Safety Culture in the Gynecology Robotics Operating Room

Study ObjectiveTo measure the safety culture in the robotics surgery operating room before and after implementation of the Robotic Operating Room Computerized Checklist (RORCC).DesignProspective study.SubjectsGynecology surgical staff (n = 32).SettingAn urban community hospital.InterventionsThe Safety Attitudes Questionnaire domains examined were teamwork, safety, job satisfaction, stress recognition, perceptions of management, and working conditions. Questions and domains were described using percent agreement and the Cronbach alpha. Paired t-tests were used to describe differences before and after implementation of the checklist.Measurements and Main ResultsMean (SD) staff age was 46.7 (9.5) years, and most were women (78%) and worked full-time (97%). Twenty respondents (83% of nurses, 80% of surgeons, 66% of surgical technicians, and 33% of certified registered nurse anesthetists) completed the Safety Attitudes Questionnaire; 6 were excluded because of non-matching identifiers. Before RORCC implementation, the highest quality of communication and collaboration was reported by surgeons and surgical technicians (100%). Certified registered nurse anesthetists reported only adequate levels of communication and collaboration with other positions. Most staff reported positive responses for teamwork (48%; α = 0.81), safety (47%; α = 0.75), working conditions (37%; α = 0.55), stress recognition (26%; α = 0.71), and perceptions of management (32%; α = 0.52). No differences were observed after RORCC implementation.ConclusionQuality of communication and collaboration in the gynecology robotics operating room is high between most positions; however, safety attitude responses are low overall. No differences after RORCC implementation and low response rates may highlight lack of staff support.     

Assessing emotional and behavioral problems in children with intellectual disability: revisiting the factor structure of the developmental behavior checklist

The objective of the reported study was to reassess the factor structure of the Developmental Behaviour Checklist (DBC) in a large cross-cultural sample representing all levels of intellectual disability. Parent and teacher DBC ratings on a combined sample of 1536 Dutch and Australian children and adolescents (ages 3–22) with mild to profound intellectual disability were used. Principal components analyses produced five subscales: Disruptive/Antisocial, Self-Absorbed, Communication Disturbance, Anxiety, and Social Relating, explaining 43.7% of the total variance. Internal consistencies of these subscales ranged from .66 to .91. The revised factor structure of the DBC appears to be an improved and useful tool for assessing emotional and behavioral problems in children with intellectual disabilities.     

标准化病人在循证医学教学中的作用

采用标准化病人（standardized patient,SP）模拟临床场景实践和考核医学生,强化和促进临床技能的掌握,而且促进循证医学教学的实践性、社会性,以此获得个体病人特征和重要信息,这是搜寻循证最佳证据以及积累丰富经验的基础和前提.循证医学强调“以病人为中心”的教学,不同的个体病人在循证决策中应采取不同的策略和形式.     

The development and adjustment of 7-year-old children adopted in infancy

The present study (N = 159) provides evidence of an increased risk for behavior problems of infant-placed 7-year-old internationally, transracially adopted children in the Netherlands. However, parents reported more behavior problems for adopted boys than for adopted girls. Notably, about 30% of the adopted children were classified as clinical on the CBCL scale for total problems, which is a much larger percentage than the 10% found in the normative population. It was suggested that these results could be explained by the operation of multiple risk factors before and after adoption placement, e.g. the child's genetic disposition, pre-natal and pre-adoption care, or the child's cognitive understanding of adoption in middle childhood. Also, results suggest that maternal sensitive responsiveness in adoptive families declines in the transition from early to middle childhood. In contrast to the home setting, the adopted children showed favorable behavioral and socioemotional adjustment at school, while their academic achievement and intelligence were in the normal range or above average. In particular Korean children had high IQs: 31% of these children obtained an intelligence score above 120. It was suggested that adoptive parents seem to offer their children sufficient or even more than average cognitive stimulation. Furthermore, adopted girls scored higher in optimal ego-control, social competence, and peer group popularity than nonadopted girls from the general population: 30% of the adopted girls were rated as popular by their classmates, which compares favorably to the 13% found in the general school population.     

Mental health in international adoptees as teenagers and young adults. An epidemiological study

Sweden has now around 38,000 individuals who have been adopted from other countries. Most often they are transracially adopted and have a different appearance from their new parents—"visible " adoptions. This study was made to explore the mental health of a teenager/young adult group that arrived with their families in the southernmost county of Sweden between 1970 and 1977. They were placed through the largest Swedish adoption agency at that time. One hundred and forty-seven families and their 211 adopted children, who were 13 years of age or older at the time of the investigation, were interviewed in their homes. CBCL, SCL-90, a self-esteem questionnaire, and two family relations inventories were also completed. Compared to nonadopted Swedish young persons of the same ages, who had been investigated with the same inventories in earlier epidemiological studies, the adoptees had as good mental health. The adoptees also reported good self-esteem. The pre-adoption conditions were more important than the age of arrival in itself for the risk of later maladaptation. Family relations, various aspects of identity, and peer relations explained much of the variance of mental health and self-esteem. Those who were most engaged in questions about their identity and felt mostly non-Swedish had more behaviour problems. The association, however, between the factor " Identity " and the mental health variables approached zero for the older subjects (18–27 years of age). The majority (about 90%) of the adoptees felt mostly Swedish. Seventy per cent didn't feel any connection to their country of origin.     

The prevalence of child-psychiatric disorders among 8-9-year-old children in Danish mainstream schools

OBJECTIVE: Prevalence rates for child psychopathology in Denmark are unknown; and efficient screening and non-respondent analyses are essential for epidemiological purposes. METHOD: A multi-method strategy involving a two-step design: first screening of 621 children between the ages of 8-9 years attending mainstream education using the Child Behaviour Checklist (CBCL). Second, screen-positive probands and a sample of screen-negative probands were given in-depth child-psychiatric assessment. In cases of non-respondents, children were assessed by teachers. RESULTS: CBCL screening results were compared with case status in clinical assessment. A positive predictive value of 0.25 and a correct classification rate (CCR) of 0.72 were obtained. The teacher interviews, used in cases of non-respondents, had a CCR of 0.87. According to DSM-IV criteria, the prevalence rate of psychiatric disorders was 10.l% [95% CI; 7.0-13.2]. CONCLUSIONS: The CBCL proved an effective screening tool. The brief interview with teachers is a valid assessment of psychiatric disorders among non-respondents.     

Testing a maternal attachment model of behavior problems in early childhood

BACKGROUND: The purpose of the present study was to test a maternal attachment model of behavior problems in early childhood using phase I data from the NICHD Study of Early Child Care, a prospective study of 1,364 children from birth through sixth grade. METHODS: Mothers' and caregivers' ratings of children's internalizing and externalizing problems at age three were regressed separately on a set of fifteen predictors that included security and disorganization scores from 15, 24, and 36 months using hierarchical and logistical modeling. RESULTS: There were three main findings. First, Q-set mother-child attachment security, based on home observations at 24 months, provided the best evidence that attachment was associated with behavior problems, especially above-average levels of problems. Second, insecurity in the 36-month modified Strange Situation predicted mothers' and caregivers' ratings of internalizing problems for boys and girls as well as their ratings of externalizing problems for boys. Third, maternal depressive symptoms predicted mothers' ratings of internalizing and externalizing problems. CONCLUSIONS: There are meaningful associations between attachment insecurity and behavior problems as assessed not only by mothers but also by caregivers.     

Psychological adjustment in children and adults with congenital adrenal hyperplasia

OBJECTIVE: To determine psychological health in individuals with one form of intersexuality, congenital adrenal hyperplasia (CAH), and its relation to characteristics of the disease and treatment. STUDY DESIGN: Participants (ages 3-31 years) included 72 females and 42 males with CAH, and unaffected relatives (44 females and 69 males). Psychological adjustment was assessed with parent-reports on the Child Behavior Checklist (CBCL) and subject self-reports on the Self-Image Questionnaire for Young Adolescents (SIQYA) or the Multidimensional Personality Questionnaire (MPQ). Information about disease characteristics and genital surgery was obtained from medical records. RESULTS: There were no significant differences between females with CAH and unaffected females on any measure. Psychological adjustment was not significantly associated with genital virilization or age at genital surgery. Males with CAH were not significantly different from unaffected males in childhood, but they showed more negative affect at older ages. CONCLUSIONS: Psychological adjustment is not compromised in females with virilized genitalia who are treated early in life and reared as females. Adjustment does not appear to depend on the characteristics of the disease or its treatment, but sample size and restricted range limit generalizability about adjustment-disease associations.     

Evaluation of four highly cited energy and fatigue mood measures

This paper evaluates four highly cited measures of energy and fatigue moods. Substantial experimental and correlational evidence supports the conclusion that scores from the vitality scale of the SF-36 Health Survey can provide a valid measure of the recalled frequency of month-long feelings of energy and fatigue. Substantial experimental and correlational evidence supports the conclusion that scores from the fatigue and vigor scales of the Profile of Mood States (POMS) can provide reliable and valid measures the intensity of both week-long and "right now" fatigue and energy mood states, respectively. A smaller body of evidence supports the conclusion that scores from the energy scale of the Activation-Deactivation Adjective Checklist (AD-ACL) can provide a valid measure of the "right now" mood of energy; however, the energy scale of the AD-ACL has several limitations compared to the POMS vigor scale. All the measures lacked integration within a compelling theory of the mood of energy-fatigue. It is concluded that progress in understanding of energy and fatigue mood states will be aided by advances in both the psychobiological conceptualization of fatigue and energy mood states and their measurement.     

The predictors of unsuccessful transition to foster care

The placement movements of 235 children entering foster care over a 12-month period were followed up 4 months after referral into care. Baseline and follow-up measures of the 170 children who were still in care at follow-up were also compared. Results indicated that adolescents with mental health or behavioural problems were the least likely to achieve placement stability or to display improved psychological adjustment in care. In fact, unsatisfactory transition to foster care was found to be so prevalent among these children that conventional foster family care should be considered unsuitable for them. The paper concludes that there is an urgent need for a wider range of alternative care options for the adolescent population.