Creating and sustaining effective pipeline initiatives to increase diversity in biostatistics: the ENAR Fostering Diversity in Biostatistics Workshop.

Biostatisticians with advanced degrees are highly sought after. Employment opportunities in the fields of mathematics and statistics are expected to increase dramatically by 2028. Underrepresentation of minorities in biostatistics has been a persistent problem, yielding a demographic landscape that differs substantially from the general US population. In some instances, students may have the appropriate quantitative skills, but are unaware of biostatistics and in other instances, students may not yet have the appropriate quantitative background, but are intellectually capable and willing to shore up those skills once they learn about biostatistics as a viable, exciting career option. Therefore, in order to ensure robust scientific advancement, there must be a concerted effort to increase the pipeline of intellectually talented persons available with exposure to the appropriate quantitative skills who are interested in careers in biostatistics. The overarching goal of this paper is to discuss the development, implementation, and impact of a federally funded pipeline initiative aimed at increasing the number of underrepresented minorities successful in graduate training and professional careers in biostatistics as well as establishing effective mentoring and networking relationships. Our findings provide a roadmap for the development of sustainable initiatives to promote diversity in biostatistics and STEM fields more broadly.

Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals.

OBJECTIVE: This study aimed to establish whether longitudinal participation in an accreditation program is translated into improvement in continuity of quality patient care and human resource management (HRM) processes outcomes. MATERIALS AND METHODS: This was a secondary data analysis of accreditation panel data from acute hospitals participating in the Australian Council on Healthcare Standards' Evaluation and Quality Improvement Program (EQuIP). EQuIP criteria data from 311 hospitals were collected by external surveyors across 2003-2006 (Time 1) and 2007-2010 (Time 2). Mandatory accreditation criteria ratings at Time 1 were used to determine hospital performance group membership (1 = below moderate, 2 = moderate, 3 = above moderate). Analysis was undertaken of ratings across continuity of quality patient care and HRM process criteria, at Time 1 and 2. RESULTS: Continuity of quality patient care and HRM processes improved across time in the three performance groups. Lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. The groupings and performance order did not change over time. CONCLUSIONS: An accreditation program is an external driver that facilitates continual and systemic quality improvement changes to sub-systems with an organisation.

Health service accreditation reinforces a mindset of high-performance human resource management: lessons from an Australian study.

OBJECTIVE: To investigate whether an accreditation program facilitates healthcare organizations (HCOs) to evolve and maintain high-performance human resource management (HRM) systems. DESIGN: Cross-sectional multimethod study. SETTING AND PARTICIPANTS: Healthcare organizations participating in the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program (EQuIP 4) between 2007 and 2011. MAIN OUTCOME MEASURES: Ratings across the EQuIP 4 HRM criteria, a clinical performance measure, surveyor reports (HRM information) and interview data (opinions and experiences regarding HRM and accreditation). RESULTS: Healthcare organizations identified as high performing on accreditation HRM criteria seek excellence primarily because of internal motivations linked to best practice. Participation in an accreditation program is a secondary and less significant influence. Notwithstanding, the accreditation program provides the HCO opportunity for internal and external review and assessment of their performance; the accreditation activities are reflective learning and feedback events. CONCLUSIONS: This study reveals that HCOs that pursue highly performing HRM systems use participation in an accreditation program as an opportunity. Their organizational mindset is to use the program as a tool by which to reflect and obtain feedback on their performance so to maintain or improve their management of staff and delivery of care.

Post-stroke autonomic nervous system function: palmar sympathetic skin responses thirty or more days after cerebrovascular accident.

We studied sympathetic nervous system (SNS) function after cerebrovascular accident (CVA) by measuring hypothenar sympathetic skin responses (SSR) to normal or hemiplegic arm electrical stimulation. We anticipated SNS function after CVA to be asymmetric and selected null hypotheses of bilaterally symmetric SSR latencies and amplitudes irrespective of side of stimulation and/or recording. Thirteen patients between ages 44 and 77 years (median 59) were tested between 1 and 72 months (median 15) after CVA. Hypothenar recording and dorsal reference surface electrodes were used. Amplifier bandwidth was set from 0.5 to 100 Hz. Gain was adjusted to allow adequate recognition of the waveforms. Sweep speed was set to 500ms/div. Stimulus width was set to 0.2 ms and intensity was increased stepwise from 10mA initially until optimum responses were obtained. Nonparametric statistics were used to analyze the data. SSRs were present in all patients on both the normal and the hemiplegic sides irrespective of the side of stimulation. Median SSR latency recorded homolaterally to the stimulus site was found to be 80ms shorter than median SSR latency recorded heterolaterally. Median SSR latency in left hemiplegics was found to be 16% longer than in right hemiplegics. Otherwise, neither side of hemiplegia, side of stimulation, side of recording nor any paired combination thereof were found to be significant. Our finding of bilaterally obtainable SSRs after CVA diverges from that of Uncini and colleagues but presumably only reflects the difference in poststroke chronology between the respective samples.

Knowledge and attitudes about acquired immunodeficiency syndrome in nursing and nonnursing groups.

A study was undertaken to determine the difference in knowledge and attitudes about acquired immunodeficiency syndrome (AIDS) in nursing and nonnursing groups, and to determine the effect that knowledge acquisition would have on attitudes about AIDS. The total study population consisted of 60 registered nurses, 50 baccalaureate nursing students, 42 liberal arts college students, and 30 nonnurse adults. An AIDS knowledge and attitude assess test was developed and used in the study. Univariate descriptive methodology, descriptive correlational analysis, and a pretest-posttest design were used. Phase I showed that professional nurses with graduate degrees have the highest knowledge base and the most positive attitudes about AIDS; and that nursing students' attitudes are more similar to the attitudes of nonnursing students than of professional nurses. Phase II showed that people's attitudes about AIDS could be changed by increasing their knowledge levels, and nursing students showed more increase in knowledge and more significant changes in attitudes following education than liberal arts college students.

Helping patients cope with the stress of myocardial infarction.

The victims of myocardial infarction pose a real challenge to nursing. Effective nursing intervention is based on an understanding of human responses to the stress of heart disease and the series of behavioral changes individuals undergo in an attempt to cope with the stress. Cardiac teaching is an essential aspect of this intervention. After a myocardial infarction, patients first go through two stages on the way to recovery--independency and dependency--before they are receptive to teaching. It is during the next two stages--interdependency and self-dependency--that nurses can use specific behavioral changes of the patients to plan health teaching and to negotiate contracts with them to effect learning and permanent behavioral change.

The nurse and job related stress: responses, Rx, and self-dependency.

There is no simple answer to the complex problem of job related stress, which is inherent in the practice of nursing. However, some solution to the problem has to be found otherwise young people will not enter the profession and older, experienced nurses will continue to leave the profession, resulting in a continuation of the current shortage and generating more critical future shortages. Teaching nurses to become self-dependent and to assume the role of avatar offers one possible solution to cope with the problem, a solution which requires active participation by the persons involved.