The response of the Irish pharmaceutical manufacturing sector to the COVID-19 pandemic with a focus on Lean and JIT

Background

Just in Time (JIT) and Lean manufacturing are concepts that originated in the automotive industry and were then adopted by pharmaceutical and biopharmaceutical companies during the 1990s. However, the Covid-19 pandemic and the urgent demand for pharmaceutical treatment challenged JIT and Lean manufacturing processes. Production of Covid-19-related medicines increased, putting pressure on global supply chains and operations. This also hindered the production of medicines using the same or similar materials. Thus, questions are raised concerning JIT and Lean supply chains in the pharmaceutical industry.

Objectives

The present study aimed to explore (1) if material and supply constraints occurred due to the Covid-19 pandemic, (2) how companies were impacted and managed and (3) if changes are required to future proof the JIT supply chain approach for future global events.

Design

A mixed-method cross-sectional survey design was used and focused on material supply, qualification and validation in Irish pharmaceutical manufacturing sites.

Methods

Employees working in the Irish pharmaceutical manufacturing industry were recruited using convenience sampling through online advertisement using the social media platform 'LinkedIn'. Quantitative data was analysed using percentages and qualitative data from free-text responses were used to add context to the quantitative survey questions.

Results

A total of 41 participants were recruited. The results suggested that the pandemic had a negative effect on material availability according to 81% of participants. This translated to delays or stoppage of production activity and was mainly handled by sourcing new materials (70%). To cope with future global crises, 60% of participants recommended more flexibility in future validation processes while 78% of participants acknowledged the importance of validating additional suppliers. A hybrid model of manufacturing and supply chain management was also a preferred approach to exclusive Lean and JIT (42%).

Conclusions

The production of non-Covid-19 medicines was adversely affected by the Covid-19 pandemic, but the pharmaceutical industry in Ireland demonstrated resilience and collaboration in response to these challenges. This study suggests that the JIT and Lean manufacturing model should be adjusted to ensure medicine supply chains are not disrupted during future global events.

Designing, Conducting, and Reporting Survey Studies: A Primer for Researchers

Survey studies have become instrumental in contributing to the evidence accumulation in rapidly developing medical disciplines such as medical education, public health, and nursing. The global medical community has seen an upsurge of surveys covering the experience and perceptions of health specialists, patients, and public representatives in the peri-pandemic coronavirus disease 2019 period. Currently, surveys can play a central role in increasing research activities in non-mainstream science countries where limited research funding and other barriers hinder science growth. Planning surveys starts with overviewing related reviews and other publications which may help to design questionnaires with comprehensive coverage of all related points. The validity and reliability of questionnaires rely on input from experts and potential responders who may suggest pertinent revisions to prepare forms with attractive designs, easily understandable questions, and correctly ordered points that appeal to target respondents. Currently available numerous online platforms such as Google Forms and Survey Monkey enable moderating online surveys and collecting responses from a large number of responders. Online surveys benefit from disseminating questionnaires via social media and other online platforms which facilitate the survey internationalization and participation of large groups of responders. Survey reporting can be arranged in line with related recommendations and reporting standards all of which have their strengths and limitations. The current article overviews available recommendations and presents pointers on designing, conducting, and reporting surveys.

Canadian Registered Dietitians' Utilization of the 2018 Diabetes Canada Nutrition Therapy Clinical Practice Guidelines: A Cross-sectional Study

OBJECTIVES

Our aim in this work was to ascertain Canadian registered dietitians' (RDs) use of the 2018 Diabetes Canada nutrition therapy (NT) recommendations and to identify the degree of agreement with facilitator-to-use statements.

METHODS

A national 28-item anonymous cross-sectional survey of RDs who counsel people with diabetes was conducted.

RESULTS

Three hundred sixty RDs responded to the survey, but some questions had fewer responses. Mean age of respondents was 36.8±10.1 years and 51.3% were certified diabetes educators (CDEs). Energy/macronutrient recommendations used most were regular timing/spacing of meals (85%), 30 to 50 g/day dietary fibre intake (71%), and maintaining a low glycemic index (65%). Mediterranean and Dietary Approaches to Stop Hypertension (DASH) dietary patterns had similar utilization rates as macronutrient distribution ranges, at 50% to 60%. Specific food recommendations were used most often, with the emphasis on fruits/vegetables and whole grains at 92% and 86%, respectively. Of the special considerations for people on insulin, regular meals/meal spacing was the recommendation used most often (88%). The statements "I trust the content …" and "I understand the scientific basis …" of the NT chapter were the internal facilitators most agreed with, at 86% each. The least agreed upon external facilitators were "my workplace encourages me to use the NT chapter," at 54%, and "I learned about the NT chapter in my formal education," at 44%. CDEs had significantly higher agreement on 12 of the 21 facilitator statements compared with non-CDEs.

CONCLUSIONS

Canadian RDs are utilizing the NT guidelines, including the new dietary patterns. Simple, easy-to-implement recommendations, such as specific foods and timing/spacing of meals, were used most frequently. Opportunities for increased use could include encouraging dietetic training programs and worksites to promote utilization of CPGs in practice.

Predictors of acute coronary syndrome symptom knowledge, attitudes, and beliefs in adults without self-reported heart disease

BACKGROUND

The time of symptom onset to the time an individual decides to seek care is the most significant contributor to total treatment delay.

OBJECTIVES

To explore predictors of ACS symptom knowledge, attitudes, and beliefs in adults without diagnosed heart disease.

METHODS

We used a cross-sectional, descriptive, and correlational design, employing an online survey including the ACS Response Index and the avoidance subscale of the Coping Strategy Indicator. We leveraged social media platforms and a university email list-serv to enroll participants. Stepwise hierarchical linear regressions were used.

RESULTS

We analyzed responses from 981 participants, with a mean age of 35.2 years (SD 16.5) and 75% female. The regression analyses yielded models that explained 14%, 23%, and 25% of the variance for knowledge, beliefs, and attitudes, respectively. Ethnicity, race, exposure to ACS symptom information (in the media or by teaching), and perceived health were the predictors of ACS symptom knowledge, attitudes, and beliefs with the largest effect, though others were statistically significant.

CONCLUSIONS

The findings underscore the importance of community education to raise awareness of ACS symptoms while considering social determinants of health. Future research and clinician interventions for ACS symptom knowledge, attitudes and beliefs should be expanded with a focus on ethnicity and gender.

Do Gender and Country of Residence Matter? A Mixed Methods Study on Lay Causal Beliefs about PTSD

Laypersons' causal beliefs about mental disorders can differ considerably from medical or psychosocial clinicians' models as they are shaped by social and cultural context and by personal experiences. This study aimed at identifying differences in causal beliefs about post-traumatic stress disorder (PTSD) by country and gender. A cross-sectional, vignette-based online survey was conducted with 737 participants from Germany, Greece, Ecuador, Mexico, and Russia. Participants were presented with a short unlabeled case vignette describing a person with symptoms of PTSD. Causal beliefs were assessed using an open-ended question asking for the three most likely causes. Answers were analyzed using thematic analysis. Afterwards, themes were transformed into categorical variables to analyze differences by country and by gender. Qualitative analyses revealed a wide range of different causal beliefs. Themes differed by gender, with women tending to mention more external causal beliefs. Themes also differed between the five countries but the differences between countries were more pronounced for women than for men. In conclusion, causal beliefs were multifaceted among laypersons and shared basic characteristics with empirically derived risk factors. The more pronounced differences for women suggest that potential gender effects should be considered in cross-cultural research.

Social Media Use for Research Participant Recruitment: Integrative Literature Review

BACKGROUND

Social media tools have provided health researchers with the opportunity to engage with communities and groups in a nonconventional manner to recruit participants for health research. Using social media to advertise research opportunities and recruit participants facilitates accessibility to participants from broad geographical areas and diverse populations. However, little guidance is provided by ethics review boards for researchers to effectively use this recruitment method in their research.

OBJECTIVE

This study sought to explore the literature on the use of social media for participant recruitment for research studies and identify the best practices for recruiting participants using this method.

METHODS

An integrative review approach was used to synthesize the literature. A total of 5 health sciences databases, namely, EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost), were searched using predefined keywords and inclusion and exclusion criteria. The initial search was conducted in October 2020 and was updated in February 2022. Descriptive and content analyses were applied to synthesize the results, and the findings are presented in a narrative and tabular format.

RESULTS

A total of 96 records were included in this review, 83 (86%) from the initial search and 13 (14%) from the updated search. The publication year ranged between 2011 and 2022, with most publications (63/96, 66%) being from the United States. Regarding recruitment strategy, 45% (43/96) of the studies exclusively used social media, whereas 51% (49/96) used social media in conjunction with other strategies. The remaining 4% (4/96) provided guidelines and recommendations for social media recruitment. Notably, 38% (36/96) of these studies involved hard-to-reach populations. The findings also revealed that the use of social media is a cost-effective and efficient strategy for recruiting research participants. Despite the expanded use across different populations, there is limited participation of older adults in social media recruitment.

CONCLUSIONS

This review provides important insights into the current use of social media for health research participant recruitment. Ethics boards and research support services in academic institutions are encouraged to explicitly provide researchers with guidelines on the use of social media for health research participant recruitment. A preliminary guideline prepared based on the findings of this review is proposed to spark further development in this area.

An empirical study into the reasons for failure of sustaining operational excellence initiatives in organizations

Purpose

Operational excellence (OPEX) initiatives such as Lean, Six Sigma, Lean Six Sigma and Agile have some common characteristics that can be understood through their adoption in organizations. The objective of this research is to present the results of an online survey highlighting the most critical reasons for failure of OPEX initiatives.

Design/methodology/approach

This study presents the results of a survey from 106 experts from different countries who have been involved in OPEX implementation. The experts were Six Sigma Master Black Belts, Black Belts and Champions from different manufacturing and service organizations. The developed questionnaire was initially tested with the help of seven experts to ensure their technical validity and soundness.

Findings

The study found 15% of companies surveyed have not adopted any form of OPEX methodology. The top three reasons for non-adoption of OPEX were also found. In terms of the use of various OPEX methodologies, more than 75% of companies were employing Six Sigma and less than 50% were engaged in Lean initiatives. Another surprising result was that less than 5% of the companies were utilizing Kaizen and other continuous improvement methodologies for improving the efficiency and effectiveness of organizational processes. The study further finds top five failure factors for sustaining OPEX initiatives in manufacturing, service, large and small organizations.

Research limitations/implications

The study reports the outcomes based on an online survey with limited sample size. Moreover, the number of samples from small and medium-sized enterprises (SMEs) was less than 25, and therefore it was difficult to make any robust conclusions in the comparison of failure factors between large enterprises and SMEs.

Originality/value

To the best of the authors’ knowledge, this is the first empirical study that has attempted to explore the reasons for failure of OPEX initiatives. The authors argue that a greater understanding of the reasons for failure of OPEX initiatives can provide an input to develop a framework that can mitigate the failures and costs associated with such failures.

Critical failure factors for continuous improvement methodologies in the Irish MedTech industry

Purpose

The main objective of this study is to investigate what are the critical success factors that exist for continuous improvement (CI) methodology deployment in the Irish medical technology (MedTech) industry. The research will, in particular, seek to establish if the highly regulated nature of the global MedTech industry is an additional critical failure factor (CFF) for the deployment of CI methodology. The study involves the analysis of the benefits, challenges, CFFs and tools most utilised for the application to the deployment of CI methodologies in the Irish medical device (MD) industry.

Design/methodology/approach

A quantitative survey was utilised in this study. The main participants were made up of senior quality professionals working in operational excellence, quality consultants, quality directors, quality engineers, quality managers and quality supervisors working in both manufacturing and service sectors from Irish MD companies. A total of 94 participants from the Irish MedTech industry responded to the survey.

Findings

The main finding of this study is that 42% of participants perceived that a highly regulated environment was a CFF to CI, whilst 79% of respondents utilised Lean Six Sigma in their organisations, and productivity and financial factors were found to be the highest reasons for CI deployment amongst the Irish MedTech industry. The top CFFs highlighted for CI in regulated industries were fear of extra validation activity, compliance versus quality culture and a regulatory culture of being “safe”. Another relevant finding presented in this paper is that just over 48% of participants felt that CI tools are very strongly integrated into the industries quality management systems (QMSs) such as the corrective and preventative action system, non-conformance and audit systems.

Research limitations/implications

All data collected in the survey came from professionals working for Irish indigenous and multinational MedTech companies. It is important to highlight that n = 94 is a low sample size, which is enough for a preliminary survey but reinforcing the limitation in terms of generalisation of the results. A further study on a wider European and global scale as well as a comparison with the highly regulated pharma industry would be informative.

Originality/value

The authors understand that this is the very first research focussed on the CFFs for CI in the MedTech/MD manufacturing industry with a specific focus on the highly regulated nature of the industry as a potential CFF. The results of this study represent an important first step towards a full understanding of the applicability and use of CI in the medical-device-manufacturing industries on a global scale.

Facebook recruitment for research of children and parents during the COVID-19 pandemic

The COVID-19 pandemic has created unique challenges for recruitment of adults and children into clinical research. The sudden onset of stay-at-home orders and social distancing enacted in much of the United States created sudden barriers for researchers to recruit participants in-person. Recognizing the critical need to understand the impact of COVID-19 on children and families in real time, studies required an alternative approach. The present study sought to develop methods and establish the feasibility of utilizing Facebook's targeted advertising to enroll schoolaged children and their parents for a study examining the impact of the COVID-19 pandemic on families.

This study used an 8 week pay-per-click advertisement approach via Facebook for research recruitment. Parents of children age 8 to 17 were invited and asked to include their child. Standardized measures were included for parents and children. Zip code targeting was used to increase diversity in participants.

The ad campaign reached 213,120, yielding 3563 clicks, 684 parent participants, 494 child participants and a 26% conversion rate over eight weeks. The cost-per-click was $0.64, and cost-per-participant was $3.30 and $4.60 for parents and children, respectively.

This nationwide study successfully used social media to recruit a robust nationwide sample of parent-child dyads during the COVID-19 pandemic. Social media recruitment mitigated typical time and engagement barriers for participants while also circumventing social and physical distancing orders due to the pandemic which allowed for real time assessment of the pandemic's effects on families. Future consideration should be given.to social media as a research recruitment methodology.

COVID-19 restrictions and recreational fisheries in Ontario, Canada: Preliminary insights from an online angler survey

The COVID-19 pandemic and corresponding public health mitigation strategies have altered many facets of human life. And yet, little is known about how public health measures have impacted complex socio-ecological systems such as recreational fisheries. Using an online snowball survey, we targeted resident anglers in Ontario, Canada, to obtain preliminary insights on how the pandemic has impacted recreational fishing and related activity. We also explored angler perspectives on pandemic-related restrictions and other aspects of fisheries management. Our results point to the value of recreational fisheries for the mental and physical well-being of participants, as well as the value and popularity of outdoor recreation during a pandemic. Although angling effort and fish consumption appeared to decline during the early phases of the pandemic, approximately 21 % of the anglers who responded to our survey self-identified as new entrants who had begun or resumed fishing in that time. Self-reported motivations to fish during the pandemic suggest that free time, importance to mental and physical health, and desires for self-sufficiency caused some anglers to fish more, whereas a lack of free time, poor or uncertain accessibility, and perceived risks caused some anglers to fish less. Respondents also expressed their desires for more clear and consistent communication about COVID-19 fishing restrictions from governments, and viewed angling as a safe pandemic activity. Information on recreational angler behaviours, motivations, and perspectives during the pandemic may prove valuable to fisheries managers and policy makers looking to optimize their strategies for confronting this and other similar crises.

Consumer perceived authenticity of organizational corporate social responsibility (CSR) statements: a test of attribution theory

Purpose

This study aims to explore how consumers judge corporate social responsibility (CSR) authenticity. Kelley’s covariation attribution theory (Kelley, 1973) was deployed to explain information consumers use that leads to either a substantive or symbolic attribution.

Design/methodology/approach

In total, 101 consumers were randomly assigned to one of three experimental conditions and responded to an online survey: an organization whose CSR practices were unique (low consensus), across their business (low distinctiveness) and over time (high consistency), practiced CSR like competitors (high consensus), in few areas if their business (high distinctiveness) and just initiated their CSR activities (low consistency) or no relevant CSR information (control). The dependent variables were consumer’s substantive attribution, symbolic attribution and the extent that consumers’ reported that consensus, distinctiveness and consistency were important in judging CSR authenticity in general. ANOVA and Scheffe post hoc tests were conducted as appropriate.

Findings

Consumers in the first experimental condition ascribed greater substantive attribution than consumers in the control group and marginality more than the second experimental condition. On the other hand, these same consumers also ascribed greater symbolic attribution than did the control group. After consumers were shown an organization whose CSR activities were unique, practiced across their business and for a long time reported that distinctiveness and consistency were more important in judging authenticity in general.

Research limitations/implications

The survey respondents constituted a convenience sample; however, they were randomly assigned to conditions. This randomization enabled an experimental design capable of making causal statements. The Linkedin platform is mainly used by white-collar individuals and does not incorporate the entire spectrum of airline passengers from other industries, and therefore, may limit generalizability to other industrial sector populations. The sample age was somewhat young and may not be representative of older individuals and young teenagers. Like all online surveys, individuals without internet access did not have an opportunity to participate. Future research should deploy larger sample sizes and greater demographic diversity (e.g. age, country and income).

Practical implications

Executives must lead and engage stakeholders in their organizations’ CSR initiatives. Managers must implement efficiently, using CSR audits that assess the extent that unique initiatives are implemented throughout the business and over time. The findings also suggest that marketing should then effectively communicate CSR in consensus, distinctiveness and consistency terms.

Social implications

Multiple stakeholders urge organizations to be socially responsible. Consumers incorporate social responsibility into buying and investment decisions, and therefore, expect to demand CSR transparency and authenticity. Unfortunately, little is known about how consumers assess CSR authenticity, which is the aim of this research.

Originality/value

This is among the first studies that generalize Kelley’s covariation attribution theory from the micro-level of individual perception and social psychology to the macro organizational level and the first to empirically test the theory at the macro organizational level. This study used an experimental design to test attribution theory as a theoretic explanation of how consumers judge CSR authenticity and the first study to explore whether exposure to CSR information influences the extent that such information is believed to be important in judging authenticity.

Ethical leadership, corporate social responsibility, firm reputation, and firm performance: A serial mediation model

Due to globalization expansion, corporate social responsibility (CSR) is no longer an unfamiliar concept in emerging markets. In the case of Vietnam, its implementation will be influenced by several factors, including ethical leadership. Drawing upon the stakeholder theory, this study develops and tests a serial mediation model to explain how CSR and firm reputation can connect ethical leadership to enhanced firm performance. The PLS-SEM results from survey data collected from 653 mid- and top-level managers from large companies in Vietnam indicate that ethical leadership positively influences CSR, which, in turn, results in enhanced firm reputation and firm performance. This study contributes to research on the intersection between CSR and leadership in the context of emerging markets. This study also provides some managerial implications for Vietnamese firms striving to promote ethical leadership to achieve CSR outcomes.

A study on the Ishikawa's original basic tools of quality control in South American companies: results from a pilot survey and directions for further research

Purpose

The main purpose of this study is to revisit Dr. Ishikawa's statement: “95% of problems in processes can be accomplished using the seven quality control (QC) tools” from his book “What is Quality Control?”. The authors are interested in critically investigating if this statement is still valid nowadays. It involves the analysis of the usage of the seven QC tools in the manufacturing and service sectors and the benefits, challenges and critical success factors (CSFs) for the application of the seven QC tools.

Design/methodology/approach

In order to evaluate Kaoru Ishikawa's statement and how valid his statement is for manufacturing and service industries nowadays, an online survey instrument was developed, and data collection was performed utilising a stratified random sampling strategy. The main strata/clusters were formed by senior quality professionals working in operational excellence, quality consultants, quality directors, quality engineers, quality managers and quality supervisors working in both manufacturing and service sectors from South American companies. A total of 97 participants from different countries in South America responded to the survey.

Findings

The main finding of this study is that only about 20% of respondents felt that the original seven basic tools of QC can solve above 80% of quality related problems in their businesses. This is quite different from the findings reported by Dr Ishikawa in his work in between 1970 and 1980s. Another relevant finding presented in this paper is that Pareto analysis, histograms and cause and effect analysis are the most used tools in both manufacturing and service sectors. This paper also revealed that the seven QC tools proposed by Dr. Ishikawa were least used by human resources (HR), information technology (IT) and finance functions. This work presents a list of critical success factors required for the proper application of the seven QC tools.

Research limitations/implications

All data collected in the pilot survey came from professionals working for South American companies. So, this paper does present limitations in terms of generalisation of the results. Also, data were collected at an individual level, so parameters such as the inter reliability of judgements on a particular survey item could not be evaluated. It is important to highlight that n = 97 is a low sample size, enough for a preliminary survey but reinforcing the limitation in terms of generalisation of the results.

Originality/value

Authors understand that this is the very first research focused on challenging Dr. Ishikawa's statement: “95% of problems in processes can be accomplished using the seven quality control (QC) tools” from his book “What is Quality Control?”. The results of this study represent an important first step towards a full understanding of the applicability of these tools in manufacturing and service industries in a global scale.

Metal hypersensitivity screening among frontline healthcare workers-A descriptive study

AIMS AND OBJECTIVES

The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice.

BACKGROUND

Adverse device-related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T-cell-mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment.

DESIGN

Following the STROBE checklist, a cross-sectional, descriptive study was conducted.

METHODS

Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation.

RESULTS

Three hundred forty-five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'.

CONCLUSION

The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.

Social Media Recruitment for a Web Survey of Sexual and Gender Minority Youth: An Evaluation of Methods Used and Resulting Sample Diversity

Purpose: The purpose of this study was to assess the feasibility and efficacy of using advertisements (ads) on Facebook, Instagram, and Snapchat to recruit a national sample of adolescent sexual minority males ages 13-18 and transgender youth ages 13-24 for a web survey. Methods: The Survey of Today's Adolescent Relationships and Transitions (START) used targeted ads as survey recruitment tools. We assessed the efficacy of these varied forms of recruitment ads in reaching our target population. To understand how our sample differed from a national probability sample targeting the general adolescent population, we compared START respondents with sexual minority men identified from the 2017 Youth Risk Behavior Survey (YRBS). Results: The use of targeted language produced higher rates of completes per click compared with ads without targeted language. Video ads (compared with static images) were more effective at recruiting younger respondents. START and YRBS samples differed along lines of sexual identity, race and ethnicity, and age. The START sample had a greater percentage of Hispanic/Latino and Other/Multiracial respondents relative to the YRBS sample, thus providing additional data on these underserved sexual minority youth. Conclusion: The factors associated with design decisions for a hard-to-reach, non-probability sample impact the likelihood that respondents engage in and complete a survey. The ads proved to be effective and efficient at recruiting the targeted population.

Oxygen therapy practices in the acutely ill medical patients: A social media-based nationwide study of clinicians’ preferences and summary of current recommendations

Oxygen is the most commonly used drug in emergency medicine. The aim of this study was to identify healthcare professionals’ preferences regarding oxygen therapy in common medical emergencies. An online 9-part-questionnaire was distributed through Facebook to doctors and nurses working in Greek hospitals. The questionnaire included background information of the respondents and addressed individual preferences regarding best oxygenation parameter and oxygen targets in specific acute settings. We received 678 responses and we included 663 in our analysis. We found significant differences between doctors’ and nurses’ attitudes towards oxygenation targets in ARDS, sepsis, acute coronary syndrome, and post cardiac-arrest patients. Nurses preferred a more conservative oxygen strategy compared to doctors. Furthermore, nurses favor SaO2 as the best oxygenation parameter, while doctors prefer PaO2. In our survey, the type of hospital and department of the respondents did not affect the preferred oxygen strategy. Social media-based survey research is feasible and effective. In this single country study, doctors showed a tendency to liberally administer oxygen in acutely ill medical patients. On the other hand, Greek nurses preferred a more conservative approach.

Using the ARTIC-35 to Measure Nurses' Attitudes Related to Trauma-Informed Care

BACKGROUND AND PURPOSE

Trauma-informed care (TIC) acknowledges the lasting effects of trauma on individuals. The Attitudes Related to Trauma-Informed Care (ARTIC-35) scale was developed to examine healthcare providers' attitudes related to TIC. Here, we present an item-level analysis of the ARTIC-35 scale for use with nurses and compare our findings to the current ARTIC-35 structure.

METHODS

Principal components analysis, qualitative inter-item analysis, and qualitative intra-item analysis of the ARTIC-35.

FINDINGS

Our principal component analysis structure supported a nine-factor solution, inter-item qualitative analysis structure supported five subscales, and intra-item qualitative analysis identified 13 acceptable items and 22 items requiring revision for use with nurses.

DISCUSSION

When used with nurses, there are important considerations regarding scale validity and challenges with the design of the original ARTIC-35 scale.