The relational underpinnings of quality internal auditing in medical clinics in Israel

Internal auditing is a key mechanism in enhancing organizational reliability. However, research on the ways quality internal auditing is enabled through learning, deterrence, motivation and process improvement is scant. In particular, the relational underpinnings of internal auditing have been understudied. This study attempts to address this need by examining how organizational trust, perceived organizational support and psychological safety enable internal auditing. Data collected from employees in medical clinics of one of the largest healthcare organizations in Israel at two points in time six months apart. Our results show that organizational trust and perceived organizational support are positively related to psychological safety (measured at time 1), which, in turn, is associated with internal auditing (measured at time 2).     

Disease-related social and family life: people coping with rheumatoid arthritis in Estonia

Objective: The aim of the article is to investigate the most severe problems aggravating the quality of life of people with rheumatism and to outline the role of support and assistance people with rheumatism receive from their family members/acquaintances in order to cope with their daily life. Methods: The article is based on the data and findings of the national sociological survey ‘Chronic Rheumatic Patients 2006’ carried out by the Rheumatic Association of Tallinn in the years 2005–2006 with the support from the Ministry of Social Affairs of Estonia. Data were collected via a questionnaire from 808 respondents. Results: The respondents indicated their state of health and shortage of money as their most severe problems, followed by dysfunctional family relations, poor living conditions, loneliness, etc. The problems are more severe for the respondents who live alone and have been coping with illness for over 10 years. The assistance received from relatives/acquaintances to cope with daily life is more varied and thorough than that received from children. Assistance is mostly received occasionally. On average, every tenth respondent does not have anyone to turn to for assistance. Conclusion: Severe problems and stress symptoms display a cumulative effect–the occurrence of one aspect often triggers others. To break this vicious circle, people with rheumatism need assistance and support from the state as well as from their immediate environment.     

Bayes分析指导孤立性肺结节的临床决策

目的：探讨Bayes分析指导孤立性肺结节（solitary pulmonary nodules, SPN）临床决策的可行性及其临床意义。方法：利用Bayes分析法先从352例SPN训练集（恶性135例,良性217例）中求出恶性SPN的验前比及各临床和CT表现的似然比,再以此计算每个SPN的恶性概率。比较Bayes分析与医生常规判断132例SPN测试集（恶性61例,良性71例）样本的诊断效能,并分析在不同计算概率下的实际诊断结果。结果：Bayes分析诊断测试集SPN的敏感度、特异度、符合率、阳性预测值及阴性预测值分别为88.5％,85.9％,87.1％,84.4％,89.7％,其诊断符合率与高年资甲、乙医生比较无统计学差异（均P＞0.05）,但高于低年资丙、丁医生（均P＜0.05）;Bayes分析,高年资甲、乙医生及低年资丙、丁医生的Brier值分别为0.099,0.140,0.137,0.154,0.179;除外被错判的11例孤立性肺转移瘤,Bayes分析法估算概率＜20％的假阴性率为1.0％（5/484）。结论：运用Bayes分析诊断SPN性质的符合率高,预测恶性概率的精度高,且假阴性率低,用于指导SPN的临床决策具有一定的可行性。     

人工肝技术发展概况

人工肝的研究已有五十余年的历史。近年,人工肝的临床应用已成为新一代的研究热点。本文着重对各型人工肝的组成、应用及其前景和存在问题进行扼要综述。     

Effects of exogenous factors on spatial accuracy in neurosurgery

The study aimed to assess the effect of exogenous factors such as surgeon posture, surgical instrument length, fatigue after a night shift, exercise and caffeine consumption on the spatial accuracy of neurosurgical manipulations. For the evaluation and simulation of neurosurgical manipulations, a testing device developed by the authors was used. The experimental results were compared using nonparametric analysis (Wilcoxon test) and multivariate analysis, which was performed using mixed models. The results were considered statistically significant at p < 0.05. The study included 11 first-year neurosurgery residents who met the inclusion criteria. Hand support in the sitting position (Wilcoxon test p value = 0.0033), caffeine consumption (p = 0.0058) and the length of the microsurgical instrument (p = 0.0032) had statistically significant influences on the spatial accuracy of surgical manipulations (univariate analysis). The spatial accuracy did not significantly depend on the type of standing position (Wilcoxon test p value = 0.2860), whether the surgeon was standing/sitting (p = 0.1029), fatigue following a night shift (p = 0.3281), or physical exertion prior to surgery (p = 0.2845).When conducting the multivariate analysis, the spatial accuracy significantly depended on the test subject (p < 0.0001), the use of support during the test (p = 0.0001), and the length of the microsurgical instrument (p = 0.0397). To increase the spatial accuracy of microsurgical manipulations, hand support and shorter tools should be used. Caffeine consumption in high doses should also be avoided prior to surgery.     

Fathers of children with autism spectrum disorder: Their perceptions of paternal role a predictor of caregiving satisfaction,self-efficacy and burden

BackgroundThe positive effect of a father’s involvement in children’s upbringing is now recognised. However, research on fathers raising children with autism spectrum disorder (ASD) are still few. This study examines the relationship between the perception, fathers of children with ASD have of the importance of their role in the development of their children and the feelings (self-efficacy, caregiving burden, satisfaction) they express about their parenting experience.MethodSixty-three Swiss Italian fathers of children with ASD completed The Role of the Father Questionnaire (ROFQ), three sub-scales of the Caregiver Survey, a subtest of the Child Adjustment and Parent Efficacy Scale and a home-made questionnaire measuring Perceived Social Support.ResultsThe results from hierarchical multiple regression analyses show that the importance that fathers attach to the paternal role predicts positively their caregiving satisfaction and their feeling of self-efficacy. The children’s challenging behaviours predict positively the caregiving burden whereas the assessment of social support predicts it negatively.ConclusionsThe perception of the importance of the paternal role needs to be considered in the support offered to families with a child with ASD. A better understanding of the fathers’ feelings could be of value for the programmes.     

Understanding perceptions underlying the self-reported stress among parents of adolescents with autism spectrum disorder: Considerations for supporting families

BackgroundParents raising adolescents with autism spectrum disorder (ASD) often report higher stress than other parents. The influence of parents’ internal, or cognitive, experiences (i.e., their own perceptions) on this elevated stress has yet to be explored. Addressing this gap may reveal opportunities for enhancing support for families by elucidating malleable targets for reducing parents’ self-reported stress and/or informing family-focused intervention. The Double ABCX Model of Family Adaptation is a framework for understanding how perceptions, social support, and personal resources (i.e., coping) may affect stress.MethodsWe examined parents’ perceptions about ASD, perceived support, and coping among 214 parents of adolescents with ASD. Regression analyses were used to explore whether these factors were associated with parenting stress among those raising adolescents with ASD. Moderation effects of positive coping on the relationship between parent perceptions and parenting stress were also explored.ResultsParent perceptions about within family support, the extent of ASD symptom predictability, and treatment being able to ‘control’ ASD were related to parenting stress. However, positive coping did not moderate the relationship between these perceptions and parenting stress.ConclusionsStudy findings emphasize significant associations between specific parental perceptions and the self-reported stress among families of adolescents with ASD. Particularly important to parenting stress were how much parents’ perceived adequate support within the family, that treatment was useful for controlling their adolescent’s ASD, and that their adolescent’s symptoms were predictable. These findings suggest that the way parents think about their adolescents’ ASD and the adequacy of the support within their own families are associated with parenting stress, and therefore may serve as treatment targets for positively affecting whole family outcomes, as well as foundations for additional research.     

EEG functional connectivity contributes to outcome prediction of postanoxic coma

ObjectiveTo investigate the additional value of EEG functional connectivity features, in addition to non-coupling EEG features, for outcome prediction of comatose patients after cardiac arrest.MethodsProspective, multicenter cohort study. Coherence, phase locking value, and mutual information were calculated in 19-channel EEGs at 12 h, 24 h and 48 h after cardiac arrest. Three sets of machine learning classification models were trained and validated with functional connectivity, EEG non-coupling features, and a combination of these. Neurological outcome was assessed at six months and categorized as “good” (Cerebral Performance Category [CPC] 1–2) or “poor” (CPC 3–5).ResultsWe included 594 patients (46% good outcome). A sensitivity of 51% (95% CI: 34–56%) at 100% specificity in predicting poor outcome was achieved by the best functional connectivity-based classifier at 12 h after cardiac arrest, while the best non-coupling-based model reached a sensitivity of 32% (0–54%) at 100% specificity using data at 12 h and 48 h. Combination of both sets of features achieved a sensitivity of 73% (50–77%) at 100% specificity.ConclusionFunctional connectivity measures improve EEG based prediction models for poor outcome of postanoxic coma.SignificanceFunctional connectivity features derived from early EEG hold potential to improve outcome prediction of coma after cardiac arrest.