Just Culture: Practical Implementation for Radiologist Peer Review

Peer review is a cornerstone of quality improvement programs and serves to support the peer learning process. Peer review in radiology incorporates the review of diagnostic imaging interpretation, interventional procedures, communication, and the evaluation of untoward patient events. A just culture is an environment in which errors and near-miss events are evaluated in a deliberately nonpunitive framework, avoiding a culture of blame and responsibility and focusing instead on error prevention and fostering a culture of continuous quality improvement. Adoption of a just culture requires careful attention to detail and relies on continuous coaching of individuals and teams to ensure future systems improvements and a culture of safety. The authors describe the practical implementation of a just culture framework for peer review in an academic radiology department and highlight its application to interpretive, noninterpretive, and procedural domains through case examples.     

Relations among multiple peer influences, body dissatisfaction, eating disturbance, and self-esteem: a comparison of average weight, at risk of overweight, and overweight adolescent girls

OBJECTIVE: The goal of this study was to evaluate peer-related influences on appearance, body dissatisfaction, eating disturbance, and self-esteem in average weight, at risk of overweight, and overweight adolescent girls. METHODS: Three hundred twenty-five adolescent girls from high schools in Florida were assessed. Ninety met criteria for being at risk of overweight or overweight. Logistic and multiple regression analyses were used to evaluate group differences on all variables and to assess the amount of variance accounted for by peer-influence variables in the prediction of body dissatisfaction, eating disturbance, and self-esteem. RESULTS: Overweight and at risk of overweight girls scored higher than average weight girls on body dissatisfaction, dieting, and a peer measure that assessed negative comments and attributions about appearance. They also scored lower than average weight girls on self-report measures that assessed conversations about appearance and anti-dieting advice. How influential friends were in determining one's body image was a unique predictor of body dissatisfaction but only for the overweight and at risk of overweight group. CONCLUSIONS: Possible implications for clinical intervention programs are discussed along with directions for future research.     

Alcohol-related affordances and group subjectivities: A Q-Methodology study

Aims: An Ecological approach to alcohol behaviour focuses on understanding individual–environment transactions, rather than on cognitive antecedents of behaviour. Meaning exists in the interdependence of individuals and their environments, in terms of affordances. Through subjective experience, this study focussed on group viewpoints related to alcohol-related affordances, or opportunities to consume alcohol in shared drinking environments. Methods: Forty students with a range of self-reported drinking behaviours participated in a Q-Methodology study, ranking 60 statements along a symmetrical grid. This varied concourse of alcohol-related affordances was obtained from a previous observation study within licenced premises and a photo-elicitation interview study with drinkers. Findings: Factor analysis and post-sort interviews revealed four subjective perspectives held by groups about their drinking behaviour: 13 participants were aware of contextual influences, but autonomous in their drinking choices; 12 participants were conscious of influences and compliant to their effects; six participants were unaware of influences, but unanimous with their peers; two participants were concerned about acting appropriately in a context by taking up canonical affordances. Conclusions: Grouping subjectivities from a varied concourse of affordances can reveal subjective experience in relation to drinking environments and alcohol behaviour. This conceptual approach for understanding drinking behaviour should be studied further.     

Regional and district peer effects in obesity: A UK panel data analysis

Most research concerning the causes of obesity has focused on macroeconomic trends or individual‐level determinants relating to socioeconomic status. There is now growing interest in the psychosocial determinants of obesity. Little research has been conducted into wide‐scale peer effects and so the aim of this study was to determine whether regional and district peer effects determine individual‐level obesity in the UK. Data from the British Household Panel Survey (for the years 2004 and 2006) were used to model individual‐level BMI and probability of obesity as a function of regional and district BMI, controlling for a variety of other variables. Instrumental variable techniques were used to investigate simultaneity bias. We found no statistically significant regional peer effect in the UK. For men, we found that a 1 point increase in average district BMI increased individual BMI by 0.640 and probability of being obese by 1.9% points; for women, BMI increased by 0.230 and probability of being obese by 1.6% points. Men appear to be more susceptible to these effects than women. Peer effects at the district level may have played a significant role in the rise of obesity in the UK. Further research must aim to disentangle the two routes by which these processes are theorised to function.     

Engaging new refugee in Australian communities at risk for chronic hepatitis B infection into care: A peer‐educator intervention

Chronic Hepatitis B (CHB) infection and subsequent liver complications are rising in prevalence in Australia due to increased migration from endemic regions. Nearly 50% of all those living with CHB in Australia are undiagnosed, leading to missed opportunities for liver cancer and cirrhosis prevention. Health literacy around CHB among refugee communities such as Afghan, Rohingyan, and Sudanese populations (all with a high prevalence of CHB) is low, partly due to a paucity of targeted health promotion programmes; despite the release of the Victorian Hepatitis B Strategy (2016–2020). We developed a peer‐education intervention in these three communities to deliver CHB focused radio programmes and community forums in their own language, following a needs assessment consisting of semistructured interviews and surveys. Effectiveness of this intervention was measured through paired comparison of disease‐knowledge assessment pre and post forum. Community forums were held between 2015 and 2016, with 25 attendees at the Rohingyan forum (68% male), 10 attendees at the Afghan forum (90% male) and 0 attendees at the Sudanese forum. Participants demonstrated a significant improvement in CHB knowledge between pre‐ and post‐forum surveys (p‐value < 0.05). A peer‐educator approach was a cost‐effective health promotion strategy in building CHB knowledge and dispelling misconceptions within the Afghan and Rohingya communities. There were significant barriers in the engagement of the South Sudanese community, which will inform future strategies for health promotion.     

Incarceration history,social network composition,and substance use among homeless youth in Los Angeles

Background: Homeless youth in the United States have high rates of substance use. Existing research has identified social network composition and street-associated stressors as contributing factors. Incarceration is a highly prevalent stressor for homeless youth. Its effect on youth’s social network composition and substance use, however, has been neglected.

Aims: This study investigated the direct and indirect associations between incarceration history and substance use (through social networks) among homeless youth in Los Angeles, California.

Methods: A sample of 1047 homeless youths were recruited between 2011 and 2013. Computerized self-administrated surveys and social network interviews were conducted to collect youth’s sociodemographic characteristics, incarceration history, social network composition, and substance use. Bootstrapping was used to identify the direct and indirect associations between youth’s incarceration history and substance use.

Results: Incarceration history was positively associated with youth’s cannabis, methamphetamine, and injection drug use. The percentage of cannabis-using peers partially mediated the associations between incarceration history and youth’s cannabis, cocaine, and heroin use. The percentage of methamphetamine-using peers partially mediated the associations between incarceration history and youth's methamphetamine, cocaine, and injection drug use. The percentage of heroin-using peers partially mediated the association between incarceration history and youth’s heroin use. Moreover, the percentage of peers who inject drugs partially mediated the associations between incarceration history and youth’s methamphetamine, heroin, and injection drug use.

Discussion: Incarceration history should be taken to a more central place in future research and practice with homeless youth in the United States.     

Peer-Led Seeking Safety: Results of a Pilot Outcome Study with Relevance to Public Health

There is a rich history of peer-led recovery efforts related to substance use disorder (SUD). Yet we know of no peer-led approaches for co-occurring SUD and trauma-related problems. This combination is widespread, has impact on multiple life domains, and presents major recovery challenges. In this pilot, we evaluated peer-led Seeking Safety (SS). SS is the most evidence-based and widely implemented therapy for SUD with co-occurring PTSD or other trauma-related problems. Eighteen women in residential substance-abuse treatment participated. All met SUD criteria (primarily opiate and cocaine dependence); most had a comorbid mental health disorder; and they had elevated trauma-related symptoms. The 25 SS topics were conducted twice-weekly. Participants were assessed at baseline and end-of-treatment, with some measures also collected monthly. Results showed significant positive outcomes in trauma-related problems (the Trauma Symptom Checklist-40); psychopathology (the Brief Symptom Inventory); functioning (the BASIS-32, including impulsive-addictive behavior); self-compassion (the Self-Compassion Scale); and SS coping skills. Effect sizes were consistently large. SS satisfaction and fidelity ratings were high. Substance use levels could not be assessed due to the residential setting. Qualitative data indicated enthusiasm for peer-SS by both peers and staff. Study limitations, future research, and public health relevance are discussed.