Should the existing science of teams be applied to fluid teams? An exploration of fluid team effectiveness within the context of healthcare simulation.

Introduction: Fluid teams have become increasingly prevalent and necessary for modern-day issues, yet they differ from more traditional teams, on which much of the current teams literature is based. For example, fluid teams are often comprised of members from different disciplines or organizational divisions who do not have a shared history or future, as they come together to perform a critical, time-sensitive task, and then disband. For these reasons, the mechanisms through which they function and perform may differ from those of more traditional teams, and research is needed to better understand these differences. Methods: To this end, this study utilized critical incident techniques and thematic analysis to examine fluid teams within healthcare, one of the primary contexts in which they are prevalent. Interdisciplinary faculty and students in the medical field who encounter fluid teams within simulation-based education were prompted to reflect on key factors that facilitate or hinder fluid team effectiveness. Results: Primary themes extracted pertained to the conditions fluid teams operate within (e.g., high-stress), the behaviors and emergent states that contribute to their success (e.g., communication), and the KSAO's of value for members of fluid teams to possess (e.g., readiness). These themes were then compared to existing literature, yielding the identification of some similarities but also many important differences between fluid and traditional teams. Discussion: A series of practical recommendations for how to promote fluid team effectiveness is then presented.

Overestimating women's representation in medicine: a survey of medical professionals' estimates and their(un)willingness to support gender equality initiatives.

OBJECTIVE: Amidst growing numbers of women in certain areas of medicine (eg, general practice/primary care), yet their continued under-representation in others (eg, surgical specialties), this study examines (1) whether medical professionals mistakenly infer that women are now broadly well represented, overestimating women's true representation in several different areas and roles; and (2) whether this overestimation of women's representation predicts decreased support for gender equality initiatives in the field, in conjunction with one's own gender. DESIGN: Cross-sectional survey. SETTING: UK-based medical field. PARTICIPANTS: 425 UK medical consultants/general practitioners and trainees (ST/CT1+/SHO/Registrar); 47% were female. MAIN OUTCOME MEASURES: Estimates of women's representation in different areas/roles within medicine, examined as a composite estimate and individually; and a multi-item measure of support for gender-based initiatives in medicine. RESULTS: Medical professionals tended to overestimate women's true representation in several different areas of medicine (general practice, medical specialties, surgical specialties) and in various roles (consultants/general practitioners, trainees, medical school graduates). Moreover, these erroneous estimates predicted a decreased willingness to support gender-based initiatives, particularly among men in the field: composite overestimation*respondent gender interaction, B=-0.04, 95% CI -0.07 to -0.01, p=0.01. Specifically, while female respondents' (over)estimates were unrelated to their level of support (B=0.00, 95% CI -0.02 to 0.02, p=0.92), male respondents' tendency to overestimate the proportion of women in medicine predicted lower support for gender-based initiatives (B=-0.04, 95% CI -0.06 to -0.02, p<0.001). CONCLUSIONS: While some progress has been made in gender representation in the medical field, this research illustrates that there are still barriers to gender equality efforts and identifies who within the field is focally maintaining these barriers. It is those individuals (particularly men) who overestimate the true progress that has been made in women's representation who are at highest risk of undermining it.

Social media in surgery: evolving role in research communication and beyond.

PURPOSE: To present social media (SoMe) platforms for surgeons, how these are used, with what impact, and their roles for research communication. METHODS: A narrative review based on a literature search regarding social media use, of studies and findings pertaining to surgical disciplines, and the authors' own experience. RESULTS: Several social networking platforms for surgeons are presented to the reader. The more frequently used, i.e., Twitter, is presented with details of opportunities, specific fora for communication, presenting tips for effective use, and also some caveats to use. Details of how the surgical community evolved through the use of the hashtag #SoMe4Surgery are presented. The impact on gender diversity in surgery through important hashtags (from #ILookLikeASurgeon to #MedBikini) is discussed. Practical tips on generating tweets and use of visual abstracts are presented, with influence on post-production distribution of journal articles through "tweetorials" and "tweetchats." Findings from seminal studies on SoMe and the impact on traditional metrics (regular citations) and alternative metrics (Altmetrics, including tweets, retweets, news outlet mentions) are presented. Some concerns on misuse and SoMe caveats are discussed. CONCLUSION: Over the last two decades, social media has had a huge impact on science dissemination, journal article discussions, and presentation of conference news. Immediate and real-time presentation of studies, articles, or presentations has flattened hierarchy for participation, debate, and engagement. Surgeons should learn how to use novel communication technology to advance the field and further professional and public interaction.

The Way to Man's Heart Is through the Stomach.

Organ systems do not exist in a vacuum. However, in an era of increasingly specialized medicine, the focus is often on the organ system alone. Many symptoms are associated with differential diagnoses from upper gastrointestinal (GI) and cardiovascular medical and surgical specialties. Furthermore, a large number of rare but deadly conditions cross paths between the upper GI tract and cardiovascular system; a significant proportion of these are iatrogenic injuries from a parallel specialty. These include unusual fistulae, herniae, and embolisms that transcend specialties. This review highlights these conditions and the shared anatomy and embryology of the two organ systems.

Impact of Randomized Controlled Trials in the Social Media: Does Science Trend As Much As Everyday Events?

BACKGROUND: The approach to the scientific literature is evolving. Currently, dissemination of articles happens in real time through social media (SoMe) channels, and little is known about its impact in medicine. The aim of this study was to investigate if SoMe dissemination followed trends independent from articles type and content. METHODS: First, the SoMe engagement of a popular theme (#BlackFriday) and a relevant theme (#ClimateChange) was compared using a SoMe analytic tool to test if the popular theme would reach more engagement. In a second analysis, themes in colorectal surgery in the SoMe community were explored. Altmetric Explorer was searched for the term "colorectal surgery" and the outputs were categorized into 'randomized controlled trials' (RCTs) and 'other studies'. Subgroups were compared for the Altmetric scores using statistical analyses. RESULTS: The analytic tool documented that #BlackFriday outnumbered #ClimateChange in mentions and engagement (1.6 million vs 127.000 mentions). Following, Altmetric Explorer identified 1381 articles, including 92 RCTs (7.1%). Overall, 25,554 mentions were documented from 1205 outputs (97.0% by Twitter). A greater percentage of "other studies" ranked in the lower Altmetric score categories (p = 0.0007). Similarly, the median Altmetric score was higher in the RCT subgroup comparing with "other studies" (6.5 vs. 2.0, Mann-Whitney p = 0.0001). CONCLUSIONS: In this study, RCTs represented just the 7.1% of the studies and produced 11% of Twitter outputs. The median Altmetric scores obtained by RCTs were higher than those of other studies.

Neuroticism as an underlying construct in youth emotional disorders.

Structural research on neuroticism, as indicated by Big Five personality traits and/or internalizing symptoms, has been conducted with youth. However, no structural research has investigated neuroticism as characterized by transdiagnostic risk factors such as distress tolerance (DT), negative affect (NA), and avoidance. No study has investigated whether DT, NA, and avoidance, as a group, are associated with anxiety, depressive, obsessive-compulsive (OC) symptoms, and independent evaluator (lE)-rated symptom severity in a clinical sample of youth. The purpose of the current investigation was to understand the proportion of variance in anxiety, depressive, OC symptoms, and independent evaluator-rated global symptom severity by a latent construct of neuroticism, as indicated by these modifiable features in youth with emotional disorders among a sample of 121 adolescents (ages 13-18, 51.2% female). A latent neuroticism factor was significantly associated with greater youth- and parent-reported anxiety, depressive, and OC symptoms, and greater IE-rated global severity.

Choosing the new normal for surgical education using alternative platforms.

The traditional methods for surgical education and professional development are changing, from a variety of external factors. The COVID-19 pandemic accelerated the pace innovative alternative tools are introduced into clinical practice, creating a new normal for teaching and training. In this new normal is the challenge to create durable changes for the future of surgical education. Social media (SoMe), a tool that uses electronic communications and applications to allow users create and share information in dynamic ways, can meet this challenge. SoMe is reshaping how we communicate and learn, and offers great benefits for effective, individualized surgical education. The limits for SoMe appear endless, and elements have already help establish digital surgery to help improve the precision and outcomes of surgery. As we work to define the new normal in surgical education and professional development, SoMe digital surgery will be critical for continued growth and progress.

Understanding of evidence-based mental health care and the perceived importance of scientific information in a sample of U.S. adults.

OBJECTIVES: This online survey sought to qualitatively ascertain the extent to which a sample of U.S. adults understood the concept of evidence-based mental health care (EBMHC). Additional goals included assessing the perceived importance of scientific information in EBMHC, and examining whether understanding EBMHC and science values varied as a function of participant factors. METHOD: Participants (N = 221) defined EBMHC and rated the importance of scientific information. Open-ended EBMHC definitions were content-coded, and binomial logistic and linear regressions examined predictors of accurately defining EBMHC and of the perceived importance of scientific information. RESULTS: Participants endorsed seven definitions of EBMHC, and only 20% defined it accurately. Having greater knowledge about mental health conditions was associated with understanding EBMHC and with the higher perceived importance of scientific information. Greater help-seeking efficacy also predicted higher perceived importance of scientific information. CONCLUSIONS: Results support customized strategies to promote basic EBMHC education among U.S. adults.

Does L-Methylfolate Supplement Methylphenidate Pharmacotherapy in Attention-Deficit/Hyperactivity Disorder?: Evidence of Lack of Benefit From a Double-Blind, Placebo-Controlled, Randomized Clinical Trial.

PURPOSE/BACKGROUND: Interventions for attention-deficit/hyperactivity disorder (ADHD) may be inadequate for some patients. There is evidence that supplementation with L-methylfolate augments antidepressant agent effects and thus might also augment ADHD treatment effects by a common catecholaminergic mechanism. METHODS: Forty-four adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of ADHD participated in a randomized, double-blind, placebo-controlled, 12-week trial of 15 mg of L-methylfolate in combination with osmotic-release oral system methylphenidate. Osmotic-release oral system methylphenidate was dose optimized over the first 6 weeks. We evaluated the effects on ADHD symptoms, self-report on the Behavior Rating Inventory of Executive Function of executive function, methylphenidate dosing, neuropsychological test measures, the Adult ADHD Self-report scale, emotional dysregulation, social adjustment, and work productivity, as well as moderating effects of body mass index, autoantibodies to folate receptors, and select genetic polymorphisms. RESULTS: L-Methylfolate was well tolerated, with no significant effect over placebo except improvement from abnormal measures on the mean adaptive dimension of the ASR scale (χ = 4.36, P = 0.04). Methylphenidate dosing was significantly higher in individuals on L-methylfolate over time (χ = 7.35, P = 0.007). Exploratory analyses suggested that variation in a guanosine triphosphate cyclohydrolase gene predicted association with higher doses of methylphenidate (P < 0.001). CONCLUSIONS: L-Methylfolate was associated with no change in efficacy on measures relevant to neuropsychiatric function in adults with ADHD, other than suggestion of reduced efficacy of methylphenidate. Further investigation would be required to confirm this effect and its mechanism and the genotype prediction of effects on dosing.

Debunking key assumptions about teams: The role of culture.

Scholars have argued that if psychologists are to gain a true understanding of human behavior, culture should be central to research and theory. The research on teams is an area where better integration between the mainstream and cross-cultural literatures is critically needed, given the increasing prevalence of multicultural teams. The purpose of this article is therefore to demonstrate how research focused on culture's influence on teams advances current mainstream theoretical understanding of team effectiveness. Guided by widely accepted frameworks of team effectiveness (Ilgen, Hollenbeck, Johnson, & Jundt, 2005) and culture (Giorgi, Lockwood, & Glynn, 2015), we extract several key assumptions from the mainstream literature that have also been examined within the cross-cultural literature. Through a process of comparing and contrasting, we determined which components of current models are upheld and debunked when seeking to generalize these models to other cultural contexts outside of North America. Although we found some consistent results across the two literatures, most of our analyses reveal there are important boundary conditions surrounding common team effectiveness assumptions when culture is considered. By anchoring our analyses around fundamental aspects of teams, including how they form, function, and finish, we then revised these assumptions according to the integration of the teams and cross-cultural literatures. Taken together, we provide a rich foundation for future research, and facilitate a more nuanced understanding of human behavior within the team context. (PsycINFO Database Record

Memantine in the Treatment of Executive Function Deficits in Adults With ADHD.

OBJECTIVE: To evaluate the efficacy and safety of memantine hydrochloride as an adjunct to stimulant pharmacotherapy for treating executive function deficits (EFDs) in adults with ADHD. METHOD: This was a 12-week, double-blind, placebo-controlled, randomized clinical trial of memantine added to open-label treatment with stimulant medication. Because of the small sample size, we considered a standardized mean difference (equivalent to effect size) of ≥0.5 and odds ratios ≥2 as indicators of trend improvements. RESULTS: Twelve participants received memantine and 14 received a placebo. Trend improvements favoring memantine were observed on Behavior Rating Inventory of Executive Functions-Adult Inhibition and Self-Monitor subscales when compared with Placebo. No significant changes were noted on the Cambridge Neuropsychological Test Automated Battery. CONCLUSION: Among adults with ADHD and EFDs, adjunct treatment with memantine to osmotic release oral system-methylphenidate (OROS-MPH) was associated with improvements in selective areas of executive functioning, supporting the need for further research.

Mild Traumatic Brain Injury and Attention-Deficit Hyperactivity Disorder in Young Student Athletes.

A recent meta-analysis documented a significant statistical association between mild traumatic brain injury (mTBI) and attention deficit hyperactivity disorder (ADHD) (Adeyemo et al., 2014), but the direction of this effect was unclear. In this study, we hypothesized that ADHD would be an antecedent risk factor for mTBI. Participants were student athletes ages 12 to 25 who had sustained a mTBI and Controls of similar age and sex selected from studies of youth with and without ADHD. Subjects were assessed for symptoms of ADHD, concussion severity, and cognitive function. mTBI subjects had a significantly higher rate of ADHD than Controls, and in all cases the age of onset of ADHD was before mTBI onset. mTBI+ADHD subjects also had more severe concussion symptoms (fatigue and poor concentration) than mTBI-ADHD subjects. These results support ADHD as an antecedent risk factor for mTBI in student athletes and that its presence complicates the course of mTBI.

Measuring team cohesion: observations from the science.

OBJECTIVE: The aim of this study was to review literature relevant to cohesion measurement, explore developing measurement approaches, and provide theoretical and practical recommendations for optimizing cohesion measurement. BACKGROUND: Cohesion is essential for team effectiveness and performance, leading researchers to focus attention on understanding how to enhance it. However, cohesion is inconsistently defined and measured, making it difficult to compare findings across studies and limiting the ability to advance science and practice. METHOD: We reviewed empirical research through which we uncovered specific information about cohesion's conceptualization, measurement, and relationships with performance, culminating in a set of current trends from which we provide suggestions and possible solutions to guide future efforts and help the field converge toward greater consistency. RESULTS: Cohesion demonstrates more significant relationships with performance when conceptualized using social and task (but not other) dimensions and when analyses are performed at the team level. Cohesion is inherently temporal, yet researchers rarely measure cohesion at multiple points during the life of a team. Finally, cohesion matters in large, dynamic collectives, complicating measurement. However, innovative and unobtrusive methodologies are being used, which we highlight. CONCLUSION: Practitioners and researchers are encouraged to define cohesion with task and social subdimensions and to measure with behavioral and attitudinal operationalizations. Individual and team-oriented items are recommended, though team-level analyses are most effective. Innovative/unobtrusive methods should be further researched to enable cohesion measurement longitudinally and in large, dynamic collectives. APPLICATION: By applying our findings and conclusions, researchers and practitioners will be more likely to find consistent, reliable, and significant cohesion-to-performance relationships.

Reduced Renal Methylarginine Metabolism Protects against Progressive Kidney Damage.

Nitric oxide (NO) production is diminished in many patients with cardiovascular and renal disease. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthesis, and elevated plasma levels of ADMA are associated with poor outcomes. Dimethylarginine dimethylaminohydrolase-1 (DDAH1) is a methylarginine-metabolizing enzyme that reduces ADMA levels. We reported previously that a DDAH1 gene variant associated with increased renal DDAH1 mRNA transcription and lower plasma ADMA levels, but counterintuitively, a steeper rate of renal function decline. Here, we test the hypothesis that reduced renal-specific ADMA metabolism protects against progressive renal damage. Renal DDAH1 is expressed predominately within the proximal tubule. A novel proximal tubule-specific Ddah1 knockout (Ddah1(PT-/-)) mouse demonstrated tubular cell accumulation of ADMA and lower NO concentrations, but unaltered plasma ADMA concentrations. Ddah1(PT-/-) mice were protected from reduced kidney tissue mass, collagen deposition, and profibrotic cytokine expression in two independent renal injury models: folate nephropathy and unilateral ureteric obstruction. Furthermore, a study of two independent kidney transplant cohorts revealed higher levels of human renal allograft methylarginine-metabolizing enzyme gene expression associated with steeper function decline. We also report an association among DDAH1 expression, NO activity, and uromodulin expression supported by data from both animal and human studies, raising the possibility that kidney DDAH1 expression exacerbates renal injury through uromodulin-related mechanisms. Together, these data demonstrate that reduced renal tubular ADMA metabolism protects against progressive kidney function decline. Thus, circulating ADMA may be an imprecise marker of renal methylarginine metabolism, and therapeutic ADMA reduction may even be deleterious to kidney function.