Us helping us: The evolution of a peer support group for formerly incarcerated people.

Introduction: Physical, psychological, and emotional trauma experienced while incarcerated influences subsequent mental health outcomes. Upon release, there is a fragmented landscape of mental health services and many of the existing services do not account for the root causes of challenges faced by formerly incarcerated people (FIP). To address the unmet social, psychological, behavioral, and emotional needs of FIP in Louisiana, the Formerly Incarcerated Peer Support (FIPS) Group developed a twelve-unit curriculum in 2019. Methods: We detail the evolution, development, and evaluation of the FIPS Group program. Additionally, we describe the community-driven process for developing the curriculum. Results: The FIPS Group has grown from informal meetings of a handful of FIP in New Orleans, Louisiana, into a multi-state, interdisciplinary network of more than 150 stakeholders. FIPS Group has developed the only peer support curriculum we are aware of that is designed by FIP, for FIP, and uses the shared experience of incarceration and reentry as its organizing principle. Limitations of the model include the lack of pending evaluation data and challenges with technological proficiency among FIP. Conclusions: The FIPS Group model may be generalized in a number of settings. Similar approaches may benefit the mental health of the millions of Americans involved in the criminal-legal system.

An Appreciative Inquiry Approach to the Core Competencies: Taking it From Theory to Practice.

OBJECTIVE: To operationalize the surgical core competencies by using a qualitative inquiry strategy to explore how surgical competence is behaviorally demonstrated by faculty. DESIGN: Categorical general and vascular surgery residents completed a survey soliciting opinions regarding which faculty were deemed most representative of each core competency. The surveys served as a theoretical sample, as surgeons selected were then interviewed, and interviews transcribed. A qualitative research approach using grounded theory coding methods was used for transcript analysis. Iterative coding was performed, and emergent themes were then extracted from transcript analysis. SETTING: Southern Illinois University School of Medicine, Department of Surgery in Springfield, IL, a tertiary academic center. PARTICIPANTS: Fourteen of 19 residents completed the survey (74% response rate). Two surgeons were selected for each competency. A total of 7 interviews were performed, with 4 surgeons being chosen for 2 competencies. RESULTS: Emergent themes revealed that competent surgeons shared qualities that drove their development and execution of each competency. These qualities included self-awareness, a selfless character, responsibility and ownership, context awareness, reliance on relationships and community, and a pattern of habit formation and discipline. Additionally, the competencies were noted to be pursued in an interrelated and interdependent fashion. CONCLUSIONS: Surgeons deemed competent in any core domain shared common qualities. Further study exploring how each of these is identified, developed and taught is warranted. The competencies are an inter-related matrix whose development and execution correlates with foundational personal disciplines.

Evaluation of a Prison Occupational Therapy Informal Education Program: A Pilot Study.

This pilot study explored the strengths and weaknesses of an informal education program and identified elements of the program valued by participants. Participants were men living in a minimum security prison who had been incarcerated for ten or more years. The outside researcher was joined by three former program participants as co-researchers. Together, they interviewed 27 residents who completed the informal education program. Interviews were transcribed and de-identified. Researchers used the summative content analysis approach to analyze the data. Initial content analysis yielded five concepts: doing (engaging in purposeful activities); information (program handouts and discussions that included data and descriptions of all of the topics discussed); re-entry fears (socialization; making amends with victims and/or reuniting with family and friends); technology (includes, but not limited to, using smartphones, internet and other technology in all areas of occupation); and self-worth as a person. Further interpretation per the summative content analysis method yielded three themes: doing (engaged in purposeful activities), validation of self-worth (confirmation of being a valued human being in spite of having committed a serious crime) and concerns about the future (being able to successfully engage in virtually all occupations). Whilst informal education programs may help people who are incarcerated gain information, gain a sense of self-worth and allay some reentry fears, understanding the long-term affect such programs may have such as preparing them for successful re-entry to society or reducing recidivism rates, will require long-term follow-up. Regardless of the occupational therapy intervention, the practice of occupational therapy in the criminal justice system needs to be client-centred. Because of the small number of participants and limited access to participants, one should not generalize the findings of this study to other situations or populations. Further research to examine the effectiveness of an occupational therapy education program is warranted. Copyright © 2016 John Wiley & Sons, Ltd.

Critical Reflections on Participatory Action Research in a Prison Setting: Toward Occupational Justice.

There is little information about prison-related occupational deprivation, and about doing research in prison. To document an occupational therapist and two prisoners' critical reflections on an informal occupational therapy education program using participatory action research (PAR), we reflect on our combined experiences of evaluating an occupational therapy program. The reflections include articulation of power differentials and examples of occupational deprivation and injustice at every stage of the program evaluation process. We found that the PAR process allowed all collaborators to engage of co-occupation and gain a keener understanding of occupational justice. With co-occupation came personal growth and an appreciation for each other's humanity despite our diverse backgrounds. Recognizing that research in prison can be challenging, the results suggest it can also be rewarding. We offer insights and practical suggestions for doing research in prison.

The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.

BACKGROUND: Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care. METHODS: Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations. RESULTS: Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention. CONCLUSIONS: Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams.

Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection.

OBJECTIVES: No single reliable sepsis biomarker exists for risk stratification and prognostication in pediatric patients presenting to the emergency department (ED). Serum lactate (LA) predicts mortality in septic adults. We sought to determine if serum LA correlated with the diagnosis of sepsis, admission rates, and outcomes in pediatric patients presenting to the ED with suspected infection. METHODS: This retrospective study was performed in an ED with a sepsis protocol that included serum LA with every blood culture. Of 735 pediatric patients with blood cultures drawn, 289 had serum LA obtained concomitantly. Appropriate statistical analyses determined the relationship between serum LA and variables of interest. RESULTS: A significant positive correlation was found between serum LA and pulse, respiratory rate, white blood cell count, platelets, and length of stay, whereas a significant negative correlation was seen with temperature, HCO3, and blood urea nitrogen. Admitted patients had higher serum LA (2.36 mM) than did those not admitted (1.70 mM), P = 0.0001. Of patients discharged, there was no difference in serum LA between those who returned within 3 days (1.80 mM) and those who did not (1.72 mM), P = 0.6654. Mean serum LA for those with sepsis (2.03 mM) did not differ from those without sepsis (1.91 mM), P = 0.3364. CONCLUSIONS: Higher serum LA in pediatric patients presenting to the ED with suspected infection correlated with increased pulse, respiratory rate, white blood cell count, and platelets and decreased blood urea nitrogen, HCO3, and age. Serum LA may be predictive of hospitalization and length of stay and thus suggestive of disease severity, but not of return rates or pediatric sepsis screening in the ED.

Engaging medical students in the feedback process.

BACKGROUND: There are potential advantages to engaging medical students in the feedback process, but efforts to do so have yielded mixed results. The purpose of this study was to evaluate a student-focused feedback instructional session in an experimental setting. METHODS: Medical students were assigned randomly to either the intervention or control groups and then assigned randomly to receive either feedback or compliments. Tests of knowledge, skills, and attitudes were given before and after the intervention. RESULTS: There was a significant gain of knowledge and skill in the group that received instruction. Satisfaction was higher after compliments in the control group but higher after feedback in the instructional group. There was no change in the subject's willingness to seek feedback. CONCLUSIONS: A student-focused component should be carefully included as part of an overall effort to improve feedback in surgical education. The role of medical student attitudes about feedback requires further investigation.

Neurogenic tumors of the pelvis: clinicopathologic features and surgical outcomes using a multidisciplinary team.

BACKGROUND: Few data exist regarding the outcomes in patients undergoing surgery for pelvic tumors of neurogenic origin. Our aim was to characterize the clinical and pathologic features of pelvic neurogenic tumors and assess surgical outcomes. METHODS: All patients who underwent operations for pelvic neurogenic tumors at our institution between 1956 and 2004 were identified. Data analyzed included demographics, clinical features, histopathology, local recurrence, and survival. RESULTS: Eighty-nine patients were identified, of whom 44 were male. Median age was 38 years. The most common presenting symptom was low back or pelvic pain (56%). Malignant lesions were found in 43 patients (48%). Schwannomas were the most common benign tumor (61%) and malignant peripheral nerve sheath tumors the most common malignant lesion (81%). Median tumor size was 9.5 cm (range 0.8-32 cm). Malignant tumors had histopathologic evidence of infiltration of surrounding structures in 49% of cases. Intralesional resection was the most common surgical technique for both benign and malignant tumors. Thirty-day mortality was nil; major morbidity was seen in 13%. Adjuvant therapy was given to 91% of the patients with malignant disease. Five-year local recurrence rates for benign and malignant lesions were 35.9% and 35.0%, respectively. Distant recurrence for malignant lesions was 65.1% at 5 years. Five-year disease-free survival for malignant tumors was 25.9%. CONCLUSION: Pelvic neurogenic tumors occurring in young patients may be large when detected and present with nonspecific symptoms. Benign and malignant tumors had a high local recurrence rate and survival for malignant tumors was poor. Early detection and aggressive surgical intervention should improve outcome.

Outcomes of primary liver cancer in children: an appraisal of experience.

INTRODUCTION: Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common primary liver cancers in children. Recent advances in management of pediatric liver cancer have improved disease-specific survival (DSS). This is a review of our experience with childhood liver malignancy over the past 3 decades. MATERIALS AND METHODS: A retrospective chart review from 1975 to 2005 identified patients who were 18 years old or younger with a histologically confirmed diagnosis of primary liver cancer. Patients were staged according to the Children's Cancer Group and Pediatric Oncology Group (CCG/POG) system. Patients were followed up prospectively through clinic visits and mail correspondence. Standard statistical methods were used for comparison, risk, and survival analyses. RESULTS: Fifty-two patients were confirmed to have primary liver cancers, where 24 (46%) patients had HB, 22 (42%) had HCC, 3 (6%) had sarcomas, and 3 (6%) had other histologies. Mean ages at presentation for HB and HCC were 3.2 and 13.1 years old, respectively. The most common presentations were abdominal mass (67%) and pain (40%). Most patients underwent major liver resection (n = 45, 87%), including: lobectomy (n = 25, 48%), and trisegmentectomy (n = 11, 21%). Three patients underwent liver transplantation (n = 3, 6%) for advanced local disease. Forty-five (87%) received primary or neoadjuvant and/or adjuvant chemotherapy. Patients had the following CCG/POG stages: I (n = 31, 60%), II (n = 6, 11.5%), III (n = 9, 17%), and IV (n = 6, 11.5%). Complete gross resection (stage I and II) was achieved in 37 (71%) patients. The perioperative mortality and morbidity rates were 0% and 29%, respectively. Patients with complete resection had significantly better 5-year DSS and median survival compared with incomplete gross resection: 62% vs 9% and 216 vs 18 months, P < .001. Patients treated during the period 1995-2005 had better 5-year DSS and median survival compared with those treated during 1975-1994: 68% vs 32% and 117 vs 27 months, P = .032. All 3 patients who underwent transplantation for conventionally unresectable disease are alive without disease recurrence (follow-up period, 1-15 years). CONCLUSION: Complete resection of the pediatric primary liver tumors remains the cornerstone of treatment to achieve cure. Major liver resection can be performed with minimal perioperative mortality and morbidity. Patients with HB appeared to have better survival compared with patients with HCC, and there was significant improvement in the DSS of children treated in the recent decade. Liver transplantation in conjunction with chemotherapy may have an increasing role in the management of locally advanced primary liver cancers.