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Objective: To examine the factorial validity of the Team Skills Scale (TSS). The TSS is a 17-item scale developed by Hepburn, Tsukuda, and Fasser (1996). The Scale is purported to assess self-perceived team skills.Data Source: Data for this study were provided by The New York University Geriatric Interdisciplinary Team Training (GITT) Resource Center and were collected as part of the evaluation of the GITT program. The data were collected between January 1997 and June 2000.Study Design: This quasi-experiential study was focused on the trainee (N=1,715) as the unit of analysis. The Model of Individual-Level Team Competencies (Model of I-LTC) served as the conceptual framework and guided a priori specification of the TSS confirmatory factor analysis measurement model. The Model of I-LTC was developed by this author based on review and interpretation of the team literature.Principal Findings: The TSS is a one-factor structure comprised of eight of the original 17 indicators. Also, the revised measurement model was found to be invariant when the data were randomly divided into two equal samples. Finally, the covariance structure model indicated that attitude about the physician as team leader and sole patient care decision-maker had a significant and negative association with variation in responses to the TSS. Attitude about the quality of team delivered patient care had a significant and positive association with variation in responses to the TSS.Conclusion: This study found that the TSS in a single factor structure comprised of eightof the original 17 TSS items. It is believed that the eight items measure self-perceivedteam collaboration skills. Although the factor structure was confirmed by the data, thisdoes not mean that the proposed structure is absolute. It just means that the structure hasnot been falsified. However, it is possible that this constellation of indicators was datadriven. Therefore, further psychometric testing, to include the use of other data sources,is recommended.

Oral history is a method of preserving historical information through in-depth interviews. Because the process requires narrators to use remote recall while sharing their life experiences, it can also be considered a reminiscence-related activity. Before this study, the positive effects on narrators of providing an oral history were noted in the research literature but had not been evaluated through quantitative methods. Based on theoretical constructs of Erikson and Butler, it was hypothesized that participation in oral history interviews would improve the life satisfaction of narrators. Life satisfaction was operationalized and measured using the Life Satisfaction Index Version A (LSIA). The purposes of this study were to evaluate the influence of an oral history intervention on the life satisfaction of community-dwelling elders and to identify participant characteristics associated with change in life satisfaction scores.Sixty community-dwelling, older adults who were free of cognitive impairment and mental illness were recruited from agencies serving the social and recreational needs of elders in Richmond, VA. Participants were randomly assigned to an intervention group or a control group. LSIA scores were collected pretest, posttest, and again at retest, ten weeks after the intervention. Mean LSIA scores from the control and treatment groups were compared for differences at posttest and retest using an analysis of covariance (ANCOVA). Regression analysis was used to identify participant characteristics associated with improved life satisfaction at posttest and retest. Oral history interviews were conducted by Virginia Commonwealth University students enrolled in a gerontology course. Participants discussed lifetime events with students on three occasions for approximately one hour per session using a researcher-developed interview guide. No statistically significant differences in LSIA scores were found between groups at posttest (p=0.74) or retest (p=0.051) although retest scores may indicate a trend toward improvement. Lower LSIA scores at pretest were associated with positive change in LSIA scores at retest (p=5.001). These results suggest that oral history may not improve life satisfaction immediately but there may be a trend toward improvement given time and that elders least satisfied with their lives at the onset are most likely to show positive change by retest.

Researchers have studied memory recall of crisis-oriented or emotional events in non-educational settings. However, within the health care field, there has been a limited study of the the concept of recall of crisis oriented or emotional events in& health care education. Crisis-oriented events such as natural disasters, acts of bioterroism, and industrial accidents, have been reported to impact memory. Patient safety is a primary focus in anesthesia education, appropriate crisis management is imperative to quality anesthesia care. Due to the critical nature of anesthesia delivery, there is a strong, constant need to develop methods that will enhance, support, and improve current anesthesia practices that impact patient safety. Educational methodologies used by both clinical and didactic instructors that will improve teaching effectiveness need to be investigated to ensure that patient safety content is being delivered to nurse anesthesia students in a manner consistent with the American Association of Nurse Anesthetists (AANAs) Council on Accreditation's COAs) standards of care. Utilizing a simulated anesthesia crisis situation, this study compared the differences in cognitive imprinting and application to practice between two content delivery methods, the written case study and patient safety vignettes, in nurse anesthesia students. The control group was given a written case study which is considered a traditional method of content delivery. The treatment groups studied vignettes, which are short, realistic, simulated audio-visual videos that demonstrate content to be relayed. The research hypothesis studied the use of anesthesia crisis oriented vignettes as an educational tool to impact memory recall, thus potentially improving application to clinical practice. Hypotheses for the study were: Hypothesis 1 (Hl): Student anesthetists exposed to audio-visual vignettes will exhibit superior clinical performance during simulated apparatus-related crisis events, evidenced by higher group mean demonstration scores, when compared to a matched group exposed to written case studies. Hypothesis 2 (H2): Student anesthetists exposed to audio-visual vignettes will exhibit superior recall of apparatus related material, evidenced by higher group mean post-test scores, when compared to a matched group exposed to written case studies. Using the paired samples t-test and analysis of variance procedure (ANOVA), statistical findings were evaluated for significance. The different teaching methodologies were represented in the abbreviation of the variables studied. Two different crisis oriented events were presented in vignette format, a malfunctioning unidirectional expiratory valve and a malfunctioning suctioning apparatus. Variables that were studied include: clinical performance during the anesthesia machine checkout process by recreating the stuck expiratory valve and malfunctioning suction apparatus scenarios. Statistically, mixed results were obtained. The impact that the stuck expiratory valve vignette had on student recall and clinical performance was found to be insignificant. The impact resulting from exposure to the non-functioning suction apparatus vignette was found to be significant for both student recall and clinical performance. Other recall and clinical performance measures related to the non- functioning suction apparatus were also found to be significant. Conclusions: In this research study, memory and clinical performance were impacted when the anesthesia provider incorporated the correct anesthesia apparatus checkout process and crisis management skills into their practice. This research demonstrated that under the conditions of this study, teaching methodology impacted some areas of clinical performance. Due to the small sample size and because the clinical performance measurements tools were newly designed for this particular study, findings from this study cannot be generalized to any other group or population. However, the findings from this study merit further investigation into the potential use of vignettes as an educational methodology to impact clinical practice and improve patient safety.

Problem: There is a shortage of military certified registered nurse anesthetists (CRNAs). The exodus from military service to civilian careers could be a result of relative deprivation (the discrepancy that one perceives between what one has and what one could or should have). Relative deprivation is a perception of unfairness dependent on feelings (subjective data) as well as facts (objective data). Purpose: The purpose of this study was to measure relative deprivation in active duty military nurse anesthetists, to explore variables which correlate with relative deprivation, and to validate or refute the theory of relative deprivation in active duty military CRNAs. The study was based on research conducted by Crosby who theorized that wanting (a desire for some object or opportunity) and deserving (a feeling of entitlement to an object or opportunity) were the most relevant preconditions leading to relative deprivation. It was hypothesized that antecedent factors (years as a CRNA, pay, promotion opportunities, and scope of practice/autonomy) and psychological factors (wanting and deserving) correlate with relative deprivation. It was further hypothesized, based on the theory, that psychological factors would have more influence on relative deprivation than antecedent factors.Study design: The descriptive, correlational study was conducted using a self-administered survey sent to 435 active duty Army, Navy and Air Force CRNAs. Surveys were distributed to subjects by mail and could be answered by mail or by secured website designed specifically for the conduct of this study.Results: Response rate was 58% (n = 236). Data was analyzed using descriptive and inferential statistics. Analysis of the data revealed no significant correlation (pConclusions: Further research is indicated to identify tangible factors which can be modified to improve feelings of deprivation as they relate to retention and recruitment of military CRNAs.

Anualmente, a Secretaria de Estado da Saúde de São Paulo (SES/SP) realiza o Concurso SUS-SES/SP para o preenchimento de vagas de RM oferecidas pelas instituições participantes, nas diferentes especialidades médicas. Partindo da compreensão que a decisão pela especialidade é um momento singular na trajetória da profissão médica, e que, a RM desempenha um importante papel para o sistema de saúde; este trabalho objetivou conhecer a tendência da demanda por especialidades médicas tomando como referência, o universo dos candidatos que se inscreveram no Concurso SUS, no período entre 1999 e 2004. Dentre as especialidades que contaram com aumento na procura estão a Anestesiologia, Cirurgia Cardiovascular, Cirurgia Oncológica, Cirurgia Plástica, Clínica Médica, Dermatologia, Endocrinologia e Psiquiatria. As especialidades que apresentaram queda na procura foram Cirurgia de Cabeça e Pescoço, Gastroenterologia, Oftalmologia, Pediatria e Pneumologia / Annually, the Secretaria de Estado da Saúde de São Paulo (SES/SP) opens Single Health System SES/SP Medical Residency Contest offered by participant institutions in different medical specialties. The public selection process has been held in partnership with Fundação Carlos Chagas for more than fifteen years. Currently, this process counts with almost six thousand candidates enrolled from several regions of Brazil. Assuming that making decision for specialty is a very singular moment for medical career, and that, Medical Residency conducts an important function for Health System; this research aims to point out tendencies for medical specialties, using the amount of enrolled candidates for SUS Contest, between 1999 and 2004, as reference. Therefore, the number of inscriptions raised 18% in this period, distinguishing male predominance. Considering candidates hometown, 52% lived outside Sao Paulo State in the moment of contest inscription, making evident the attractive potential for doctors from different regions of Brazil. In terms of numbers, basic specialties took part in half inscriptions in this period. In terms of numbers, basic specialties took part in half inscriptions in this period. The specialties with raised number of searching were Anesthesiology, Surgery Cardiovascular, Oncology Surgery, Plastic Surgery, General Internal Medicine, Dermatology, Endocrinology and Psychiatry. The specialties with decreased number of searching were Head and Neck Surgery, Gastroenterology, Ophthalmology, Pediatrics and Pneumology

Os sistemas de saúde são respostas a demandas das sociedades, devendo ser articulados pelas necessidades de saúde. A Saúde Bucal está inserida no programa de Saúde da Família desde o ano 2000, porém foi em 2004, com o lançamento da Política Nacional de Saúde Bucal, que ocorreu uma reorganização dos serviços em todos os níveis de atenção, com ampliação e qualificação da Atenção Básica e implantação da Atenção Especializada. Considerando que houve uma forte expansão no acesso aos serviços de saúde bucal, é de fundamental importância estudar a relação presente entre estes dois serviços. Os objetivos deste estudo foram verificar a prevalência da presença de interface entre a Atenção Básica (AB) e os Centros de Especialidades Odontológicas (CEO) no Brasil, de acordo o Programa de Melhoria do Acesso e da Qualidade, e avaliar se esta interface está relacionada à características do contexto municipal e variáveis dos serviços. Trata-se de um estudo multinível de abrangência nacional, do qual participaram os 927 CEO. A avaliação externa foi realizada em 2014 com um instrumento padronizado. O estudo contou com duas variáveis dependentes que refletiam a existência de interface entre AB e CEO - interface mínima e interface abrangente, com presença de protocolos, referência e contrarreferência. Os aspectos sociodemográficos incluíram as macrorregião, IDH-M e cobertura municipal de ESB. As variáveis do serviço envolveram planejamento, acesso e matriciamento. Foram realizadas análises das frequências absolutas e relativas, regressão de Poisson Multinível para obtenção das razões de prevalências brutas e ajustadas com intervalos de confiança de 95% e nível de significância de 5%, com o software Stata 11. A modelagem utilizada foi hierárquica em dois estágios. Para análise de ajuste dos modelos foram utilizados os parâmetros deviance, AIC e BIC. 52,53% (IC 95% 49,31-55,75) dos CEO apresentavam a interface mínima e 34,51% (IC 95% 31,45- 37,58) interface abrangente. Na análise ajustada em ambos os desfechos, as regiões Sul e Sudeste apresentaram maior prevalência do desfecho que a região Norte e o mesmo ocorreu para a faixa de IDH mais elevado. As equipes que realizaram planejamento nos últimos 12 meses tiveram uma probabilidade 60% maior de apresentar uma interface mínima, sendo que o matriciamento aumentou essa probabilidade em 30% e o acesso exclusivamente agendado em 31%. Estes resultados se assemelham na interface abrangente. A relação entre a AB e os CEO traduzida na interface implica na produção de cuidados mais equânimes, integrais, eficientes e efetivos, o que está de acordo com os princípios do SUS. Com os achados deste estudo, ficam evidenciadas as desigualdades existentes entre os serviços de saúde, demonstrando que ainda há muito o que investir na qualificação da gestão e formação destes serviços. Apesar de a Rede de Atenção à Saúde Bucal estar melhor estruturada ainda há muito o que avançar. / Health systems are the answers to social demands and must be articulated by health needs. Oral Health has been inserted in Family Health program in 2000, but in 2004, with the National Oral Health Policy, there was a reorganization of services at all levels of health care, with the extension and qualification of Primary Care and implementation of Specialized Attention. The strong expansion inthe access to oral health services demands studies about the relationship between the Primary Care and Specialized Dental Services. This study aimed to verify the prevalence of the interface between a Primary Health Care(PHC) and Specialized Dental Care(SDC) in Brazil, using data of the Program of Improvement of Access and Quality of SDC, and to evaluate if this interface isrelated to the municipal context and variablesrelated tothe services. This was a multi-level study of national scope including 927 municipal SDC. An external evaluation was carried out in 2014 through the application of a standardized instrument. The study had two dependent variables that reflected the interface between PHC and SDC - minimal interface and comprehensive interface. The sociodemographic aspects included the variables: macro-region, HDI-M and municipal Primary Care Dentistrycoverage. Service variables included planning, access and matrix support. Absolute and relative frequency analyzes and multi-level Poisson regression were performed to obtain prevalence raw ratios and adjusted with 95% confidence intervals and significance level of 5% (software Stata 11 ©). The modeling was hierarchical in two stages.There were used the deviance parametersfor adjustment analysis of the models, AIC and BIC. 52.53% (95% CI 49.31- 55.75) of the SDC presented a positive endpoint for the minimal interface and 34.51% (95% CI 31,45-37,58) for the comprehensive interface.The adjusted analysis shown that in both outcomes South and Southeast regions presented higher prevalence than theNorth region .The relationship between PHC and CEO,as represented by the interface, may lead to more equitable, comprehensive, efficient and effective care, in acordance with SUS principles. In conclusion, inequalities in dental health services are evidenced, showing that there is still much to invest in qualification of the management of these services.

Physical activity is part of a healthy lifestyle, but participating in athletic activities like team sports can lead to injury. This study was designed to find the differences in types of high school sports injuries and how frequently these injuries occur among different sports and between males and females. A survey was given to members of the football, boys’ basketball, girls’ basketball, baseball, softball, and volleyball teams of a central Appalachian high school. The highest rate of injury was found in girls’ basketball at 86.7%, followed by football at 85.2%, boys’ basketball at 70.6%, softball and volleyball each at 69.2%, and baseball at 33.3%. Significant differences were also found between the most prevalent types of injuries in each sport. Differences in types of injuries were reported by male and female athletes who participated in comparable sports such as boys’ and girls’ basketball and softball and baseball. More research into why these differences exist could result in more individualized prevention strategies for high school athletes.

The primary, descriptive aim of this dissertation was to describe the nighttime sleep quality of previously mechanically ventilated older adult patients within 24-48 hours of transfer out of the intensive care unit (ICU) to a medical-surgical floor. The secondary, exploratory aim was to examine the relationships between post-ICU sleep efficiency (SE) and wake after sleep onset (WASO) with grip strength in previously mechanically ventilated older adult patients within 24-48 hours of transfer out of the ICU. The study included 30 adults ages 65 and older (11 women, 19 men; age 71.37 ± 5.35, range 65-86 years), who were functionally independent at home prior to hospitalization, mechanically ventilated during their ICU stay, and were within 24-48 hours of transfer out of ICU to a medical-surgical floor at Tampa General Hospital, a level 1 trauma center. Subjects wore an actigraph monitor on the dominant wrist (Actiwatch Spectrum) to monitor sleep over two consecutive nights. Parameters of post-ICU sleep quality included total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), sleep latency (SL), and number of awakenings (NA). The outcome measure of motor function was dominant hand grip strength, assessed by the National Institutes of Health Toolbox Motor Battery Grip Strength Test. Sleep data collected between nighttime hours (9:00 PM to 9:00 AM) on both nights were analyzed. For the descriptive aim, means for each sleep parameter and clinical characteristics were reported. For the exploratory aims, multiple regression analyses examined the individual associations between mean sleep parameters (SE and WASO) and grip strength. Study subjects had a mean SE of 63.24 ± 3.88% and spent 135.39 ± 9.94 minutes awake after sleep onset. The mean TST among subjects was 7.55 ± 2.52 hours, ranging from 2.02 to 10.84 hours of sleep, out of the 12 hours of total time in bed. A total of 6 (20%) subjects slept less than 5 hours each night, and a total of 6 (20%) subjects slept greater than 10 hours each night. The mean SL among study subjects was 42.57 minutes, and ranged from 0.0 to 237.75 minutes. Overall, subjects’ average NA was 78.28 ± 26.39, ranging from 35 to 136 awakenings. In multiple regression analysis, SE was significantly and negatively associated with grip strength, after adjusting for potential confounding factors. The model predictors explained 80.8% of the variance in grip strength, [R2 = .808, F(10, 15) = 6.324, p = .001]. Higher SE independently predicted worse grip strength (β = -0.326, p = .036). Further, among the tertiles of subjects with moderate or high TST (sleep duration ≥ 6 hours, n = 23), there remained a significant, negative association between SE and grip strength. The predictors explained 73.7% of the variance in grip strength, [R2 = .737, F(5, 15) = 8.416, p = .001]. Higher SE independently predicted worse grip strength among the subset of subjects with moderate or high sleep duration (β = -0.296, p = .046). Among the two quartiles of subjects with moderate-high or high WASO (≥ 120 minutes spent awake after sleep onset, n = 16), there was a significant, negative association between WASO and grip strength, after adjusting for covariates. The model indicated that the predictors explained 91.4% of the variance in grip strength [R2 = .914, F(6, 8) = 14.134, p = .001]. Greater WASO independently predicted worse grip strength (β = -0.276, p = .04). Finally, the effects of sex and preexisting obstructive sleep apnea (OSA) on grip strength were individually examined. Higher SE independently predicted worse grip strength among male subjects (β = -0.353, p = .039), as did preexisting OSA (β = -0.493, p = .033). In summary, objectively measured sleep quality was disturbed among previously mechanically ventilated, hospitalized older adults, even after transfer out of ICU to a medical-surgical floor. Longer TST and greater SE predicted worse grip strength among these frail patients who were previously independent, community dwelling older adults. Among the subjects with more severely fragmented sleep, WASO also independently predicted weaker grip strength. As poor grip strength is an indicator of ICU-acquired weakness, optimal sleep duration and less sleep disturbances may be crucial in prevention of worse functional outcomes and new institutionalization. Additional research is needed to discern the temporality of associations between sleep quality and motor function among older adult survivors of critical illness.

The study aimed to identify leading practices to promote environmentally friendly and efficient efforts in surgical healthcare. Despite widespread enthusiasm for going green in the U.S. economy, little information is available to inform the medical community on the effort. We explore safe and efficient strategies for hospitals and healthcare providers to protect the environment while delivering high-quality care. As part of the study design, we performed a systematic review of the literature using relevant Pubmed search terms and surveyed a panel of hospital managers and CEOs of healthcare organizations pursuing green initiatives. Recommendations were itemized and reviewed with each panelist for a consensus agreement. At the end, we identified forty-three published articles and obtained interview data from the 7-member expert panel. Five green recommendations for surgical practices were identified: (1) OR Waste Reduction and Segregation; (2) Environmentally Preferable Purchasing; (3) Energy Consumption Management; (4) Pharmaceutical Waste Management; (5) Reprocessing of Single Use Medical Devices. We concluded that the medical community has a large opportunity to implement green practices in surgical units. These practices can have significant benefits to both the healthcare community and the environment.