over the 8 weeks, and no increased propensity toward manic-like behaviors were reported. Our results suggest that the enhancement of dopaminergic activity influences risk-associated decision-making performance in euthymic BPD. The clinical implications remain unknown.