Improved early growth in Danish children with cystic fibrosis from 2000-2022.

BACKGROUND: Improved growth in children with CF may have resulted from advances in treatment for cystic fibrosis (CF) over the past two decades, including the implementation of newborn screening in Denmark in 2016. This observational cohort study focuses on changes in early growth in Danish children with CF born between 2000 and January 2022. METHODS: Age, length/height, and weight data of children 0-5 years old were obtained from the Danish CF Cohort. Data were stratified to four birth cohorts born between 2000 and 2022. Weight-for-age (WAZ), length-for-age (LAZ), height-for-age (HAZ) and body-mass-index (BMZ) z-scores were computed using WHO growth curves. Cubic spline mixed effects models were used to evaluate growth over 5 years between birth cohorts. RESULTS: We included 255 children in the analyses. Cubic spline mixed effects models show that catch-up growth improved in birth cohorts over time, with the 2016-2022 birth cohort achieving growth reference curve values in WAZ, LAZ/HAZ and BMZ the earliest. The proportion of underweight and stunting observations among children born 2000-2004 decreased by the 2016-2022 birth cohort, while the proportion of overweight, low BMZ and high BMZ observations increased. CONCLUSION: Advances in care for young children with CF have led to improvements in growth - with the 2016-2022 birth cohort approaching potential for overweight. Nonetheless, low BMZ remains. Immediate, individualized nutrition care throughout early childhood remain crucial in mitigating malnutrition.

Learning strategies for the advanced trainee in specialist training.

BACKGROUND: A significant factor of clinicians' learning is based on their ability to effectively transfer acquired knowledge, skills, and attitudes from specialty-specific clinical courses to their working environment. MATERIAL AND METHOD: We conducted semi-structured interviews with 20 anaesthesiologist trainees (i.e. residents) in four group and five individual interviews using SRL principles as sensitizing concepts. Data were collected and analyzed iteratively using thematic analysis. RESULTS: Advanced trainees are highly motivated to explore what they have learned in specialty-specific courses, but they often face several barriers in implementing their learning in the workplace environment. Four themes emerged from the interview data: 'Be ready to learn', "Take the 'take-home-messages' home', "Be ready to create your own opportunities', and "Face it, it's not entirely up to you'. Understanding the challenges regarding transferring knowledge from courses to the working environment is an important lesson for assisting trainees set their learning goals, monitor their progress, and re-evaluate their SRL processes. CONCLUSION: Even for advanced trainees, successfully transferring knowledge from specialty-specific courses often requires adequate commitment and support. Medical supervisors and other relevant stakeholders must be aware of their shared responsibility for creating individual environments that support opportunities for trainees to self-regulate their learning.

Egg consumption and growth in children: a meta-analysis of interventional trials.

Introduction: Stunting and wasting are prevalent in low- and middle-income countries, putting children at risk for disease and disability. Eggs are a nutrient-rich food that can potentially facilitate growth. Purpose: The aim of this meta-analysis was to evaluate the potential beneficial effect of egg supplementation on growth in children. Methods: Following the PRISMA guidelines, PubMed and Healthline (Ovid) were systematically searched for interventional studies on egg supplementation for growth in children aged 6 months to 18 years, with no restrictions on date. Studies were evaluated for quality using Cochrane's GRADE technique. Data were pooled and reported as means and 95% confidence intervals. Results: Seven studies reporting on 9 unique interventions in 3,575 male and female participants were included in the meta-analysis. Participants in the intervention groups experienced significantly greater increases in height/length (by 0.47 [0.13, 0.80] cm, p < 0.01) and weight (by 0.07 [0.01, 0.13] kg, p = 0.03) when compared to those in the control groups. Conclusion: Eggs are an affordable, nutritious option for improving growth in children, though more studies with longer interventions are warranted.Systematic review registration: PROSPERO (CRD42021289609: https://www.crd.york.ac.uk/prospero/).

Business as (un)usual: A qualitative study of clerkship experiences during a health crisis.

INTRODUCTION: During a health crisis, hospitals must prioritise activities and resources, which can compromise clerkship-based learning. We explored how health crises affect clinical clerkships using the COVID-19 pandemic as an example. METHODS: In a constructivist qualitative study, we conducted 22 semi-structured interviews with key stakeholders (i.e. medical students and doctors) from two teaching hospitals and 10 different departments. We used thematic analysis to investigate our data and used stakeholder theory as a sensitising concept. RESULTS: We identified three themes: (1) emotional triggers and reactions; (2) negotiation of legitimacy; and (3) building resilience. Our results suggest that the health crisis accentuated already existing problems in clerkships, such as students' feelings of low legitimacy, constant negotiation of roles, inconsistencies navigating rules and regulations and low levels of active participation. Medical students and doctors adapted to the new organisational demands by developing increased resilience. Students responded by reaching out for guidance and acceptance to remain relevant in the clinical clerkships. Doctors developed a behaviour of closing in and focused on managing themselves and their patients. This created tension between these two stakeholder groups. CONCLUSION: A health crisis can critically disrupt the hierarchical structure within the clinical clerkships and exacerbate existing conflicts between stakeholder groups. When medical students are not perceived as legitimate stakeholders in clinical clerkships during a health crisis, their attendance is perceived as unnecessary or even a nuisance. Despite increased student proactiveness and resilience, their roles inevitably shift from being doctors-to-be to students-to-be-managed.

A Narrative Review of the Safety of Anti-COVID-19 Nutraceuticals for Patients with Cancer.

Interest in dietary supplements and their efficacy in treating and preventing disease has increased greatly since the outbreak of the COVID-19 pandemic. Due to the risk of severe COVID-19 in patients with cancer, we conducted a narrative review aiming to better understand the data on the safety of the most efficacious "anti-COVID-19" nutraceuticals for patients with cancer. We conducted a PubMed database search aimed at identifying the most effective nutrients for use against COVID-19. For the identified nutraceuticals, we searched PubMed again regarding their safety for patients with cancer. Fifty-four total records (52 independent studies) were retrieved, pertaining to vitamin D, vitamin C, selenium, omega-3 fatty acids, and zinc. Vitamin D results from 23 articles indicated safe use, but two articles indicated potential harm. All 14 articles for vitamin C and five out of six articles for selenium indicated the safety of use (one study for selenium suggested harm with high-dose supplementation). Results for omega-3 fatty acids (seven articles) and zinc (one article), however, were rather mixed regarding safety. We conclude that vitamin D, vitamin C, and selenium supplements are likely safe or even beneficial at typically recommended doses; however, caution is urged with omega-3 fatty acid supplements, and zinc supplements should likely be avoided. More experimental research is needed, and nutraceutical use by patients with cancer should always be under the supervision of a healthcare team.

Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams.

INTRODUCTION: The need to maintain medical ethical standards during conflict and peace has been the source of considerable academic discourse. Although still an unsolved challenge, scholars have made significant contributions to the literature, constructing categorizations that can help military providers contend with ethical conflicts. However, insights into the ethical comportment of military interprofessional healthcare teams (MIHTs) have yet to be reported. MATERIALS AND METHODS: This interview-based study collected insights from 30 military healthcare providers who participated in and/or led MIHTs. Altogether, participants represented 11 health professions, both officers and enlisted military members, and the U.S. Army, Navy, and Air Force. Following Grounded Theory methodology, data were collected and analyzed in iterative cycles until theme saturation was reached. RESULTS: The research team identified two themes of ethical bearing that enable MIHT success in and across care contexts. One theme of successful ethical bearing is "raising concerns," referring to speaking up when something needs to be addressed. The other is "making compromises," where individuals have to make sacrifices (e.g., lack of equipment, non-sterile environment, etc.) to give patient care. CONCLUSIONS: These data suggest that effective MIHTs have a collective moral compass. This moral compass is the team's ability to judge what is ethically right and wrong, as well as the team's willingness and ability to act accordingly-to consistently "do the right thing." There is a collective moral compass, and while the team may not all agree on what exactly is true north-they are all bending that way.

Interchangeability in Military Interprofessional Health Care Teams: Lessons Into Collective Self-healing and the Benefits Thereof.

INTRODUCTION: Interchangeability-i.e., the capacity to change places with another-is necessary for military interprofessional health care teams (MIHTs) to provide around-the-clock patient care. However, while interchangeability is clearly a necessity for modern health care delivery, it raises uncomfortable questions for civilian health care teams where it is usually labeled as unsafe. This perception surfaces because interchangeability runs counter to some of health care's cultural beliefs including those around patient ownership and professional scopes of practice. It is, therefore, not surprising that little is known about whether and how some level of interchangeability can be harnessed to improve the productivity of health care teams overall. In this article, we explore the notion of interchangeability in the particular context of MIHTs given that these health care teams are familiar with it. This exploration will offer insights into how interchangeability could maximize civilian health care teams' capacity to adapt. MATERIALS AND METHODS: We conducted a secondary analysis of interview data as an analytic expansion: "the kind of study in which the researcher makes further use of a primary data set in order to ask new or emerging questions that derive from having conducted the original analysis but were not envisioned within the original scope of the primary study aims". Within our secondary analysis approach, we used thematic analysis as our analytical tool to describe (1) what interchangeability looks like in MIHT teams, (2) how it is fostered in MIHTs, and (3) how it is enacted in MIHTs. RESULTS: Interchangeability was realized in MIHTs when individual team members adapted to take on roles and/or tasks that were not clearly niched in their specific areas of expertise but instead drew on the broad foundation of their clinical skill set. Cross-training and distributed leadership were ways in which MIHT members described how interchangeability was fostered. Furthermore, five features of working within MIHT teams were identified as key conditions to enact interchangeability: knowing your team members; being able to work with what/who you have; actively seeking others' expertise; situating your role within the broader picture of the mission; and maintaining a learning/teaching mindset. CONCLUSIONS: Interchangeability can be understood through the theoretical lens of Swarm Intelligence and more specifically, the principle of collective self-healing-which is the ability of collectives to continue to successfully perform despite disruption, challenges, or the loss of a team member. Our findings highlight how MIHTs have adopted interchangeability in a wide array of contexts to realize collective self-healing. Despite the discomfort it provokes, we suggest that interchangeability could be a powerful asset to civilian health care teams.

Leadership and Followership in Military Interprofessional Health Care Teams.

INTRODUCTION: The U.S. Military has long been aware of the vital role effective leaders play in high-functioning teams. Recently, attention has also been paid to the role of followers in team success. However, despite these investigations, the leader-follower dynamic in military interprofessional health care teams (MIHTs) has yet to be studied. Although interprofessional health care teams have become a topic of increasing importance in the civilian literature, investigations of MIHTs have yet to inform that body of work. To address this gap, our research team set out to study MIHTs, specifically focusing on the ways in which team leaders and followers collaborate in MIHTs. We asked what qualities of leadership and followership support MIHT collaboration? MATERIALS AND METHODS: This study was conducted using semi-structured interviews within a grounded theory methodology. Participants were purposefully sampled, representing military health care professionals who had experience working within or leading one or many MIHTs. Thirty interviews were conducted with participants representing a broad range of military health care providers and health care specialties (i.e., 11 different health professions), ranks (i.e., officers and enlisted military members), and branches of the U.S. Military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until thematic saturation was achieved. The subsets of data for leadership and followership were further analyzed separately, and the overlap and alignment across these two datasets were analyzed. RESULTS: The insights and themes developed for leadership and followership had significant overlap. Therefore, we present the study's key findings following the two central themes that participants expressed, and we include the perspectives from both leader and follower viewpoints to illustrate each premise. These themes are as follows: (1) a unique collaborative dynamic emerges when team members commit to a shared mission and a shared sense of responsibility to achieve that mission; and (2) embracing and encouraging both leader and follower roles can benefit MIHT collaboration. CONCLUSIONS: This study focused on ways in which team leaders and followers on MIHTs collaborate. Findings focused on qualities of leadership and followership that support MIHT's collaboration and found that MIHTs have a commitment to a shared mission and a shared sense of responsibility to achieve that mission. From this foundational position of collective responsibility to achieve a common goal, MIHTs develop ways of collaborating that enable leaders and followers to excel to include (1) understanding your role and the roles of others; (2) mutual respect; (3) flexibility; and (4) emotional safety. The study data suggest that MIHT members work along a continuum of leadership and followership, which may shift at any moment. Military interprofessional health care teams members are advised to be adaptive to these shared roles and contextual changes. We recommend that all members of MIHTs acquire leadership and followership training to enhance team performance.

The Ties That Bind: Camaraderie in Military Interprofessional Healthcare Teams.

INTRODUCTION: Multiple aspects of interpersonal dynamics can help or hinder the success of teams, particularly those in a Military Interprofessional Healthcare Team (MIHT). One specific mechanism for MIHTs' success is camaraderie and how these military teams are able to achieve, maintain, and enable the development of this important characteristic. Despite our understanding of military service members as being bonded like a family, we have a limited understanding of how this bond is translated into their MIHT experiences. MATERIALS AND METHODS: This study conducted interviews among 30 individuals who had participated in, led individual, and/or led many MIHTs, using a grounded theory methodology. Participants represented 11 different health professions, including officers and enlisted military members, and three branches of the U.S. military (e.g., army, navy, and air force). Data were collected and analyzed in iterative cycles until saturation was achieved. RESULTS: We identified six themes that shaped the overarching concept of camaraderie in MIHTs. These themes were (1) confidence in competent peers, (2) shared goals, (3) mutual respect, (4) desire to help one another improve, (5) personal is professional, and (6) bonds of military service. This paper describes each of these themes, provides illustrative examples from the data, and describes how these components contribute to MIHTs' team dynamics. We present a model for how to understand these themes. CONCLUSIONS: Through the identification and exploration of these aspects of camaraderie, we are able to better understand how MIHTs are able to be successful. MIHTs that demonstrated confidence in their brother/sister in arms possessed shared goals and missions, while maintaining mutual respect, a desire to help one another do better, and creating a personal and professional overlap tended to form stronger bonds of military service. Critically, these six aspects support a more nuanced understanding of the spirit of camaraderie and how it underpins MIHT success.

Perseverance: An Essential Trait of Military Interprofessional Healthcare Teams.

INTRODUCTION: Perseverance-doing something despite difficulty-is an asset to healthcare professionals, yet not all providers display this trait. The literature offers no conceptualization of perseverance as it relates to military caregivers. This research sought to explore the perseverance displayed by members of military interprofessional healthcare teams (MIHTs) and to construct a framework for explaining the role of perseverance in MIHTs' collaborative work. METHODS: Using Grounded Theory, this interview-based study collected insights from 30 individuals who had participated in MIHTs and/or led MIHTs. Participants represented 11 different health professions, both officers and enlisted military members, and three branches of the U.S. military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until theme saturation was achieved. RESULTS: We identified practices through which perseverance was exhibited by members of MIHTs: (1) humility, (2) mission focus, (3) team effort, (4) failure is not an option, (5) comfort with discomfort, and (6) continuous improvement. We then clustered these practices into three subcategories, reflecting how certain practices may connect to support MIHT perseverance. CONCLUSIONS: These six practices appear connected in significant ways to support the MIHTs' efforts. Humility, mission focus, and team effort can help team members collaborate as a unified and mutually supportive team. From this base, MIHTs seemed able to become comfortable with discomfort and to refuse failure as an option. These orientations then allowed the team to engage in continuous improvement. Together, these practices may enhance team perseverance and ultimately team performance.

Situational Awareness: Forecasting Successful Military Medical Teams.

INTRODUCTION: Military healthcare providers working in military interprofessional healthcare teams (MIHTs) require situational awareness (SA) to ensure safe and efficacious patient care. This study aimed to explore SA in MIHTs to understand how SA can be reinforced and maintained in MIHTs. The research team set out to answer two questions: "What aspects of individual and team SA are particularly important for MIHTs?" and "How can we enable military healthcare providers to be effective MIHTs members with robust SA?". METHODS: This study used Grounded Theory methodology collecting perspectives from 30 study participants from various backgrounds, including 11 different healthcare professions from the U.S. Army, Air Force, and Navy. Each study participant had experiences participating in, leading one, or leading many MIHTs. Data were collected in three cycles and analyzed within each cycle until saturation was reached. RESULTS: Five themes were robustly represented in the data set regarding SA: (1) contextually informed adaptability, (2) readiness, (3) trust, (4) communication, and (5) mission focus. CONCLUSIONS: The urgency often faced by MIHTs brings SA and the principles that underpin SA into sharper focus. The SA themes identified in this research may provide insight into training effectiveness, team strengths and weaknesses, and team performance.

Military Interprofessional Healthcare Teams: Identifying the Characteristics That Support Success.

Military interprofessional healthcare teams (MIHTs) are foundational to the care provided to military members and their families. However, to date, very little research has investigated MIHTs. Notably, we have few insights into what distinguishes successful MIHTs. This manuscript presents findings from a program of research that was carried out to address this gap. We review what is known about MIHTs to date and the Uniformed Services University's (USU) focused efforts to ensure that greater understanding of MIHTs was developed. We provide an overview of the USU-supported research and of the findings that were generated by that inquiry. After summarizing the manuscripts included in this special edition of Military Medicine, we close by acknowledging and thanking key members of the U.S. military healthcare system who supported this research.

New Insights About Military Interprofessional Healthcare Teams: Lessons Learned and New Directions From a Program of Research.

The success of the military is significantly supported by highly effective collaborative teams. While much is known about successful military teams outside the context of healthcare delivery, considerably less attention has been paid to teams working in patient care. Thus, this supplement has explored the features of successful military interprofessional healthcare teams (MIHTs). In this summary paper, the authors discuss what this supplement's investigations have taught us about MIHTs and offer a series of proposed future investigations of MIHTs and their role in military healthcare.

Delivering patient care during large-scale emergency situations: Lessons from military care providers.

BACKGROUND: Today, physicians are at the front lines of a pandemic response. Military physicians are uniquely trained to excel in such large-scale emergency situations. Civilian physicians can harness military know-how, but it will require research into military healthcare responses-specifically, we need to learn lessons from military interprofessional healthcare teams (MIHTs). METHODS: This research answers two questions: What are the characteristics of successful MIHTs? Why are those characteristics important to MIHT success in large-scale emergency situations? Using a Grounded Theory approach, 30 interviews were conducted soliciting perspectives from the broadest range of healthcare professionals who had experiences working in and leading MIHTs. Purposive sampling was used to recruit participants broadly across: contexts where MIHTs work; military branches; ranks; genders; and healthcare professions. Data were iteratively collected and analyzed. RESULTS: 30 participants were interviewed (18 male (60%); 21 officers (70%); 9 enlisted (30%)) who held various healthcare occupations (medic/tech/corpsman (9); nurse (7); physician (7); dentist (2); occupational therapist (2); chaplain (1); physician's assistant (1); and psychiatrist (1)). Six characteristics of successful MIHTs that are directly applicable to large-scale emergency situations were identified thatthat clustered into two themes: own your purposes and responsibilities (through mission focus and ethical bearing) and get it done, safely (via situational awareness, adaptability, and leadership with followership). CONCLUSIONS: This study provides insights, informed by decades of military service and training, to help civilian physicians succeed in large-scale emergency situations. These experiences from the war front can support today's pandemic responses on the home front.

Is two a crowd? A qualitative analysis of dyad learning in an OBGYN clinical clerkship.

INTRODUCTION: Dyad learning occurs when two students work together to acquire new skills and knowledge. Several studies have provided evidence to support the educational rationale for dyad learning in the controlled simulated setting. However, the role of dyad learning in the clinical setting remains uncertain. Unlike the simulated setting, learning in the clinical setting depends on a complex interplay between medical students, doctors, nurses and patients potentially making dyad learning less valuable in clerkships. The objective of this study was to explore how key stakeholders perceive the value of implementing dyad learning during medical students' clinical clerkships. METHODS: In a constructivist qualitative study, we conducted 51 semi-structured interviews with 36 key stakeholders involved in dyad learning, including 10 medical students, 12 doctors, five nurses and nine patients. Data were coded inductively using thematic analysis, then coded deductively using stakeholder theory as a theoretical framework. RESULTS: We found that stakeholders generally perceived the educational impact of dyad learning in the clinical setting similarly but disagreed on its value. Students emphasised that dyad learning made them participate more actively during patient encounters and patients did not mind having two students present. Doctors and nurses considered dyad learning disruptive to the balance between service and training and reported that it did not resonate with their perception of good patient care. CONCLUSION: Dyad learning enables students to be more active during their clinical clerkships, but it easily disrupts the balance between service and training. This disruption may be exacerbated by the shifted balance in priorities and values between different stakeholder groups, as well as by making implicit teaching obligations more explicit for supervising doctors and nurses. Consequently, implementing dyad learning may not be perceived as valuable by doctors and nurses in the clinical setting, regardless of its pedagogical rationale.

Interprofessional education in the U.S. military: harnessing simulation for team readiness.

Research into military interprofessional healthcare teams (MIHTs) is rarely reported in the interprofessional literature. MIHTs must effectively collaborate in the low resource and chaotic contexts of humanitarian and combat deployments; however, we have yet to study how MIHTs learn to work in these contexts. To address this gap, we investigated military interprofessional education (MIPE). Using an ethnographic approach, we conducted non-participant observations (n = 30.5 hours) of a specific platoon (n = 32 participants) during an MIPE simulation called Operation Bushmaster - a large-scale immersive simulation of battlefield deployment. Findings indicated three aspects of MIPE: (1) a culture where flailing isn't failing; (2) the importance of followership; and (3) an interprofessional respect fostered by role adoption. Considering these findings through Dweck's fixed vs growth mind-set conceptualization, we suggest that - although unusual when compared with traditional IPE - MIPE's teaching and learning methods provide developmental opportunities for team members. We also suggest why Dweck's mind-set conceptualizations could be usefully extended from an individual-focus to also include a collaborative-team-focus. We contend that the findings developed from this research could be transferred to civilian contexts so that the lessons learned by those who serve on the war front could inform those who serve at home.

Attaining full professor: Women's and men's experiences in medical education.

INTRODUCTION: The underrepresentation of women among senior faculty members in medical education is a longstanding problem. The purpose of this international qualitative investigation was to explore women and men's experiences of attaining full professorship and to investigate why women remain underrepresented among the senior faculty ranks. METHODS: Conducted within a social constructionist orientation, our qualitative study employed narrative analysis. Two female and two male participants working in medical education were recruited from five nations: Australia, Canada, the Netherlands, United Kingdom and United States. All participants held an MD or PhD. During telephone interviews, participants narrated the story of their careers. The five faculty members on the research team were also interviewed. Their narratives were included in analysis, rendering their experiences equal to those of the participants. RESULTS: A total of 24 full professors working in medical education were interviewed (n = 15 females and n = 9 males). While some aspects were present across all narratives (ie personal events, career milestones and facilitating and/or impeding factors), participants' experience of those aspects differed by gender. Men did not narrate fatherhood as a role navigated professionally, but women narrated motherhood as intimately connected to their professional roles. Both men and women narrated career success in terms of hard work and overcoming obstacles; however, male participants described promotion as inevitable, whereas women narrated promotion as a tenuous navigation of social structures towards uncertain outcomes. Female and male participants encountered facilitators and inhibitors throughout their careers but described acting on those experiences differently within the cultural contexts they faced. DISCUSSION: Our data suggest that female and male participants had different experiences of the work involved in achieving full professor status. Understanding these gendered experiences and their impact on career progression is an important advancement for better understanding what leads to the underrepresentation of women among senior faculty members in medical education.