Supplemental digital content is available in the text. Objective Burnout is a problem among physi... more Supplemental digital content is available in the text. Objective Burnout is a problem among physicians. Debriefing may be a tool to decrease burnout and increase resiliency in pediatric emergency medicine (PEM) providers. The objective of this study was to determine rates of burnout and resiliency in PEM fellows and their experience with debriefing. Methods A validated survey was administered to PEM fellows during their first and then third years of fellowship. The survey included the abbreviated Maslach Burnout Index (MBI), the Brief Resilience Scale (BRS), and debriefing experience. The percent of respondents with moderate to high burnout was determined by their scores in each of 3 MBI categories. Their resilience was determined by the BRS score. The effect of debriefing on resiliency scores was analyzed. Results There were 47 first-year respondents (of 148 first-year PEM fellows) and 34 third-year respondents (of 118 third-year PEM fellows). There were burnout scores in at least 1 MBI category in 80.9% of first years and 65% of third years. In first years, 42.6% showed burnout in personal accomplishment, 38.3% in depersonalization, and 55.3% in emotional exhaustion. By third year, they were 35.3%, 29.4%, and 52.9%, respectively. About 59% of first and third years had low resiliency scores. Fifty-five percent of first year respondents felt comfortable with debriefing compared with 67.6% of third years. The fellows' comfort and experience with debriefing did not significantly affect their BRS score. Conclusions This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.
Objectives: Effective trainee-led debriefing after critical events in the pediatric emergency dep... more Objectives: Effective trainee-led debriefing after critical events in the pediatric emergency department has potential to improve patient care, but debriefing assessments for this context have not been developed. This study gathers preliminary validity and reliability evidence for the Debriefing Assessment for Simulation in Healthcare (DASH) as an assessment of trainee-led post-critical event debriefing. Methods: Eight fellows led teams in three simulated critical events, each followed by a video-recorded discussion of performance mimicking impromptu debriefings occurring after real clinical events. Three raters assessed the recorded debriefings using the DASH, and their feedback was collated. Data were analyzed using generalizability theory, Gwet's AC 2 , intraclass correlation coefficient (ICC), and coefficient alpha. Validity was examined using Messick's framework. The DASH instrument had relatively low traditional inter-rater reliability (Gwet's AC 2 = 0.24, single-rater ICC range = 0.16-0.35), with 30% fellow, 19% rater, and 23% rater by fellow variance. DASH generalizability (G) coefficient was 0.72, confirming inadequate reliability for research purposes. Decision (D) study results suggest the DASH can attain a G coefficient of 0.8 with five or more raters. Coefficient alpha was 0.95 for the DASH. A total of 90 and 40% of items from Elements 1 and 4, respectively, were deemed "not applicable" or left blank. Our results suggest that the DASH does not have sufficient validity and reliability to rigorously assess debriefing in the post-critical event environment but may be amenable to modification. Further development of the tool will be needed for optimal use in this context. E ffective debriefing after resuscitations can poten- tially improve future care. The American Heart Association and American Academy of Pediatrics recommend regular postevent debriefings. The
Perkembangan iptek nuklir berpengaruh terhadap teknik eksplorasi hidrokarbon, antara lain terbukt... more Perkembangan iptek nuklir berpengaruh terhadap teknik eksplorasi hidrokarbon, antara lain terbukti dengan adanya penggunaan isotop radioaktif untuk menentukan umur absolute batuan. Penentuan umur batuan yang pada awalnya menggunakan fosil penunjuk umur (baik mikro maupun makro-fosil) yang menghasilkan umur relatif batuan, belakangan ini diperkaya dengan metode perhitungan peluruhan mineral radioaktif untuk menentukan umur absolute batuan, sehingga posisi stratigrafi suatu lapisan batuan (batuan induk dan reservoir) dapat ditentukan dengan pasti. Sementara itu, aplikasi teknologi nuklir juga dipergunakan dalam survey sumur pemboran eksplorasi yang antara lain dikenal dengan Nuclear Magnetic Resonance (NMR) yang membantu ahli geologi dalam mengukur porositas dan permiabilitas secara langsung di lapangan, sehingga dapat memprediksi keberadaan hidrokarbon. Dari sisi sedimentologi, iptek nuklir juga diaplikasikan dalam laboratorium X Ray Diffraction (XRD Laboratory) untuk menentukan jenis mineral penyusun batuan dan laboratorium Scanning Electron Microscope (SEM Laboratory) untuk mengetahui porositas batuan. Kedua hal tersebut membantu ahli eksplorasi dalam menyusun manajemen reservoir.
Prezygotic mating isolation has been a major interest of evolutionary biologists during the past ... more Prezygotic mating isolation has been a major interest of evolutionary biologists during the past several decades because it is likely to represent one of the first stages in the transition from populations to species. Mate discrimination is one of the most commonly measured forms of prezygotic isolation and appears to be relatively common among closely related species. In some cases, it has been used as a measure to distinguish populations from subspecies, races, and sister species, yet the influences of various evolutionary mechanisms that may generate mate discrimination are largely unknown. In this study, we measured the level and pattern of mate discrimination among 18 populations of a cosmopolitan drosophilid species, Drosophila ananassae, from throughout its geographical range and its sister species, Drosophila pallidosa, which has a restricted geographical distribution in the South Pacific Islands. In addition, we measured genetic differentiation between all 18 populations using mitochondrial DNA polymorphism data. Mate discrimination varies considerably throughout the species range, being higher among populations outside the ancestral Indonesian range, and highest in the South Pacific. Our results suggest that colonization and genetic differentiation may have an influence on the evolutionary origin of mate discrimination. Our phylogeographical approach clarifies the ancestral relationships of several populations from the South Pacific that show particularly strong mate discrimination and suggests that they may be in the early stages of speciation. Furthermore, both the genetic and behavioral results cast doubt on the status of D. pallidosa as a good species.
Quality and Safety Conference (Q/S) (monthly) • Residents on the inpatient team present a safety ... more Quality and Safety Conference (Q/S) (monthly) • Residents on the inpatient team present a safety event or near miss from their inpatient experience. • The lead senior resident describes an intervention relevant to one event. • All residents are tasked with entering events into the system-wide safety net. Morbidity/Mortality Conference (M&M) (quarterly) • Chief residents address core safety topics, focus on sentinel events from across the department, and more fully review the events on the inpatient service. • Residents and faculty discuss and analyze errors openly. Through these initiatives, residents have demonstrated progress in achieving the PS Pathways: • PS1: All residents verbally report events during Q/S conference. The institution has documented increased reporting into the system-wide safety net by pediatric residents • PS2: Open discussion and follow-up regarding analysis of errors and proposed interventions provides education for residents • PS3: Discussion occurs in a supportive, non-punitive manner. • PS4: Residents and Faculty participate in group analysis of events during M&M Conferences • PS5/6: The clinical site monitors resident reporting into the system-wide safety net, and analyzes types of errors reported. Participation in M&M and Q/S conferences is tracked. • PS7: Open discussion at M&M and Q/S Conference includes comment about disclosure of events to the family. As a result of resident-led safety conferences, residents are: • More often recognizing and reporting safety events • Participating more frequently in discussions about safety • Increasingly motivated to become involved in QI initiatives • Discussing errors openly in multiple settings
Supplemental digital content is available in the text. Objective Burnout is a problem among physi... more Supplemental digital content is available in the text. Objective Burnout is a problem among physicians. Debriefing may be a tool to decrease burnout and increase resiliency in pediatric emergency medicine (PEM) providers. The objective of this study was to determine rates of burnout and resiliency in PEM fellows and their experience with debriefing. Methods A validated survey was administered to PEM fellows during their first and then third years of fellowship. The survey included the abbreviated Maslach Burnout Index (MBI), the Brief Resilience Scale (BRS), and debriefing experience. The percent of respondents with moderate to high burnout was determined by their scores in each of 3 MBI categories. Their resilience was determined by the BRS score. The effect of debriefing on resiliency scores was analyzed. Results There were 47 first-year respondents (of 148 first-year PEM fellows) and 34 third-year respondents (of 118 third-year PEM fellows). There were burnout scores in at least 1 MBI category in 80.9% of first years and 65% of third years. In first years, 42.6% showed burnout in personal accomplishment, 38.3% in depersonalization, and 55.3% in emotional exhaustion. By third year, they were 35.3%, 29.4%, and 52.9%, respectively. About 59% of first and third years had low resiliency scores. Fifty-five percent of first year respondents felt comfortable with debriefing compared with 67.6% of third years. The fellows' comfort and experience with debriefing did not significantly affect their BRS score. Conclusions This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.
Objectives: Effective trainee-led debriefing after critical events in the pediatric emergency dep... more Objectives: Effective trainee-led debriefing after critical events in the pediatric emergency department has potential to improve patient care, but debriefing assessments for this context have not been developed. This study gathers preliminary validity and reliability evidence for the Debriefing Assessment for Simulation in Healthcare (DASH) as an assessment of trainee-led post-critical event debriefing. Methods: Eight fellows led teams in three simulated critical events, each followed by a video-recorded discussion of performance mimicking impromptu debriefings occurring after real clinical events. Three raters assessed the recorded debriefings using the DASH, and their feedback was collated. Data were analyzed using generalizability theory, Gwet's AC 2 , intraclass correlation coefficient (ICC), and coefficient alpha. Validity was examined using Messick's framework. The DASH instrument had relatively low traditional inter-rater reliability (Gwet's AC 2 = 0.24, single-rater ICC range = 0.16-0.35), with 30% fellow, 19% rater, and 23% rater by fellow variance. DASH generalizability (G) coefficient was 0.72, confirming inadequate reliability for research purposes. Decision (D) study results suggest the DASH can attain a G coefficient of 0.8 with five or more raters. Coefficient alpha was 0.95 for the DASH. A total of 90 and 40% of items from Elements 1 and 4, respectively, were deemed "not applicable" or left blank. Our results suggest that the DASH does not have sufficient validity and reliability to rigorously assess debriefing in the post-critical event environment but may be amenable to modification. Further development of the tool will be needed for optimal use in this context. E ffective debriefing after resuscitations can poten- tially improve future care. The American Heart Association and American Academy of Pediatrics recommend regular postevent debriefings. The
Perkembangan iptek nuklir berpengaruh terhadap teknik eksplorasi hidrokarbon, antara lain terbukt... more Perkembangan iptek nuklir berpengaruh terhadap teknik eksplorasi hidrokarbon, antara lain terbukti dengan adanya penggunaan isotop radioaktif untuk menentukan umur absolute batuan. Penentuan umur batuan yang pada awalnya menggunakan fosil penunjuk umur (baik mikro maupun makro-fosil) yang menghasilkan umur relatif batuan, belakangan ini diperkaya dengan metode perhitungan peluruhan mineral radioaktif untuk menentukan umur absolute batuan, sehingga posisi stratigrafi suatu lapisan batuan (batuan induk dan reservoir) dapat ditentukan dengan pasti. Sementara itu, aplikasi teknologi nuklir juga dipergunakan dalam survey sumur pemboran eksplorasi yang antara lain dikenal dengan Nuclear Magnetic Resonance (NMR) yang membantu ahli geologi dalam mengukur porositas dan permiabilitas secara langsung di lapangan, sehingga dapat memprediksi keberadaan hidrokarbon. Dari sisi sedimentologi, iptek nuklir juga diaplikasikan dalam laboratorium X Ray Diffraction (XRD Laboratory) untuk menentukan jenis mineral penyusun batuan dan laboratorium Scanning Electron Microscope (SEM Laboratory) untuk mengetahui porositas batuan. Kedua hal tersebut membantu ahli eksplorasi dalam menyusun manajemen reservoir.
Prezygotic mating isolation has been a major interest of evolutionary biologists during the past ... more Prezygotic mating isolation has been a major interest of evolutionary biologists during the past several decades because it is likely to represent one of the first stages in the transition from populations to species. Mate discrimination is one of the most commonly measured forms of prezygotic isolation and appears to be relatively common among closely related species. In some cases, it has been used as a measure to distinguish populations from subspecies, races, and sister species, yet the influences of various evolutionary mechanisms that may generate mate discrimination are largely unknown. In this study, we measured the level and pattern of mate discrimination among 18 populations of a cosmopolitan drosophilid species, Drosophila ananassae, from throughout its geographical range and its sister species, Drosophila pallidosa, which has a restricted geographical distribution in the South Pacific Islands. In addition, we measured genetic differentiation between all 18 populations using mitochondrial DNA polymorphism data. Mate discrimination varies considerably throughout the species range, being higher among populations outside the ancestral Indonesian range, and highest in the South Pacific. Our results suggest that colonization and genetic differentiation may have an influence on the evolutionary origin of mate discrimination. Our phylogeographical approach clarifies the ancestral relationships of several populations from the South Pacific that show particularly strong mate discrimination and suggests that they may be in the early stages of speciation. Furthermore, both the genetic and behavioral results cast doubt on the status of D. pallidosa as a good species.
Quality and Safety Conference (Q/S) (monthly) • Residents on the inpatient team present a safety ... more Quality and Safety Conference (Q/S) (monthly) • Residents on the inpatient team present a safety event or near miss from their inpatient experience. • The lead senior resident describes an intervention relevant to one event. • All residents are tasked with entering events into the system-wide safety net. Morbidity/Mortality Conference (M&M) (quarterly) • Chief residents address core safety topics, focus on sentinel events from across the department, and more fully review the events on the inpatient service. • Residents and faculty discuss and analyze errors openly. Through these initiatives, residents have demonstrated progress in achieving the PS Pathways: • PS1: All residents verbally report events during Q/S conference. The institution has documented increased reporting into the system-wide safety net by pediatric residents • PS2: Open discussion and follow-up regarding analysis of errors and proposed interventions provides education for residents • PS3: Discussion occurs in a supportive, non-punitive manner. • PS4: Residents and Faculty participate in group analysis of events during M&M Conferences • PS5/6: The clinical site monitors resident reporting into the system-wide safety net, and analyzes types of errors reported. Participation in M&M and Q/S conferences is tracked. • PS7: Open discussion at M&M and Q/S Conference includes comment about disclosure of events to the family. As a result of resident-led safety conferences, residents are: • More often recognizing and reporting safety events • Participating more frequently in discussions about safety • Increasingly motivated to become involved in QI initiatives • Discussing errors openly in multiple settings
Uploads
Papers by Shiva Zargham