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Wine O, McNeil D, Kromm SK, Foss K, Caine V, Clarke D, Day N, Johnson DW, Rittenbach K, Wood S, Hicks M. The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention. BMC Health Serv Res 2023; 23:448. [PMID: 37149626 PMCID: PMC10164330 DOI: 10.1186/s12913-023-09440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model's key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation's impact/outcomes. METHODS A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. DISCUSSION The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. TRIAL REGISTRATION ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.
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Affiliation(s)
- Osnat Wine
- Department of Pediatrics, Division of Neonatal-Perinatal Care, College of Health Sciences, Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, AB, T6G 1C9, Canada
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Deborah McNeil
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Seija K Kromm
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Foss
- Stollery, Edmonton, Alberta Health Services, Edmonton, AB, Canada
| | - Vera Caine
- University of Victoria, Victoria, BC, Canada
| | - Denise Clarke
- Stollery, Edmonton, Alberta Health Services, Edmonton, AB, Canada
| | | | - David W Johnson
- Departments of Pediatrics, Emergency Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Stephen Wood
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matt Hicks
- Department of Pediatrics, Division of Neonatal-Perinatal Care, College of Health Sciences, Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, AB, T6G 1C9, Canada.
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Bryant E, Broomfield C, Burrows J, McLean S, Marks P, Maloney D, Touyz S, Maguire S. Gaining consensus on clinical quality outcomes for eating disorders: Framework for the development of an Australian national minimum dataset. BMJ Open 2023; 13:e071150. [PMID: 37076147 PMCID: PMC10124290 DOI: 10.1136/bmjopen-2022-071150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Eating disorders (EDs) are complex psychiatric illnesses requiring multidisciplinary care across both mental and medical healthcare settings. Currently, no nationally comprehensive, consistent, agreed on or mandated data set or data collection strategy exists for EDs in Australia: thus, little is known about the outcomes of care nor treatment pathways taken by individuals with EDs. InsideOut Institute was contracted by the Australian Government Department of Health to develop a minimum dataset (MDS) for the illness group with consideration given to data capture mechanisms and the scoping of a national registry. DESIGN A four-step modified Delphi methodology was used, including national consultations followed by three rounds of quantitative feedback by an expert panel. SETTING Due to social distancing protocols throughout the global SARS-CoV-2 pandemic, the study was conducted online using video conferencing (Zoom and Microsoft Teams) (Step 1), email communication and the REDCap secure web-based survey platform (Steps 2-4). PARTICIPANTS 14 data management organisations, 5 state and territory government departments of health, 2 Aboriginal and Torres Strait Islander advising organisations and 28 stakeholders representing public and private health sectors across Australia participated in consultations. 123 ED experts (including lived experience) participated in the first quantitative round of the Delphi survey. Retention was high, with 80% of experts continuing to the second round and 73% to the third. MAIN OUTCOME MEASURES Items and categories endorsed by the expert panel (defined a priori as >85% rating an item or category 'very important' or 'imperative'). RESULTS High consensus across dataset items and categories led to the stratification of an identified MDS. Medical status and quality of life were rated the most important outcomes to collect in an MDS. Other items meeting high levels of consensus included anxiety disorders, depression and suicidality; type of treatment being received; body mass index and recent weight change. CONCLUSIONS Understanding presentation to and outcomes from ED treatment is vital to drive improvements in healthcare delivery. A nationally agreed MDS has been defined to facilitate this understanding and support improvements.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Catherine Broomfield
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Jennifer Burrows
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sian McLean
- Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, Victoria, Australia
- Australia and New Zealand Academy for Eating Disorders, Castlecrag, New South Wales, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
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Sabahi A, Asadi F, Rabiei R, Paydar S. Providing a Population Based Registry Model of Drug Poisoning in Iran. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2022; 21:e130124. [PMID: 36937211 PMCID: PMC10016136 DOI: 10.5812/ijpr-130124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
Background The prevalence of drug poisoning is on the rise in Iran due to the increased public access to drugs. A national drug poisoning registry system is a suitable tool for better management, control, and prevention of drug poisoning. Objectives This study aimed to propose a national drug poisoning registry model for Iran. Methods This was an applied research conducted in two major phases. In the first phase, all sources pertaining to drug poisoning registries were reviewed, and a national drug poisoning registry model was proposed. In the second phase, this model was validated and finalized using a researcher-made questionnaire and through a two-stage Delphi technique. Results The focus of national drug poisoning activities and registry management reached the 100% consensus of experts at the Drug and Poison Information Center of the Food and Drug Organization (Ministry of Health and Medical Education). Goals, data sources, registry system structure, data set, standards, data exchange, registry features, and processes of the proposed model also achieved unanimous expert consensus. Conclusions Given the importance of a national drug poisoning registry in gathering, storing, analyzing, and reporting the data of patients, it is essential to provide a framework for evaluating and controlling drug poisoning and for generating valuable data for decision-making. The model proposed herein can offer the information infrastructure for designing and implementing such a system.
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Affiliation(s)
- Azam Sabahi
- Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| | - Farkhondeh Asadi
- Department of Health Information Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Health Information Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122737474, Fax: +98-2122754101,
| | - Reza Rabiei
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Paydar
- Department of Health Information Technology, School of Allied Medical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Design and Evaluation of Web-Based Dental Implant Registry (DIR) for Better Clinical Outcomes. Int J Biomater 2022; 2022:7162645. [PMID: 35186089 PMCID: PMC8856821 DOI: 10.1155/2022/7162645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/15/2022] [Accepted: 01/21/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Identification of dental implant system in undocumented patients is a major challenge for dentists due to the vast variety of tools and technologies that are used in dental care. It also takes a long time to identify the type of connection or length and diameter of implant. To obtain accurate and timely information, it is necessary to have a Dental Implant Registry (DIR). In the present study, a DIR was designed, developed, and evaluated at the Dental Implant Research Center of Tehran University of Medical Sciences. Materials and Methods This is an applied, developmental, and cross-sectional study that was conducted between 2018 and 2020. In the present study, after determining the objectives of DIR system, its conceptual model was designed by EDraw Max 7.9 software. Then, the registry was developed in Visual Studio 2018 environment with the C# programming language and, finally, it was evaluated by Nielsen's ten principles of usability assessment. Results After creating the registry, its data entry search and report functions were tested. Also, in the exploratory evaluation, the highest number of problems related to the principles of system clarity and compatibility between the system and real world was identified. Conclusion The web-based DIR created in C# programming language has the ability to gather data, provide report with different access levels, and send text messages to patients for follow-up. This tool enables physicians to quickly identify the components of dental implant. The web-based DIR also provides support for health research, quality assessment, and dental performance assessment.
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