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Nygaard HS, Øen KG. Public health nurses' experiences following up children with overweight and obesity according to national guidelines. A qualitative study. Int J Qual Stud Health Well-being 2024; 19:2306658. [PMID: 38262000 PMCID: PMC10810652 DOI: 10.1080/17482631.2024.2306658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024] Open
Abstract
PURPOSE This study aimed to develop knowledge of how the follow-up regarding overweight and obesity among children in primary school is experienced by the PHN and how the guidelines may be used to improve health services in this follow-up. METHODS We analysed semi-structured interviews of 9 PHNs using qualitative content analysis. RESULTS Two themes emerged: Following up with children with overweight and obesity is an important but challenging duty; The PHNs call for clearer guidelines. Following five sub-themes: PHNs strive to adhere to the guidelines, show compassion in the follow-up, have difficulty handling parents' feelings and reactions, feel alone with the responsibility, and have suggestions for clearer guidelines. CONCLUSIONS PHNs call for enough resources to communicate the results of the child's weight in a sufficient form. PHNs and families should establish common goals. The PHN should avoid one-way communication but meet the parents' concerns and needs. This requires the PHN to focus on building a secure relation to the child and the families, as described by Peplau. Guidelines must include instructions and tools on how to communicate and meet the family's concerns. Political action and increased funding could strengthen the follow-up and thereby prevent more obesity among children, which can be a predictor of poorer health outcomes later in life.
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Affiliation(s)
- Hanna Skjelbred Nygaard
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kirsten Gudbjørg Øen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Hoffman ND, Ciarleglio A, Lesperance-Banks S, Corbeil T, Kaur H, Silver EJ, Bauman L, Sandfort TGM. A Provider-Focused Intervention to Increase Universal HIV Testing among Adolescents in School-Based Health Centers. AIDS Behav 2024; 28:3596-3604. [PMID: 39046611 DOI: 10.1007/s10461-024-04444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/25/2024]
Abstract
We describe a provider-focused intervention to increase universal HIV testing among adolescent users in a network of School-Based Health Centers (SBHC) and compare the rate of HIV test offer and acceptance for SBHCs with and without the HIV testing intervention. The intervention was implemented at the six largest SBHCs in the 12-site network and included system- and staff-level initiatives, including an implementation coach to support SBHC associates. Rates of HIV test offer and acceptance at six sites in the Intervention Cohort were compared to that at the six sites in a Non-Intervention Cohort which was not randomly selected but had comparable distributions by age, gender and race/ethnicity. The model showed an intervention effect for universal HIV test offer, but no overall effect for test acceptance. Analyzing the intervention effect by whether a patient had a history of sexual activity, the intervention was very effective early in its implementation at increasing test offer to those with no history of sexual activity, and late in its implementation at increasing test acceptance for those with no or unknown sexual activity. Increasing and sustaining universal HIV testing in SBHCs may benefit from using Implementation Science frameworks to guide adaptation of the intervention.
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Affiliation(s)
- Neal D Hoffman
- Division of Adolescent Medicine, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA.
| | - Adam Ciarleglio
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Tom Corbeil
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Harpreet Kaur
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen J Silver
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laurie Bauman
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theo G M Sandfort
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
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Gonzalez-Aquines A, Rosales J, De Souza AC, Corredor-Quintero A, Barboza MA, Navia-Gonzalez V, Brunet-Perez F, Lagos-Servellon J, Novarro-Escudero N, Ortega-Moreno DA, Villarroel-Saavedra V, Abanto C, Barrientos-Guerra JD, Saltos-Mata F, Papavasileiou V, Todd O, Gongora-Rivera F. Availability and barriers to access post-stroke rehabilitation in Latin America. J Stroke Cerebrovasc Dis 2024; 33:107917. [PMID: 39111374 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVES To describe the availability and barriers to access post-stroke rehabilitation services in Latin America. MATERIALS AND METHODS We conducted a multi-national survey in Latin American countries. The survey consisted of three sections: (1) the national state of post-stroke rehabilitation; (2) the local state of post-stroke rehabilitation; and (3) the coverage and financing of post-stroke services. Stroke leaders from the surveyed countries were involved in developing and disseminating the survey. RESULTS 261 responses were collected from 17 countries. The mean age of respondents was 42.4 ± 10.1 years, and 139 (54.5 %) of the respondents were male. National clinical guidelines for post-stroke rehabilitation were reported by 67 (25.7 %) of the respondents. However, there were discrepancies between respondents within the same country. Stroke units, physiotherapy, occupational therapy, speech therapy, and neuropsychological therapy services were less common in public than private settings. The main barriers for inpatient and outpatient services included limited rehabilitation facilities, coverage, and rehabilitation personnel. The main source of financing for the inpatient and outpatient services was the national health insurance, followed by out-of-pocket payments. Private and out-of-pocket costs were more frequently reported in outpatient services. CONCLUSIONS Post-stroke rehabilitation services in Latin American countries are restricted due to a lack of coverage by the public health system and private insurers, human resources, and financial aid. Public settings offer fewer post-stroke rehabilitation services compared to private settings. Developing consensus guidelines, increasing coverage, and using innovative approaches to deliver post-stroke rehabilitation is paramount to increase access without posing a financial burden.
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Affiliation(s)
| | - Julieta Rosales
- Vascular Neurology Division, Department of Neurology, Fleni, Argentina. Montañeses, 2325, Buenos Aires, Argentina
| | - Ana Claudia De Souza
- Neurology and Neurosurgery Department, Hospital Moinhos de Vento, Brazil. Rua Ramiro Barcelos, 910, Bairro Moinhos de Ven, Porto Alegre, RS, 90.035-001
| | - Angel Corredor-Quintero
- Centro de ACV, Departamento de Neurología, Clínica Central del Quindío, Armenia, Colombia. Carrera 13 # 1N - 35, Armenia, Quindío, Colombia
| | - Miguel A Barboza
- Departamento de Neurociencias, Hospital Dr. Rafael A. Calderón Guardia, CCSS. San José, Costa Rica. Avenidas 7 y 9, calles 15 y 17, C. 17, San José, Aranjuez, Costa Rica
| | - Victor Navia-Gonzalez
- Facultad de Medicina, Clínica Alemana, Departamento de Neurologia, Universidad del Desarrollo, Chile. Avenida Manquehue Norte, 1410, Chile
| | | | - Javier Lagos-Servellon
- Hospital Nacional Mario Catarino Rivas, GXG5+665, 1 Calle, 21102, San Pedro Sula, Cortés, Honduras; Hospital CEMESA, 21 Calle A, 21104, San Pedro Sula, Honduras
| | - Nelson Novarro-Escudero
- Primary Stroke Center, Pacifica Salud, Panama. Pacific Boulevard and, Blvd, Pacífica, Panamá, Panama; Centro de Neurociencias, Ciudad de la Salud, Caja de Seguro Social, Panamá
| | - Diego A Ortega-Moreno
- Department of Neurology, University Hospital, Universidad Autonoma de Nuevo Leon, Gonzalitos y Madero S/N, Monterrey, Nuevo Leon, Mexico
| | - Victor Villarroel-Saavedra
- Hospital Obrero N 2-seguro de la Caja Nacional de Salud, Cochabamba, Bolivia. Av. Avenida Blanco Galindo km 5 ½, Bolivia
| | - Carlos Abanto
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Jr. Ancash 1271, Barrios Altos, Lima, Perú
| | | | - Filadelfo Saltos-Mata
- Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador. Q482+VGH, Av. 25 de Julio, Guayaquil, 090203, Ecuador
| | - Vasileios Papavasileiou
- Department of Neurosciences, Leeds Teaching Hospitals NHS Trust, England, St. James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF; School of Medicine, Faculty of Medicine and Health, University of Leeds, England, University of Leeds Woodhouse Lane Leeds, LS2 9JT
| | - Oliver Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, England, LS2 9LH, UK; Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, England, BD9 6RJ, UK
| | - Fernando Gongora-Rivera
- Department of Neurology, University Hospital, Universidad Autonoma de Nuevo Leon, Gonzalitos y Madero S/N, Monterrey, Nuevo Leon, Mexico
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Marchak JG, Beauchemin MP, Broglie L, Kelly KP, Seelisch J, Dupuis LL. Impact of the Children's Oncology Group's supportive care clinical practice guideline endorsement program: An institutional survey. Pediatr Blood Cancer 2024; 71:e31178. [PMID: 39010277 DOI: 10.1002/pbc.31178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Supportive care clinical practice guidelines (CPGs) facilitate the incorporation of the best available evidence into pediatric cancer care. We aimed to assess the impact of the work of the Children's Oncology Group (COG) Supportive Care Guideline Task Force on institutional supportive care practices. PROCEDURE An online survey was distributed to representatives at 209 COG sites to assess the awareness, use, and helpfulness of COG-endorsed supportive care CPGs. Availability of institutional policies regarding 13 topics addressed by current COG-endorsed CPGs was also assessed. Respondents described their institutional processes for developing supportive care policies. RESULTS Representatives from 92 COG sites responded to the survey, and 78% (72/92) were "very aware" of the COG-endorsed supportive care CPGs. On average, sites had policies that addressed seven COG-endorsed supportive care CPG topics (median = 7, range: 0-12). Only 45% (41/92) of sites reported having institutional processes for developing supportive care policies. Of these, most (76%, 31/41) reported that the COG-endorsed CPGs have a medium or large impact on policy development. Compared with sites without processes for supportive care policy development, sites with established processes had policies on a greater number of topics aligned with current COG-endorsed CPG topics (mean = 6.6, range: 0-12 vs mean = 7.9, range: 2-12; p = 0.027). CONCLUSIONS Most site respondents were aware of the COG-endorsed supportive care CPGs. Less than half of the COG sites represented in the survey have processes in place to implement supportive care policies. Improvement in local implementation is required to ensure that patients at COG sites receive evidence-based supportive care.
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Affiliation(s)
- Jordan Gilleland Marchak
- Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Melissa P Beauchemin
- Columbia University School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
| | - Larisa Broglie
- Department of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Patterson Kelly
- Department of Nursing Science, Professional Practice, and Quality, Children's National Hospital, Washington, District of Columbia, USA
| | - Jennifer Seelisch
- Children's Hospital London Health Sciences Centre, Division of Hematology/Oncology, Western University, London, Ontario, Canada
| | - L Lee Dupuis
- Child Health Evaluative Sciences, Research Institute and Department of Pharmacy, The Hospital for Sick Children; Lesley Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Westerheim I, Cormier-Daire V, Gilbert S, O'Malley S, Keen R. Osteogenesis Imperfecta: A study of the patient journey in 13 European countries. Orphanet J Rare Dis 2024; 19:331. [PMID: 39252130 PMCID: PMC11386111 DOI: 10.1186/s13023-024-03345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/29/2024] [Indexed: 09/11/2024] Open
Abstract
INTRODUCTION Osteogenesis imperfecta (OI) is a heritable skeletal disorder and comprises various subtypes that differ in clinical presentation, with Type I considered the least severe and Types III/IV the most severe forms. The study aim was to understand the OI patient diagnostic and treatment journey across Europe. METHODS We conducted a qualitative, descriptive study to understand the OI patient journey. A selection of people with OI/their caregivers and clinicians involved in OI-patient care from across Europe were interviewed using a specially developed questionnaire. RESULTS Between May 2022 and July 2022, 22 people with OI/caregivers and 22 clinicians (endocrinologists, orthopaedic surgeons, geneticists and metabolic specialists) from across Europe were interviewed. Our study showed various areas of concerns for the OI community. Timely diagnosis of OI is essential; misdiagnoses and a delay to treatment initiation are all too common. There are a lack of consensus guidelines regarding optimal treatments (including when bisphosphonate therapy should be initiated and the route of administration) and patient management throughout the duration of the patient's life. Adult OI patients do not have a medical home and are often managed by endocrinologists and rheumatologists. Adult care is often reactive based on the development of new symptoms. The psychosocial burden of OI impacts on the patient's quality of life. CONCLUSIONS There is an urgent need for increased awareness about OI and its wide range of symptoms. In particular, there is a need for consensus guidelines outlining the optimum care throughout the duration of the OI patient's life.
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Affiliation(s)
- Ingunn Westerheim
- Osteogenesis Imperfecta Federation Europe (OIFE), Schotelveldstraat 17, Heffen, 2801, Belgium.
| | - Valerie Cormier-Daire
- Reference Center for Skeletal Dysplasia, Paris Cité University, INSERM UMR 1163, Imagine Institute, Hôpital Necker-Enfants Malades, 149 rue de Sévres, Paris, 75015, France
| | - Scott Gilbert
- , Putnam Associates, 22-24 Torrington Place Fitzrovia, London, WC1E 7HJ, UK
| | - Sean O'Malley
- , Putnam Associates, 22-24 Torrington Place Fitzrovia, London, WC1E 7HJ, UK
| | - Richard Keen
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Eriks-Hoogland I, Müller L, Baumberger M, Huber B, Michel F, Belfrage C, Elmerghini H, Veseli-Abazi M, Böthig R, Fiebag K, Thietje R, Jordan X. Evidence based clinical practice guideline for follow-up care in persons with spinal cord injury. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1371556. [PMID: 39314837 PMCID: PMC11417090 DOI: 10.3389/fresc.2024.1371556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/09/2024] [Indexed: 09/25/2024]
Abstract
Introduction While it is well-established that follow-up care programs play a crucial role in preventing and early detecting secondary health conditions (SHCs) in persons with spinal cord injury [SCI, including spina bifida (SB)], the availability of evidence-based follow-up care programs remains limited. Under the leadership of the German-speaking Medical Society for Paraplegiology (DMGP), we have developed an evidence based clinical practice guideline for follow-up care of SHCs in persons with SCI and identify research gaps. Methods This guideline was developed in accordance with the regulations of the Association of the Scientific Medical Societies in Germany (AWMF e.V.). To ensure an evidence-based guidance, we utilized the International Classification of Functioning, Disability and Health (ICF) generic core set and ICF Core Set for individuals with SCI in long-term context as our foundational framework. We conducted a comprehensive literature review to identify existing recommendations for follow-up care and graded the level of evidence according to relevant instruments. Subsequently, we formulated recommendations and achieved consensus through a structured nominal group process involving defined steps and neutral moderation, while adhering to the criteria outlined in the German guideline development instrument (DELBI). Results Although there is a fair number of literatures describing prevalence and severity of SHCs after SCI, the amount of literature including recommendations was low (19 for SCI and 6 for SB). Based on the current evidence on prevalence and severity of SHCs and available recommendations, a clinical practice guideline on follow-up care of most relevant SHCs was defined. The recommendations for follow-up care are described in the following chapters: (1) Nervous system; (2) (Neuropathic) pain; (3) Cardiovascular diseases; (4) Respiratory System; (5) Immunological system, vaccination and allergies; (6) Gastrointestinal tract and function; (7) Endocrinological system and nutrition; (8) Urogenital system; (9) Contraception, pregnancy, birth and postpartum care; (10) Musculoskeletal system; (11) Pressure injuries; (12) Psychological health; (13) Medication and polypharmacy. Conclusion We could successfully establish an evidence based clinical practice guideline for follow-up care of SHCs in individuals with SCI. There is however a notable lack of high-quality recommendations for SCI follow-up care.
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Affiliation(s)
- Inge Eriks-Hoogland
- Department of Paraplegiology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Health Services and Clinical Care, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Lorena Müller
- Department of Health Services and Clinical Care, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Michael Baumberger
- Department of Paraplegiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Burkhart Huber
- Department of Traumatology, AUVA Rehabilitation Centre, Häring, Austria, Switzerland
| | - Franz Michel
- Department of Paraplegiology, REHAB Basel, Basel, Switzerland
| | - Celina Belfrage
- Department of Paraplegiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Hicham Elmerghini
- Department of Paraplegiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Mide Veseli-Abazi
- Department of Paraplegiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Ralf Böthig
- Centre for Spinal Injuries, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Kai Fiebag
- Centre for Spinal Injuries, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Roland Thietje
- Centre for Spinal Injuries, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Xavier Jordan
- Department of Paraplegiology, Clinique Romande de Réadaptation, Sion, Switzerland
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Majlesara A, Aminizadeh E, Ramouz A, Khajeh E, Shahrbaf M, Borges F, Goncalves G, Carvalho C, Golriz M, Mehrabi A. Evaluation of quality and quantity of randomized controlled trials in hepatobiliary surgery: A scoping/mapping review. Eur J Clin Invest 2024; 54:e14210. [PMID: 38624140 DOI: 10.1111/eci.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
AIM To evaluate the quantity and quality of randomized controlled trials (RCTs) in hepatobiliary surgery and for identifying gaps in current evidences. METHODS A systematic search was conducted in MEDLINE (via PubMed), Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) for RCTs of hepatobiliary surgery published from inception until the end of 2023. The quality of each study was assessed using the Cochrane risk-of-bias (RoB) tool. The associations between risk of bias and the region and publication date were also assessed. Evidence mapping was performed to identify research gaps in the field. RESULTS The study included 1187 records. The number and proportion of published randomized controlled trials (RCTs) in hepatobiliary surgery increased over time, from 13 RCTs (.0005% of publications) in 1970-1979 to 201 RCTs (.003% of publications) in 2020-2023. There was a significant increase in the number of studies with a low risk of bias in RoB domains (p < .01). The proportion of RCTs with low risk of bias improved significantly after the introduction of CONSORT guidelines (p < .001). The evidence mapping revealed a significant research focus on major and minor hepatectomy and cholecystectomy. However, gaps were identified in liver cyst surgery and hepatobiliary vascular surgery. Additionally, there are gaps in the field of perioperative management and nutrition intervention. CONCLUSION The quantity and quality of RCTs in hepatobiliary surgery have increased over time, but there is still room for improvement. We have identified gaps in current research that can be addressed in future studies.
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Affiliation(s)
- Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ehsan Aminizadeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Mohammadamin Shahrbaf
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Filipe Borges
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Gil Goncalves
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Carlos Carvalho
- Digestive Unit, Clinical Oncology, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Bessadet M, Auduc C, Drancourt N, Nicolas E, El Osta N. Comparative analyses of time efficiency and cost in fabricating fixed implant-supported prostheses in digital, hybrid, and conventional workflows: A systematic review and meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00456-6. [PMID: 39069390 DOI: 10.1016/j.prosdent.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024]
Abstract
STATEMENT OF PROBLEM Economic considerations affect whether new technologies are adopted in dental practice. Limited evidence exists regarding the time and cost efficiency of different workflows for fabricating implant-supported restorations. PURPOSE The purpose of this systematic review and meta-analysis was to compare the time and cost involved in fabricating fixed implant-supported prostheses using digital, hybrid, and conventional methods throughout the entire prosthetic treatment by analyzing both clinical and laboratory steps. MATERIAL AND METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-P 2015 guidelines. The methods and inclusion criteria were specified in a protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42023458734). The databases PubMed, Cochrane, and PROSPERO were searched using keywords: (Prosthodontic OR restorative dentistry OR denture) AND (CAD CAM OR Digital workflow OR Computer Dentistry OR Digital Design) AND (Economic OR cost OR Financial OR time efficiency). Two investigators selected articles independently. RESULTS A qualitative synthesis of 12 articles published from 2010 to 2023 showed that digital scans took less time than conventional impressions (P<.05) in 7 out of 9 articles. Additionally, 8 articles revealed significant reductions in laboratory working time with digital workflows, intermediate times with hybrid workflows, and longer times with conventional workflows (P<.001). Meta-analysis confirmed the time efficiency of digital scanning over conventional impressions (Hedges g=1.65, 95% CI [0.33, 2.98]) and a substantial reduction in laboratory time with digital workflows compared with other workflows (Hedges g=6.55, 95% CI [2.69; 10.42]). However, no significant difference was found in adjustment time between digital and other workflows (Hedges g=0.91, 95% CI [-0.72; 2.55]). Direct laboratory costs were observed to be higher in conventional workflows compared with hybrid or digital workflows, with hybrid workflows also showing elevated costs compared with digital workflows (P<.05). CONCLUSIONS The digital workflow demonstrates potential benefits in reducing scan time, laboratory processing time, and direct laboratory costs for implant-supported restorations in partial edentulism. Further research is needed to validate these findings, particularly for long-span implant-supported fixed partial prostheses.
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Affiliation(s)
- Marion Bessadet
- Vice Dean and Senior Lecturer, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Chantal Auduc
- Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Noémie Drancourt
- Lecturer, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Dean and Professor, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center, University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Nada El Osta
- Professor, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France.
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Brenner MJ, Pandian V. Elevating Tracheostomy Care Through Data-Driven Innovation: What Can Education, Evidence-Based Practice, and Quality Improvement Learn from One Another? TRACHEOSTOMY (WARRENVILLE, ILL.) 2024; 1:1-6. [PMID: 39188761 PMCID: PMC11345906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
The past decade has witnessed unprecedented progress in tracheostomy care, through communication, dissemination, and implementation of key drivers including interprofessional education, team-based care, standardized protocols, patient and family engagement, and data-driven practice. Improved safety, efficiency, and quality of tracheostomy care reflects contributions from fields of competency-based education, evidence-based practice, and quality improvement. These elements are interconnected, reinforcing one another to enhance patient care. Competency-based interactive education emphasizes active and practical learning through simulations and case studies, which enhance the clinical skills essential for high-quality care. These educational strategies are grounded in clinical research, ensuring that care practices are continually updated and aligned with the latest evidence, thereby bridging the gap between research findings and clinical application. Quality improvement processes such as Plan-Do-Study-Act (PDSA) cycles refine care delivery in real-world settings. Implementation science promotes the uptake of evidence-based practices, ensuring that discoveries translate to improved health outcomes, quality of care, and overall system performance. In each of these domains, patient and family engagement ensures alignment with patient needs and values. The Global Tracheostomy Collaborative leverages this integrated approach through international educational symposia and webinars, comprehensive data analyses, and a learning community that promotes innovative technologies like in situ simulation and augmented and virtual reality. Together, these approaches enhance the learning and application of best practices in tracheostomy care. The continuous, dynamic interaction of education, research, and quality improvement, grounded in patient-centered care, fosters excellence and innovation in care of patients with tracheostomy.
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Affiliation(s)
- Michael J Brenner
- Department of Otolaryngology Head and Neck Surgery, University of Michigan
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Burton JO, Chilcot J, Fielding K, Frankel AH, Lakhani N, Nye P, Parker K, Priestman W, Willingham F. Best practice for the selection, design and implementation of UK Kidney Association guidelines: a modified Delphi consensus approach. BMJ Open 2024; 14:e085723. [PMID: 38890135 PMCID: PMC11191819 DOI: 10.1136/bmjopen-2024-085723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Despite research into how to effectively implement evidence-based recommendations into clinical practice, a lack of standardisation in the commissioning and development of clinical practice guidelines can lead to inconsistencies and gaps in implementation. This research aimed to ascertain how topics in kidney care worthy of guideline development within the UK should be chosen, prioritised, designed and implemented. METHODS Following a modified Delphi methodology, a multi-disciplinary panel of experts in kidney healthcare from across the UK developed 35 statements on the issues surrounding the selection, development and implementation of nephrology guidelines. Consensus with these statements was determined by agreement using an online survey; the consensus threshold was defined as 75% agreement. RESULTS 419 responses were received. Of the 364 healthcare practitioners (HCPs), the majority had over 20 years of experience in their role (n=123) and most respondents were nephrologists (n=95). Of the 55 non-clinical respondents, the majority were people with kidney disease (n=41) and the rest were their carers or family. Participants were from across England, Northern Ireland, Scotland and Wales. Consensus between HCPs was achieved in 32/35 statements, with 28 statements reaching ≥90% agreement. Consensus between patients and patient representatives was achieved across all 20 statements, with 13/20 reaching ≥90% agreement. CONCLUSIONS The current results have provided the basis for six recommendations to improve the selection, design and implementation of guidelines. Actioning these recommendations will help improve the accessibility of, and engagement with, clinical guidelines, contributing to the continuing development of best practice in UK kidney care.
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Affiliation(s)
- James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Wall's Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joseph Chilcot
- Department of Psychology, King's College London, London, UK
| | - Katie Fielding
- Department of Medicine for the Elderly, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | | | - Pam Nye
- UK Kidney Association, Bristol, UK
| | - Kathrine Parker
- Manchester Institute of Nephrology and Transplantation, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | - Fiona Willingham
- Social Work and Sport, University of Central Lancashire, Preston, UK
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11
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Gaberson KB, Foreman RM, Brzustowicz R. Integrative Review of Sources of Baccalaureate Nursing Students' Clinical Practice Anxiety. J Nurs Educ 2024; 63:349-355. [PMID: 38900270 DOI: 10.3928/01484834-20240207-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Nursing education research and anecdotal literature has revealed that undergraduate nursing students report anxiety related to clinical practice. Most published studies have focused on the effectiveness of interventions to reduce anxiety; only a few identify specific sources of clinical practice anxiety. METHOD We conducted an integrative literature review to understand the sources of nursing students' practice-related anxiety and how this anxiety has been measured. RESULTS We classified sources of practice-related anxiety into nine themes grouped into five categories: consequences of making a mistake; fear of the unknown; incivility of staff members or teachers; threat to self-concept, image, or health; and theory-practice gap. Practice-related anxiety was measured quantitatively with various surveys and qualitatively using semistructured individual or group interviews and students' journal entries. CONCLUSION Different sources of practice-related anxiety likely require distinct interventions. Further research is recommended to identify effective interventions to reduce anxiety related to each of the identified themes. [J Nurs Educ. 2024;63(6):349-355.].
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12
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Groot L, Schers H, Burgers JS, Smalbrugge M, Uijen AA, Hoogland J, van der Horst HE, Maarsingh OR. Optimising personal continuity for older patients in general practice: a cluster randomised stepped wedge pragmatic trial. BMJ Open 2024; 14:e078169. [PMID: 38772890 PMCID: PMC11110588 DOI: 10.1136/bmjopen-2023-078169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/23/2024] [Indexed: 05/23/2024] Open
Abstract
AIM To evaluate the effectiveness, feasibility and acceptability of a multicomponent intervention for improving personal continuity for older patients in general practice. DESIGN A cluster randomised three-wedged, pragmatic trial during 18 months. SETTING 32 general practices in the Netherlands. PARTICIPANTS 221 general practitioners (GPs), practice assistants and other practice staff were included. Practices were instructed to include a random sample of 1050 patients aged 65 or older at baseline and 12-month follow-up. INTERVENTION The intervention took place at practice level and included opTimise persOnal cOntinuity for oLder (TOOL)-kit: a toolbox containing 34 strategies to improve personal continuity. OUTCOMES Data were collected at baseline and at six 3-monthly follow-up measurements. Primary outcome measure was experienced continuity of care at the patient level measured by the Nijmegen Continuity Questionnaire (NCQ) with subscales for personal continuity (GP knows me and GP shows commitment) and team/cross-boundary continuity at 12-month follow-up. Secondary outcomes were measured in GPs, practice assistants and other practice staff and included work stress and satisfaction and perceived level of personal continuity. In addition, a process evaluation was undertaken among GPs, practice assistants and other practice staff to assess the acceptability and feasibility of the intervention. RESULTS No significant effect of the intervention was observed on NCQ subscales GP knows me (adjusted mean difference: 0.05 (95% CI -0.05 to 0.15), p=0.383), GP shows commitment (0.03 (95% CI -0.08 to 0.14), p=0.668) and team/cross-boundary (0.01 (95% CI -0.06 to 0.08), p=0.911). All secondary outcomes did not change significantly during follow-up. Process evaluation among GPs, practice assistants and other practice staff showed adequate acceptability of the intervention and partial implementation due to the COVID-19 pandemic and a high perceived workload. CONCLUSION Although participants viewed TOOL-kit as a practical and accessible toolbox, it did not improve personal continuity as measured with the NCQ. The absence of an effect may be explained by the incomplete implementation of TOOL-kit into practice and the choice of general outcome measures instead of outcomes more specific for the intervention. TRIAL REGISTRATION NUMBER International Clinical Trials registry Platform (ICTRP), trial NL8132 (URL: ICTRP Search Portal (who.int).
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Affiliation(s)
- Lex Groot
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - J S Burgers
- Guideline Development and Research, Dutch College of General Practitioners, Utrecht, Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboudumc, Nijmegen, Netherlands
| | - Jeroen Hoogland
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
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Lin PD, Rifas‐Shiman S, Merriman J, Petimar J, Yu H, Daley MF, Janicke DM, Heerman WJ, Bailey LC, Maeztu C, Young J, Block JP. Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records. J Am Heart Assoc 2024; 13:e032197. [PMID: 38639340 PMCID: PMC11179868 DOI: 10.1161/jaha.123.032197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. METHODS AND RESULTS Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines (9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC 8 report (6% lower in 2018-2019 compared to 2010-2014). CONCLUSIONS Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.
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Affiliation(s)
- Pi‐I Debby Lin
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Sheryl Rifas‐Shiman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - John Merriman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Joshua Petimar
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Han Yu
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente ColoradoAuroraCOUSA
| | - David M. Janicke
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFLUSA
| | - William J. Heerman
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - L. Charles Bailey
- Applied Clinical Research Center, Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Carlos Maeztu
- Department of Health Outcomes and Biomedical InformaticsUniversity of FloridaGainesvilleFLUSA
| | - Jessica Young
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Jason P. Block
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
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Sekhon H, Dickinson RA, Kimball JE, Cray HV, Alkhatib F, Preston A, Moore I, Trueba-Yepez AF, Fahed M, Vahia IV. Safety Considerations in the Use of Extended Reality Technologies for Mental Health with Older Adults. Am J Geriatr Psychiatry 2024; 32:648-651. [PMID: 38246832 DOI: 10.1016/j.jagp.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Harmehr Sekhon
- McLean Hospital, Belmont, MA; Centre for addictions and Mental Health (CAMH), University of Toronto Affiliated Hospital, Toronto, Canada
| | | | | | | | | | - A'mie Preston
- Central Arkansas Veterans Healthcare System Eugene J Towbin Healthcare Center (AP, IM), North Little Rock, AR
| | - Ian Moore
- Central Arkansas Veterans Healthcare System Eugene J Towbin Healthcare Center (AP, IM), North Little Rock, AR
| | - Ana F Trueba-Yepez
- McLean Hospital, Belmont, MA; Universidad San Francisco de Quito, Quito, Ecuador
| | - Mario Fahed
- University of Connecticut Health Care (MF), Farmington, CT
| | - Ipsit V Vahia
- McLean Hospital, Belmont, MA; Department of Psychiatry (IVV), Harvard Medical School, Boston, MA.
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15
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Bessadet M, Drancourt N, El Osta N. Time efficiency and cost analysis between digital and conventional workflows for the fabrication of fixed dental prostheses: A systematic review. J Prosthet Dent 2024:S0022-3913(24)00003-9. [PMID: 38302291 DOI: 10.1016/j.prosdent.2024.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
STATEMENT OF PROBLEM Time and cost are factors that influence a patient's decision on dental prosthetic treatment. Evidence is needed to demonstrate that restoration using digital systems is more rapid and less costly than the conventional process. PURPOSE The purpose of this systematic review was to analyze and compare the duration and cost of fixed dental prostheses fabricated using digital and conventional methods from scanning or impression making to delivery of the prosthesis. MATERIAL AND METHODS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria were documented in a protocol registered in the Prospective International Register of Systematic Reviews (PROSPERO) (CRD42023458734). The bibliographic search was carried out using PubMed, Cochrane, and PROSPERO databases. The main keywords used were (Prosthodontic OR restorative dentistry OR denture) AND (CAD CAM OR Digital workflow OR Computer Dentistry OR Digital Design) AND (Economic OR cost OR Financial OR time efficiency). Two investigators undertook the different steps of article selection. RESULTS A total of 8 articles published between 2010 and 2023 were found for the qualitative synthesis by using the search criteria. Two studies showed that conventional impressions took more time than digital scans for the fabrication of a single crown, and 1 study showed the opposite. One study found that a digital scan was faster than conventional impression making for the fabrication of a 3-unit fixed partial denture, and another study showed the opposite. The dental laboratory technician spent more time on the conventional workflow than the digital workflow for the 3-unit framework and veneering process. No difference was found between conventional and digital workflows for clinical evaluation and chairside adjustment for the fabrication of a single crown. No articles have compared the cost of fixed prostheses. CONCLUSIONS The digital pathway can shorten the laboratory process. However, the duration of the impression or scan may vary depending on the technique used. Studies are needed to analyze the cost-effectiveness of the fabrication of tooth-supported restorations.
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Affiliation(s)
- Marion Bessadet
- Vice Dean, Senior Lecturer, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Noémie Drancourt
- Lecturer, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Nada El Osta
- Professor, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France.
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16
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Lee JJ, Baptist AP, Blake KV. Lack of awareness and knowledge of NHLBI 2020 Asthma Focused Updates. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:226-228.e2. [PMID: 37802252 DOI: 10.1016/j.jaip.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Jenny J Lee
- Division of Allergy and Clinical Immunology, University of Michigan School of Medicine, Ann Arbor, Mich.
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Kathryn V Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, Fla
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Baykemagn ND, Nigatu AM, Fikadie B, Tilahun B. Acceptance of mobile application-based clinical guidelines among health professionals in Northwestern Ethiopia: A mixed-methods study. Digit Health 2024; 10:20552076241261930. [PMID: 39229466 PMCID: PMC11369868 DOI: 10.1177/20552076241261930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 09/05/2024] Open
Abstract
Background Globally, healthcare providers have faced significant difficulties in adhering to clinical guidelines. Applying mobile health systems is a crucial strategy for enhancing the dissemination and accessibility of clinical guidelines. This study aimed to assess the acceptance of mobile app-based primary healthcare clinical guidelines and associated factors among health professionals in central Gondar health centers. Methods A cross-sectional study supplemented with qualitative data was conducted on 403 health workers. Data were collected using a pre-test structured printed questionnaire and entered into EpiData version 4.6. Analysis was conducted using Stata version 14, which included bivariable and multivariable logistic regression analyses. For qualitative data, thematic analysis was conducted using Open Code v.4.2. Results Approximately 28% (95% confidence interval (CI): 23%-32%) of health professionals had utilized mobile app-based clinical guidelines. The availability of IT support (adjusted odds ratio (AOR) = 3.51, 95% CI: 1.82-6.78), good knowledge (AOR = 3.46, 95% CI: 1.5-6.78), perceived usefulness (AOR = 2.21, 95% CI: 1.00-4.99), m-Health app exposure (AOR = 2.34, 95% CI: 1.2-4.50), and ease of use (AOR = 5.77, 95% CI: 2.50-13.32) were significantly associated with the acceptance of the mobile app-based clinical guideline. In qualitative data, lack of training and supervision and access to smartphones were barriers to acceptance of the mobile app-based clinical guideline. Conclusion In summary, acceptance of the app is currently low. However, it can be increased by improving the availability of IT support in the workplace, offering training and supervision, and enhancing access to smartphones.
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Affiliation(s)
- Nebebe Demis Baykemagn
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Araya Mesfin Nigatu
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Berhanu Fikadie
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Binyam Tilahun
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Brørs G, Gjeilo KH, Lund T, Skevik K, Aa E, Høvik LH, Skarsvaag T, Mjølstad OC. Amiodarone-induced phlebitis: incidence and adherence to a clinical practice guideline. Eur J Cardiovasc Nurs 2023; 22:824-831. [PMID: 36594941 DOI: 10.1093/eurjcn/zvad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/22/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Abstract
AIMS Intravenous amiodarone is an irritant of peripheral blood vessels with phlebitis as an adverse effect. The aims were to determine the incidence of intravenous amiodarone-induced phlebitis, to describe adherence to a clinical practice guideline, and to determine how characteristics were distributed between those with and without phlebitis. METHODS AND RESULTS A prospective observational study was conducted. Adult patients treated with amiodarone through a peripheral intravenous catheter (PIVC) or a central venous catheter were included. PIVC characteristics were measured using the PIVC mini questionnaire. Patients with ≥two signs of phlebitis were categorized as having phlebitis. Adherence to the clinical practice guideline was registered on a standard abstract sheet. Data were collected from the amiodarone start-up to 2 days after the amiodarone was discontinued. In total, 124 patients with amiodarone infusions were observed, of which 69% were administered via a PIVC. The phlebitis rate was 44%. Fifty-three per cent developed amiodarone-induced phlebitis during the infusion phase, while 47% presented phlebitis during the post-infusion phase. The three most observed signs or symptoms of phlebitis were redness (87%), pain (81%), and swelling (71%). The most commonly used PIVC site was the elbow, and 35% of the PIVCs were large (18 gauge), which was the last preferred site and size according to the clinical practice guideline. CONCLUSION A large proportion of the patients developed amiodarone-induced phlebitis. The adherence to the clinical practice guideline was not optimal according to the PIVC recommendations. Prevention of amiodarone-induced phlebitis should have high priority to reduce patient harm.
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Affiliation(s)
- Gunhild Brørs
- Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Kari Hanne Gjeilo
- Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, P.O. Box 8900, Torgarden, 7491 Trondheim, Norway
| | - Tonje Lund
- Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Karin Skevik
- Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Elizabeth Aa
- Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Lise Husby Høvik
- Department of Public Health and Nursing, Norwegian University of Science and Technology, P.O. Box 8900, Torgarden, 7491 Trondheim, Norway
- Department of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Torhild Skarsvaag
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Ole Christian Mjølstad
- Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, P.O. Box 8900, Torgarden, 7491 Trondheim, Norway
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Hakimjavadi R, Hong HA, Fallah N, Humphreys S, Kingwell S, Stratton A, Tsai E, Wai EK, Walden K, Noonan VK, Phan P. Enabling knowledge translation: implementation of a web-based tool for independent walking prediction after traumatic spinal cord injury. Front Neurol 2023; 14:1219307. [PMID: 38116110 PMCID: PMC10728823 DOI: 10.3389/fneur.2023.1219307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Several clinical prediction rules (CPRs) have been published, but few are easily accessible or convenient for clinicians to use in practice. We aimed to develop, implement, and describe the process of building a web-based CPR for predicting independent walking 1-year after a traumatic spinal cord injury (TSCI). Methods Using the published and validated CPR, a front-end web application called "Ambulation" was built using HyperText Markup Language (HTML), Cascading Style Sheets (CSS), and JavaScript. A survey was created using QualtricsXM Software to gather insights on the application's usability and user experience. Website activity was monitored using Google Analytics. Ambulation was developed with a core team of seven clinicians and researchers. To refine the app's content, website design, and utility, 20 professionals from different disciplines, including persons with lived experience, were consulted. Results After 11 revisions, Ambulation was uploaded onto a unique web domain and launched (www.ambulation.ca) as a pilot with 30 clinicians (surgeons, physiatrists, and physiotherapists). The website consists of five web pages: Home, Calculation, Team, Contact, and Privacy Policy. Responses from the user survey (n = 6) were positive and provided insight into the usability of the tool and its clinical utility (e.g., helpful in discharge planning and rehabilitation), and the overall face validity of the CPR. Since its public release on February 7, 2022, to February 28, 2023, Ambulation had 594 total users, 565 (95.1%) new users, 26 (4.4%) returning users, 363 (61.1%) engaged sessions (i.e., the number of sessions that lasted 10 seconds/longer, had one/more conversion events e.g., performing the calculation, or two/more page or screen views), and the majority of the users originating from the United States (39.9%) and Canada (38.2%). Discussion Ambulation is a CPR for predicting independent walking 1-year after TSCI and it can assist frontline clinicians with clinical decision-making (e.g., time to surgery or rehabilitation plan), patient education and goal setting soon after injury. This tool is an example of adapting a validated CPR for independent walking into an easily accessible and usable web-based tool for use in clinical practice. This study may help inform how other CPRs can be adopted into clinical practice.
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Affiliation(s)
| | - Heather A. Hong
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, Faculty of Medicine, The University of British Columbia, UBC Hospital, Vancouver, BC, Canada
| | - Suzanne Humphreys
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Stephen Kingwell
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandra Stratton
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Eve Tsai
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Eugene K. Wai
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kristen Walden
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Philippe Phan
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Gartrell K, Warren JI, Fontelo P. PubMed4Hh: A Point-of-Care Mobile App for Evidence-Based Clinical Decision Support for Nurse Residents in Maryland. Comput Inform Nurs 2023; 41:983-992. [PMID: 38062547 PMCID: PMC10746293 DOI: 10.1097/cin.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Evidence-based clinical decision-making is considered a core competency for professional nurses. However, barriers such as lack of time in clinical practice; information overload; restricted access to resources; lack of evidence appraisal skills, awareness, and knowledge; and unreliable resources prevent them from adopting evidence-based practice. This study examined the usefulness of the PubMed4Hh (PubMed for Handhelds) mobile application for clinical decision-making at the point of care among Maryland newly licensed RNs. Using iOS and Android smartphones, 178 newly licensed RNs participated in a 6-month trial from November 2019 to April 2020. Nurses manually entered free-text queries or used voice inputs on the "Patient, Intervention, Comparison, Outcome" or "askMEDLINE" search engines. The results retrieved were presented as journal article abstracts or short summaries called "the bottom line," designed for quick reading at the point of care. Both Patient, Intervention, Comparison, Outcome and askMEDLINE were rated highly for their usefulness, and participants said they would continue using PubMed4Hh and recommend it to others. Newly licensed RNs had a significantly higher perception of the usefulness of PubMed4Hh when the results of "the bottom line" or abstracts confirmed, led, or modified their nursing skills, knowledge, or the patient's care plan.
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Affiliation(s)
- Kyungsook Gartrell
- Author Affiliations: Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore (Dr Gartrell); Maryland Organization of Nurse Leaders, Inc/Maryland Nurse Residency Collaborative, Ellicott City (Dr Warren); and Applied Clinical Informatics Branch, National Library of Medicine, Bethesda (Dr Fontelo), MD
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21
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Paranjape PR, Thai-Paquette V, Miamidian JL, Parr J, Kazin EA, McLaren A, Toler K, Deirmengian C. Achieving High Accuracy in Predicting the Probability of Periprosthetic Joint Infection From Synovial Fluid in Patients Undergoing Hip or Knee Arthroplasty: The Development and Validation of a Multivariable Machine Learning Algorithm. Cureus 2023; 15:e51036. [PMID: 38143730 PMCID: PMC10749183 DOI: 10.7759/cureus.51036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 12/26/2023] Open
Abstract
Background and objective The current periprosthetic joint infection (PJI) diagnostic guidelines require clinicians to interpret and integrate multiple criteria into a complex scoring system. Also, PJI classifications are often inconclusive, failing to provide a clinical diagnosis. Machine learning (ML) models could be leveraged to reduce reliance on these complex systems and thereby reduce diagnostic uncertainty. This study aimed to develop an ML algorithm using synovial fluid (SF) test results to establish a PJI probability score. Methods We used a large clinical laboratory's dataset of SF samples, aspirated from patients with hip or knee arthroplasty as part of a PJI evaluation. Patient age and SF biomarkers [white blood cell count, neutrophil percentage (%PMN), red blood cell count, absorbance at 280 nm wavelength, C-reactive protein (CRP), alpha-defensin (AD), neutrophil elastase, and microbial antigen (MID) tests] were used for model development. Data preprocessing, principal component analysis, and unsupervised clustering (K-means) revealed four clusters of samples that naturally aggregated based on biomarker results. Analysis of the characteristics of each of these four clusters revealed three clusters (n=13,133) with samples having biomarker results typical of a PJI-negative classification and one cluster (n=4,032) with samples having biomarker results typical of a PJI-positive classification. A decision tree model, trained and tested independently of external diagnostic rules, was then developed to match the classification determined by the unsupervised clustering. The performance of the model was assessed versus a modified 2018 International Consensus Meeting (ICM) criteria, in both the test cohort and an independent unlabeled validation set of 5,601 samples. The SHAP (SHapley Additive exPlanations) method was used to explore feature importance. Results The ML model showed an area under the curve of 0.993, with a sensitivity of 98.8%, specificity of 97.3%, positive predictive value (PPV) of 92.9%, and negative predictive value (NPV) of 99.8% in predicting the modified 2018 ICM diagnosis among test set samples. The model maintained its diagnostic accuracy in the validation cohort, yielding 99.1% sensitivity, 97.1% specificity, 91.9% PPV, and 99.9% NPV. The model's inconclusive rate (diagnostic probability between 20-80%) in the validation cohort was only 1.3%, lower than that observed with the modified 2018 ICM PJI classification (7.4%; p<0.001). The SHAP analysis found that AD was the most important feature in the model, exhibiting dominance among >95% of "infected" and "not infected" diagnoses. Other important features were the sum of the MID test panel, %PMN, and SF-CRP. Conclusions Although defined methods and tools for diagnosis of PJI using multiple biomarker criteria are available, they are not consistently applied or widely implemented. There is a need for algorithmic interpretation of these biomarkers to enable consistent interpretation of the results to drive treatment decisions. The new model, using clinical parameters measured from a patient's SF sample, renders a preoperative probability score for PJI which performs well compared to a modified 2018 ICM definition. Taken together with other clinical signs, this model has the potential to increase the accuracy of clinical evaluations and reduce the rate of inconclusive classification, thereby enabling more appropriate and expedited downstream treatment decisions.
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Affiliation(s)
- Pearl R Paranjape
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Van Thai-Paquette
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - John L Miamidian
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Jim Parr
- Department of Data Science and Machine Learning, Zimmer Biomet, Swindon, GBR
| | - Eyal A Kazin
- Department of Data Science and Machine Learning, Zimmer Biomet, Swindon, GBR
| | - Alex McLaren
- Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Krista Toler
- Department of Diagnostics Research and Development, Zimmer Biomet, Warsaw, USA
| | - Carl Deirmengian
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Philadelphia, USA
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, USA
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Dhole S, Mahakalkar C, Kshirsagar S, Bhargava A. Antibiotic Prophylaxis in Surgery: Current Insights and Future Directions for Surgical Site Infection Prevention. Cureus 2023; 15:e47858. [PMID: 38021553 PMCID: PMC10680052 DOI: 10.7759/cureus.47858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Surgical site infections (SSIs) remain a significant concern in the field of surgery, contributing to patient morbidity, prolonged hospital stays, and increased healthcare costs. Antibiotic prophylaxis, the administration of antibiotics before surgery, has been a cornerstone in preventing SSIs for decades. This review explores the current state of antibiotic prophylaxis in surgery, offering insights into its effectiveness, challenges, and emerging trends. In this comprehensive analysis, we delve into the historical development of antibiotic prophylaxis, examining its evolution from early practices to modern guidelines. We explore the various classes of antibiotics commonly used, their dosing regimens, and the importance of timing in optimizing prophylactic interventions. Additionally, we investigate the role of patient-specific factors, such as comorbidities and allergies, in tailoring antibiotic prophylaxis to individual needs. While antibiotic prophylaxis has undeniably reduced the incidence of SSIs, concerns about antimicrobial resistance and adverse effects necessitate a reevaluation of current practices. This review presents a critical assessment of the challenges posed by the overuse and misuse of antibiotics in surgery and highlights the urgent need for judicious antibiotic stewardship. Moreover, the future of antibiotic prophylaxis holds promise with the emergence of innovative strategies such as antimicrobial coatings, probiotics, and immunomodulatory agents. We discuss these novel approaches and their potential to enhance SSI prevention while minimizing antibiotic-related risks. In conclusion, antibiotic prophylaxis in surgery has been instrumental in reducing SSIs, but its continued effectiveness requires a multifaceted approach. By addressing current challenges, promoting antibiotic stewardship, and embracing innovative strategies, we can advance the field of SSI prevention and improve patient outcomes in the years to come. This review provides valuable insights and direction for clinicians, researchers, and policymakers as they navigate the evolving landscape of surgical prophylaxis.
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Affiliation(s)
- Simran Dhole
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chandrashekhar Mahakalkar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivani Kshirsagar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhilasha Bhargava
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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23
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Huo B, Smart N, Antoniou SA. Proposing a new surgical evidence ecosystem. Colorectal Dis 2023; 25:1947-1948. [PMID: 37905741 DOI: 10.1111/codi.16795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Bright Huo
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Neil Smart
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Stavros A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
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Ebben KC, de Kroon CD, Schmeink CE, van der Hel OL, van Vegchel T, Moncada‐Torres A, de Hingh IH, van der Werf J. A novel method for continuous measurements of clinical practice guideline adherence. Learn Health Syst 2023; 7:e10384. [PMID: 37860062 PMCID: PMC10582230 DOI: 10.1002/lrh2.10384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Clinical practice guidelines (hereafter 'guidelines') are crucial in providing evidence-based recommendations for physicians and multidisciplinary teams to make informed decisions regarding diagnostics and treatment in various diseases, including cancer. While guideline implementation has been shown to reduce (unwanted) variability and improve outcome of care, monitoring of adherence to guidelines remains challenging. Real-world data collected from cancer registries can provide a continuous source for monitoring adherence levels. In this work, we describe a novel structured approach to guideline evaluation using real-world data that enables continuous monitoring. This method was applied to endometrial cancer patients in the Netherlands and implemented through a prototype web-based dashboard that enables interactive usage and supports various analyses. Method The guideline under study was parsed into clinical decision trees (CDTs) and an information standard was drawn up. A dataset from the Netherlands Cancer Registry (NCR) was used and data items from both instruments were mapped. By comparing guideline recommendations with real-world data an adherence classification was determined. The developed prototype can be used to identify and prioritize potential topics for guideline updates. Results CDTs revealed 68 data items for recording in an information standard. Thirty-two data items from the NCR were mapped onto information standard data items. Four CDTs could sufficiently be populated with NCR data. Conclusion The developed methodology can evaluate a guideline to identify potential improvements in recommendations and the success of the implementation strategy. In addition, it is able to identify patient and disease characteristics that influence decision-making in clinical practice. The method supports a cyclical process of developing, implementing and evaluating guidelines and can be scaled to other diseases and settings. It contributes to a learning healthcare cycle that integrates real-world data with external knowledge.
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Affiliation(s)
- Kees C.W.J. Ebben
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Cornelis D. de Kroon
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Olga L. van der Hel
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Thijs van Vegchel
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Arturo Moncada‐Torres
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Ignace H.J.T. de Hingh
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
- Department of Surgical OncologyCatharina HospitalEindhovenThe Netherlands
| | - Jurrian van der Werf
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
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Sagam CK, Were LM, Otieno JA, Mulaku MN, Kariuki S, Ochodo E. Quality assessment of clinical practice guidelines in Kenya using the AGREE II tool: a methodological review. BMJ Open 2023; 13:e074510. [PMID: 37429677 PMCID: PMC10335456 DOI: 10.1136/bmjopen-2023-074510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To assess the quality of available and accessible national Clinical Practice Guidelines (CPGs) in Kenya using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. METHODS We searched the websites of the Kenyan Ministry of Health, professional associations and contacted experts in relevant organisations. Our scope was guidelines on maternal, neonatal, nutritional disorders, injuries, communicable and non-communicable diseases in Kenya published in the last 5 years until 30 June 2022. Study selection and data extraction were done by three independent reviewers with disagreements resolved via discussion or with a senior reviewer. We conducted a quality assessment using the online English version of AGREE II tool across six domains. Descriptive statistics were analysed using Stata software V.17. The primary outcome was the methodological quality of the included CPGs assessed by the AGREE II tool score. RESULTS We retrieved 95 CPGs and included 24 in the analysis after screening for eligibility. The CPGs scored best in clarity of presentation and least in the rigour of development. In descending order, the appraisal scores (mean and CI) per domain were as follows: Clarity of presentation 82.96% (95% CI 78.35% to 87.57%) with all guidelines scoring above 50%. Scope and purpose 61.75% (95% CI 54.19% to 69.31%) with seven guidelines scoring less than 50%. Stakeholder involvement 45.25% (95% CI 40.01% to 50.49%) with 16 CPGs scoring less than 50%. Applicability domain 19.88% (95% CI 13.32% to 26.43%) with only one CPG scoring above 50%. Editorial independence 6.92% (95% CI 3.47% to 10.37%) with no CPG scoring above 50% and rigour of development 3% (95% CI 0.61% to 5.39%) with no CPG scoring at least 50%. CONCLUSION Our findings suggest that the quality of CPGs in Kenya is limited mainly by the rigour of development, editorial independence, applicability and stakeholder involvement. Training initiatives on evidence-based methodology among guideline developers are needed to improve the overall quality of CPGs for better patient care.
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Affiliation(s)
- Caleb Kimutai Sagam
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lisa M Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jenifer A Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Mercy N Mulaku
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-Based Health Care, Department of Global Health, Stellenbosch University, Cape town, South Africa
- Department of Pharmacology, Clinical Pharmacy, and Pharmacy Practice, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-Based Health Care, Department of Global Health, Stellenbosch University, Cape town, South Africa
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Stahl J, Hauser C, Simon M, Valenta S, Favez L, Zúñiga F. Institutional Factors Associated with Residents' Malnutrition in Nursing Homes: A Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1074-1081. [PMID: 36934773 DOI: 10.1016/j.jamda.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Malnutrition is frequent in older adults, associated with increased morbidity, mortality, and higher costs. Nursing home residents are especially affected, and evidence on institutional factors associated with malnutrition is limited. We calculated the prevalence of malnutrition in Swiss nursing home residents and investigated which structure and process indicators of nursing homes are associated with residents' malnutrition. DESIGN Subanalysis of the Swiss Nursing Homes Human Resources Project 2018, a multicenter, cross-sectional study conducted from 2018 to 2019 in Switzerland. SETTING AND PARTICIPANTS This study included 76 nursing homes with a total of 5047 residents. METHODS Malnutrition was defined as a loss of bodyweight of ≥5% in the last 30 days or ≥10% in the last 180 days. Binomial generalized estimating equations (GEE) were applied to examine the association between malnutrition and structural (staffing ratio, grade mix, presence of a dietician, malnutrition guideline, support during mealtimes) and process indicators (awareness of malnutrition, food administration process). GEE models were adjusted for institutional (profit status, facility size) and specific resident characteristics. RESULTS The prevalence of residents with malnutrition was 5%. A higher percentage of units per nursing home having a guideline on prevention and treatment of malnutrition was significantly associated with more residents with weight loss (OR 2.47, 95% CI 1.31-4.66, P = .005). Not having a dietician in a nursing home was significantly associated with a higher rate of residents with weight loss (OR 1.60, 95% CI 1.09-2.35, P = .016). CONCLUSIONS AND IMPLICATIONS Having a dietician as part of a multidisciplinary team in a nursing home is an important step to address the problem of residents' malnutrition. Further research is needed to clarify the role of a guideline on prevention and treatment of malnutrition to improve the quality of care in nursing homes.
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Affiliation(s)
- Jonathan Stahl
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Nursing Development, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Claudia Hauser
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Breast, Abdomen, Pelvis, University Hospital Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sabine Valenta
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Lauriane Favez
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.
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Stovall SL, Kaplan JA, Law JK, Flum DR, Simianu VV. Diverticulitis is a population health problem: Lessons and gaps in strategies to implement and improve contemporary care. World J Gastrointest Surg 2023; 15:1007-1019. [PMID: 37405108 PMCID: PMC10315108 DOI: 10.4240/wjgs.v15.i6.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 06/15/2023] Open
Abstract
The disease burden of diverticulitis is high across inpatient and outpatient settings, and the prevalence of diverticulitis has increased. Historically, patients with acute diverticulitis were admitted routinely for intravenous antibiotics and many had urgent surgery with colostomy or elective surgery after only a few episodes. Several recent studies have challenged the standards of how acute and recurrent diverticulitis are managed, and many clinical practice guidelines (CPGs) have pivoted to recommend outpatient management and individualized decisions about surgery. Yet the rates of diverticulitis hospitalizations and operations are increasing in the United States, suggesting there is a disconnect from or delay in adoption of CPGs across the spectrum of diverticular disease. In this review, we propose approaching diverticulitis care from a population level to understand the gaps between contemporary studies and real-world practice and suggest strategies to implement and improve future care.
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Affiliation(s)
- Stephanie Lee Stovall
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
| | - Joanna K Law
- Department of Gastroenterology, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
| | - David R Flum
- Department of Surgery, University of Washington Medical, Seattle, WA 98195, United States
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
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Yaseen A, Lahiri SW. Health Care Provider Prescribing Habits and Barriers to Use of New Type 2 Diabetes Medications: A Single-System Survey Study. Clin Diabetes 2023; 41:490-501. [PMID: 37849520 PMCID: PMC10577502 DOI: 10.2337/cd22-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
This survey study evaluated type 2 diabetes medication prescribing patterns of health care providers in different specialties and of different professional designations or levels of training at an academic health care system and sought to identify factors influencing medication choices and uncover barriers to prescribing glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors. High cost and the need for prior authorizations were reported as the main barriers to prescribing drugs in these two classes, along with a lack of experience among some specialists. Greater system support to decrease the administrative burden of prescribing newer medications and greater dialogue among the specialties caring for patients with cardiorenal comorbidities can improve prescribing of these drugs in accordance with clinical practice recommendations.
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Affiliation(s)
- Aseel Yaseen
- Department of Internal Medicine, Henry Ford Health, Detroit, MI
| | - Sharon W. Lahiri
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health, Detroit, MI
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Ryles HT, Hong CX, Andy UU, Farrow MR. Changing Practices in the Surgical Management of Adnexal Torsion: An Analysis of the National Surgical Quality Improvement Program Database. Obstet Gynecol 2023; 141:888-896. [PMID: 37023448 PMCID: PMC10147583 DOI: 10.1097/aog.0000000000005142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/12/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To evaluate trends in the surgical management of adnexal torsion and to evaluate these trends with respect to the updated American College of Obstetricians and Gynecologists (ACOG) guidelines. METHODS We performed a retrospective cohort study using the National Surgical Quality Improvement Program database. Women who underwent surgery for adnexal torsion between 2008 and 2020 were identified on the basis of International Classification of Diseases codes. Surgeries were grouped as either ovarian conservation or oophorectomy with the use of Current Procedural Terminology codes. Patients were also grouped into year cohorts with respect to the publication of the updated ACOG guidelines (2008-2016 compared with 2017-2020). Multivariable logistic regression, weighted by cases per year, was used to assess differences between groups. RESULTS Of the 1,791 surgeries performed for adnexal torsion, 542 (30.3%) involved ovarian conservation and 1,249 (69.7%) involved oophorectomy. Older age, higher body mass index, higher American Society of Anesthesiologists classification, anemia, and diagnosis of hypertension were significantly associated with oophorectomy. There was no significant difference in the proportion of oophorectomies performed before 2017 compared with after 2017 (71.9% vs 69.1%, odds ratio [OR] 0.89, 95% CI 0.69-1.16; adjusted OR 0.94, 95% CI 0.71-1.25). A significant decrease in proportion of oophorectomies performed each year was identified over the entire study period (-1.6%/y, P=.02, 95% CI -3.0% to -0.22%); however, the rates did not differ before and after 2017 (interaction P=.16). CONCLUSION There was a modest decrease in the proportion of oophorectomies for adnexal torsion performed per year over the study period. However, oophorectomy is still commonly performed for adnexal torsion, despite updated guidelines from ACOG recommending ovarian conservation.
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Affiliation(s)
- Hannah T Ryles
- Department of Obstetrics and Gynecology and the Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia; and the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Brown L, Street T, Adonis A, Johnston TE, Ferrante S, Burridge JH, Bulley C. Implementing functional electrical stimulation clinical practice guidelines to support mobility: A stakeholder consultation. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1062356. [PMID: 36776737 PMCID: PMC9909018 DOI: 10.3389/fresc.2023.1062356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
Functional Electrical Stimulation (FES) has been used to support mobility for people with upper motor neuron conditions such as stroke and multiple sclerosis for over 25 years. Recent development and publication of clinical practice guidelines (CPGs) provide evidence to guide clinical decision making for application of FES to improve mobility. Understanding key barriers to the implementation of these CPGs is a critical initial step necessary to create tailored knowledge translation strategies. A public involvement and engagement consultation was conducted with international stakeholders including researchers, clinicians and engineers working with FES to inform implementation strategies for CPG use internationally. Reflexive thematic analysis of the consultation transcripts revealed themes including inconsistent use of CPGs, barriers to implementation such as limited access to FES and low clinician confidence, and the need for a tiered education approach with ongoing support. Insights derived from this consultation will inform the development of knowledge translation strategies to support the next steps to implementing FES use for mobility.
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Affiliation(s)
- Lisa Brown
- Department of Physical Therapy, Boston University, Boston, MA, United States
| | - Tamsyn Street
- Salisbury NHS Foundation Trust, Salisbury, United Kingdom,Correspondence: Tamsyn Street
| | - Adine Adonis
- Department of Physiotherapy, Imperial College Healthcare NHS, London, United Kingdom
| | - Therese E. Johnston
- Department of Physical Therapy, Arcadia University, Glenside, PA, United States
| | - Simona Ferrante
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Cassidy M, Doucet S, Luke A, Goudreau A, MacNeill L. Improving the transition from paediatric to adult healthcare: a scoping review on the recommendations of young adults with lived experience. BMJ Open 2022; 12:e051314. [PMID: 36572498 PMCID: PMC9806082 DOI: 10.1136/bmjopen-2021-051314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The goal of this review was to identify recommendations within the literature on how to improve the transition from paediatric to adult healthcare from the perspective of young adults (YAs) living with chronic conditions who have gone through the process. DESIGN This review was conducted in accordance with JBI methodology for scoping reviews. SEARCH STRATEGY We searched MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO) and EMBASE (Elsevier) databases, and conducted a grey literature search for relevant material. The databases were searched in December 2019, and re-searched June 2020 and September 2020, while the grey literature was searched in April 2020. This scoping review focused on the recommendations of YAs with chronic conditions who have transitioned from paediatric to adult healthcare, in any setting (eg, hospital, clinic or community), and across all sectors (eg, health, education and social services). RESULTS Eighteen studies met inclusion criteria for this review. These studies included YAs with 14 different chronic conditions, receiving primary health services in North America (67%) and Europe (33%). YAs' recommendations for improving the transition from paediatric to adult healthcare (n=number of studies reported) included: improving continuity of care (n=12); facilitating patient-centred care (n=9); building strong support networks (n=11) and implementing transition education preparedness training (n=7). CONCLUSION Review findings can benefit service delivery by addressing important barriers to health, education, and social services for youth transitioning to adult healthcare.
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Affiliation(s)
- Monique Cassidy
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alex Goudreau
- UNB Libraries, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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Smith SM, Eadara A, Parkash V. Addressing quality and safety in anatomic pathology in low- and middle-income countries. Front Med (Lausanne) 2022; 9:1060179. [PMID: 36619634 PMCID: PMC9817141 DOI: 10.3389/fmed.2022.1060179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
The World Health Organization (WHO) has created a sustainable development goal of reducing preventable mortality from cancer in low- and middle-income countries (LMICs) by 30% by 2030. Central to achieving this goal is the creation and maintenance of quality anatomic pathology services (APS). Within the last decade, quality assurance programs and patient safety measures have become a major focus of research for upper middle- and high-income countries (UMHICs), which has led to marked documented improvement in the quality of services provided by laboratories, as well as a decrease in patient safety events. We propose that as APS are developed in LMICs, the lessons learned by UMHICs are necessary to incorporate to produce quality and safe services toward obtaining the aforementioned goal. Furthermore, data suggests that Quality Improvement work requires change at the macrosystems and microsystems levels to achieve these goals. Here, we propose five "microsystems" strategies for professional organizations, healthcare institutions in LMICs and UMHICs that would accelerate quality improvement programs/systems implementation in APS in LMICs.
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Affiliation(s)
- Stephen M. Smith
- Department of Laboratory Medicine & Pathobiology, University Health Network, Toronto, ON, Canada
| | | | - Vinita Parkash
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, United States,*Correspondence: Vinita Parkash,
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Linn DD, Beckett RD, Faust AC. Use of the AGREE II instrument to evaluate critical care practice guidelines addressing pharmacotherapy. J Eval Clin Pract 2022; 28:1061-1071. [PMID: 35441442 DOI: 10.1111/jep.13687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Clinical practice guidelines (CPGs) have been evaluated for reporting transparency and methodological quality in a number of studies in various disciplines, but few studies have focused on critical care and none on pharmacotherapy-related guidelines specifically. The objective of this study was to evaluate the quality of critical care CPGs with a focus on pharmacotherapy using the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. METHOD A cross-sectional study of CPGs published from 2013 through August 2021 was conducted. Following establishment of interrater reliability, guidelines were independently evaluated by three reviewers to rate guidelines on criteria set forth by the AGREE II instrument. Domain scores and item scores were calculated using the AGREE II user manual, and results described with descriptive statistics. RESULTS Out of 192 guidelines identified, 73 met inclusion criteria and were screened using the AGREE II instrument. Most guidelines were authored by a professional organization or government agency. Domain quality scores were calculated for each domain as recommended by the AGREE II instrument. Domain 4 (clarity of presentation) had the highest AGREE II domain score with a median score of 87.0% (interquartile range: 79.6%-92.6%). Domain 5 (applicability) received the lowest domain score with a mean score of 41.8 ± 21.1%. The majority of guidelines were recommended for use as published or with modifications, while only six guidelines (8.2%) were not recommended for use. CONCLUSIONS The majority of critical care guidelines that include pharmacotherapy recommendations were recommended for use by study authors when the AGREE II instrument was applied. While guidelines generally scored highly in clarity of presentation, additional time and effort should focus on providing solutions to guideline implementation and inclusion of patient preferences.
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Affiliation(s)
- Dustin D Linn
- Philips Connected Care, Amsterdam, Netherlands.,Philips Connected Care, Department of Pharmacy, Parkview Health, Fort Wayne, Indiana, USA
| | - Robert D Beckett
- Pharmacy Practice Department, Manchester University, Fort Wayne, Indiana, USA
| | - Andrew C Faust
- Department of Pharmacy, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
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Carpenter CR, Southerland LT, Lucey BP, Prusaczyk B. Around the EQUATOR with clinician-scientists transdisciplinary aging research (Clin-STAR) principles: Implementation science challenges and opportunities. J Am Geriatr Soc 2022; 70:3620-3630. [PMID: 36005482 PMCID: PMC10538952 DOI: 10.1111/jgs.17993] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
The Institute of Medicine and the National Institute on Aging increasingly understand that knowledge alone is necessary but insufficient to improve healthcare outcomes. Adapting the behaviors of clinicians, patients, and stakeholders to new standards of evidence-based clinical practice is often significantly delayed. In response, over the past twenty years, Implementation Science has developed as the study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners and policymakers. One important advance in Implementation Science research was the development of Standards for Reporting Implementation Studies (StaRI), which provided a 27-item checklist for researchers to consistently report essential elements of the implementation and intervention strategies. Using StaRI as a framework, this review discusses specific Implementation Science challenges for research with older adults, provides solutions for those obstacles, and opportunities to improve the value of this evolving approach to reduce the knowledge translation losses that exist between published research and clinical practice.
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Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brendan P Lucey
- Department of Neurology, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Beth Prusaczyk
- Department of Medicine Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Vamos CA, Griner SB, Daley EM, Cayama MR, Beckstead J, Boggess K, Quinonez RB, Damschroder L. Prenatal oral health guidelines: a theory- and practice-informed approach to survey development using a modified-Delphi technique and cognitive interviews. Implement Sci Commun 2022; 3:126. [PMID: 36443891 PMCID: PMC9703729 DOI: 10.1186/s43058-022-00363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pregnancy presents an opportune time for oral health promotion and intervention; however, implementation of the prenatal oral health guidelines remains a challenge among prenatal and oral health providers. The purpose of this study was twofold: To employ a theory-based approach to identify high-priority Consolidated Framework for Implementation Research (CFIR) constructs with the greatest potential to impact prenatal oral health guideline implementation, and to operationalize and pre-test survey items based on the prioritized CFIR constructs. Identifying barriers and facilitators to guideline implementation will inform the development of targeted interventions that address gaps in adherence which can positively impact oral-systemic health. METHODS The online survey development process employed three rounds of a modified-Delphi technique with prenatal (i.e., MD/DO, CNM) and oral health (i.e., DMD) Practice Advisory Board Members, cognitive interviews with prenatal and oral health providers, and deliberations among the research team and a Scientific Advisory Board (OBGYN, pediatric dentist, and researchers). High-impact CFIR constructs were identified and translated into survey items that were subsequently piloted and finalized. RESULTS During three modified-Delphi rounds, a total of 39 CFIR constructs were evaluated with final input and deliberations with the Practice Advisory Board, Scientific Advisory Board, and the research team achieving consensus on 19 constructs. The instrument was pre-tested with four prenatal and two oral health providers. Overall, participants reported that the survey items were feasible to respond to, took an appropriate length of time to complete, and were well-organized. Participants identified specific areas of improvement to clarify CFIR items. The final survey instrument included 21 CFIR items across four domains, with five constructs included from the intervention characteristics domain, two from the process domain, two from the outer setting domain, and 12 from the inner setting domain. CONCLUSIONS Lessons learned from the survey development process include the importance of soliciting diverse scientific and practice-based input, distinguishing between importance/impact and direction of impact (barrier/facilitator), and the need for additional qualitative methods during interdisciplinary collaborations. Overall, this study illustrated an iterative approach to identifying high-priority CFIR constructs that may influence the implementation of the prenatal oral health guidelines into practice settings.
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Affiliation(s)
- Cheryl A. Vamos
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Stacey B. Griner
- School of Public Health, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd, Fort Worth, TX 76107 USA
| | - Ellen M. Daley
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Morgan Richardson Cayama
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL 33612 USA
| | - Kim Boggess
- Department of Obstetrics and Gynecology, School of Medicine, University of North, Carolina at Chapel Hill, CB 7516, Chapel Hill, NC 27599 USA
| | - Rocio B. Quinonez
- Department of Pediatric Dentistry, Schools of Dentistry, Pediatrics and Public Health, University of North Carolina at Chapel Hill, CB 7450, Chapel Hill, NC 27599 USA
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Huepenbecker SP, Wright JD, Downer MK, Incerti D, Luhn P, Dolado I, Bastiere-Truchot L, Lin YG, Chan JK, Meyer LA. Temporal Patterns and Adoption of Germline and Somatic BRCA Testing in Ovarian Cancer. Obstet Gynecol 2022; 140:758-767. [PMID: 36201776 PMCID: PMC9588544 DOI: 10.1097/aog.0000000000004958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe the testing rate, patient characteristics, temporal trends, timing, and results of germline and somatic BRCA testing in patients with ovarian cancer using real-world data. METHODS We included a cross-sectional subset of adult patients diagnosed with ovarian cancer between January 1, 2011, and November 30, 2018, who received frontline treatment and were followed for at least 1 year in a real-world database. The primary outcome was receipt of BRCA testing, classified by biosample source as germline (blood or saliva) or somatic (tissue). Lines of therapy (frontline, second line, third line) were derived based on dates of surgery and chemotherapy. Descriptive statistics were analyzed. RESULTS Among 2,557 patients, 72.2% (n=1,846) had at least one documented BRCA test. Among tested patients, 62.5% (n=1,154) had only germline testing, 10.6% (n=197) had only somatic testing, and 19.9% (n=368) had both. Most patients had testing before (9.7%, n=276) or during (48.6%, n=1,521) frontline therapy, with 17.6% (n=273) tested during second-line and 12.7% (n=129) tested during third-line therapy. Patients who received BRCA testing, compared with patients without testing, were younger (mean age 63 years vs 66 years, P <.001) and were more likely to be treated at an academic practice (10.4% vs 7.0%, P =.01), with differences by Eastern Cooperative Oncology Group performance score ( P <.001), stage of disease ( P <.001), histology ( P <.001), geography ( P <.001), and type of frontline therapy ( P <.001), but no differences based on race or ethnicity. The proportion of patients who received BRCA testing within 1 year of diagnosis increased from 24.6% of patients in 2011 to 75.6% of patients in 2018. CONCLUSION In a large cohort of patients with ovarian cancer, significant practice disparities existed in testing for actionable BRCA mutations. Despite increased testing over time, many patients did not receive testing, suggesting missed opportunities to identify patients appropriate for targeted therapy and genetic counseling.
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Affiliation(s)
| | - Jason D. Wright
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Mary K. Downer
- Personalized Healthcare Data Science, Genentech, Inc., South San Francisco, CA
| | - Devin Incerti
- Product Development Medical Affairs, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
| | - Patricia Luhn
- Product Development Oncology, Genentech, Inc., South San Francisco, CA
| | - Ignacio Dolado
- Product Development Medical Affairs, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
| | | | - Yvonne G. Lin
- Product Development Oncology, Genentech, Inc., South San Francisco, CA
| | - John K. Chan
- California Pacific Medical Center and Palo Alto Medical Foundation, Sutter Health, San Francisco, CA
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Salma I, Waelli M. Mapping research findings on change implementation in nursing practice: A scoping literature review. Nurs Open 2022; 10:450-468. [PMID: 36112719 PMCID: PMC9834520 DOI: 10.1002/nop2.1369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS The aim of this study was to map the diverse factors impacting change implementation in nursing practices and investigate different implementation strategies. DESIGN Scoping literature review following PRISMA-ScR extension. METHODS Data were collected from PubMed, Ebsco, Scopus and ScienceDirect databases from 1990 onwards. Only English peer-reviewed studies reporting an implementation of change in nursing practice were included. Of 9,954 studies, 425 abstracts were scanned and 98 full-text articles were screened. Finally, 28 studies were selected. RESULTS A multifaceted approach, with a tailored intervention, was the most effective implementation strategy. Most identified factors were considered systematic, for example resource availability, leadership and knowledge. However, others related to local social and material context were identified in fewer number of studies. These seem to be operational elements for implementation processes. Both types of factors are essential and must be considered for successful implementation. CONCLUSION We advocate the development of framework including systematic factors and which capture the local context flexibility.
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Affiliation(s)
- Israa Salma
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance
| | - Mathias Waelli
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance,Global Health InstituteGeneva UniversityGeneveSwitzerland
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Fu L, Zhang X, Hu Y, Lu Z, Yang Y, Huang M, Li Y, Zhu F, Wang Y, Huang Z. Distress management in cancer patients:Guideline implementation based on CAN-IMPLEMENT. Int J Nurs Sci 2022; 9:187-195. [PMID: 35509700 PMCID: PMC9052260 DOI: 10.1016/j.ijnss.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/07/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To standardize the distress management of gastric cancer patients receiving chemotherapy, the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource (CAN-IMPLEMENT). Methods Based on the theoretical framework of CAN-IMPLEMENT, A multidisciplinary team was established, barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed, corresponding solutions were formulated, the guidelines implementation process was monitored, and implementation results were evaluated. Results The multidisciplinary team developed review criteria, standardized work paths, assessment tools, training manuals for healthcare professionals, education manuals for patients and their caregivers. After guidelines implementation, the completion rate of the distress management record came up to 97.9% (189/193). From September 2017 to December 2018, the compliance of medical staff on most items in the audit checklist was improved, ranging from 57.1% (100/175) to 100.0% (193/193). The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7% (32/141) to 9.3% (18/193) (P < 0.05), and the Median (range) of the distress score declined from 2 (0-9) to 0 (0-7) (P < 0.001). Conclusions The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units. The review standards, standardized work paths, and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness. Quality control in the practice of distress management was effective. The compliance of healthcare professionals with distress management was improved. The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.
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Affiliation(s)
- Liang Fu
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Xiaoju Zhang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
| | - Zhenqi Lu
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Yang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mingzhu Huang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuanyuan Li
- Department of Psychological Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Fuzhong Zhu
- Department of Social Work, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Wang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhe Huang
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China
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Salma I, Waelli M. Assessing the Integrative Framework for the Implementation of Change in Nursing Practice: Comparative Case Studies in French Hospitals. Healthcare (Basel) 2022; 10:healthcare10030417. [PMID: 35326895 PMCID: PMC8953539 DOI: 10.3390/healthcare10030417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/22/2022] Open
Abstract
The implementation of healthcare policies in healthcare organizations is a pivotal issue for managers. They generally require a change in professional practices. In previous work, we developed the Integrative Framework for Implementation of change in Nursing Practices (IFINP) to support implementation initiatives for such change in nursing practices. We aimed to assess the generalizability of IFINP in other organizational settings and explore links between strategic and socio-material factors during implementation. We used a comparative qualitative case study at three French hospitals to assess the implementation of certification procedures. Data were collected from 33 semi-structured interviews with managers and nurses. Narratives reflecting actions and interactions were extracted and deductively analyzed using IFINP components. The results showed that the framework was flexible and captured the different aspects of implementation actions and interactions at the three hospitals. Strong interferences were identified between mobilization mechanisms and strategic elements. Interferences were observed mostly between ‘reflexive monitoring and work articulation’, and ‘reflexive monitoring and sense-making’ mechanisms. Leadership was integrated into the different mechanisms, especially the ‘translation’ mechanism. The IFINP facilitated a greater understanding of strategic elements and associated relationships with social and material factors during implementation. It helps to provide a clear definition of the managers’ role when implementing new nurse practices.
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Affiliation(s)
- Israa Salma
- Inserm U 1309-RSMS ARENES UMR 6051, Management Institute, EHESP, CS 74312, CEDEX, 35043 Rennes, France;
- Correspondence: ; Tel.: +33-(0)6-62-10-25-33
| | - Mathias Waelli
- Inserm U 1309-RSMS ARENES UMR 6051, Management Institute, EHESP, CS 74312, CEDEX, 35043 Rennes, France;
- Global Health Institute, Geneva University, 1202 Geneva, Switzerland
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Gómez-Barrena E, Warren T, Walker I, Jain N, Kort N, Loubignac F, Newman S, Perka C, Spinarelli A, Whitehouse MR, Zagra L, De la Torre BJ. Prevention of Periprosthetic Joint Infection in Total Hip and Knee Replacement: One European Consensus. J Clin Med 2022; 11:jcm11020381. [PMID: 35054075 PMCID: PMC8781876 DOI: 10.3390/jcm11020381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 01/09/2023] Open
Abstract
Periprosthetic joint infection (PJI) is a devastating complication in total hip and knee replacement. Its prevention is key to decrease the incidence and avoid some consequences that seriously impact patients and health systems. In view of the variety of recommendations and guidelines, we decided to conduct an expert, peer-reviewed European consensus analysis about the pre-, intra-, and postoperative prevention of PJI. A multinational group of practicing orthopedic experts developed a series of 47 consensus statements in 6 main groups of intervention, and a 2-stage Delphi approach was launched with a threshold for agreement at 75% and for very high agreement at more than 90%. A total of 306 orthopedic surgeon responses were gathered from 9 countries. Consensus was reached for 42/47 statements, 31/47 of which achieved a very high consensus. Many preoperative actions gathered strong consensus, although areas like the use of alcoholic chlorhexidine or the timing of hair removal did not attain strong consensus, despite available evidence. Intra- and postoperative actions showed more variability regarding incise drapes, skin suturing techniques, and wound follow-up. This study confirms an important consensus among orthopedic surgeons across Europe in many areas well known to contribute to the prevention of PJI; however, there are still grounds for improvement.
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Affiliation(s)
- Enrique Gómez-Barrena
- Department of Orthopaedic Surgery, Hospital La Paz, Autónoma University of Madrid, 28046 Madrid, Spain
- Correspondence: ; Tel.: +34-917277085
| | - Timothy Warren
- Triducive Ltd., Tunbridge Wells TN1 1NU, UK; (T.W.); (I.W.)
| | - Ian Walker
- Triducive Ltd., Tunbridge Wells TN1 1NU, UK; (T.W.); (I.W.)
| | - Neil Jain
- Department of Orthopaedic Surgery, Pennine Acute Hospitals NHS Trust, Manchester M8 5RB, UK;
| | - Nanne Kort
- CortoClinics, 5482 Schijndel, The Netherlands;
| | | | | | - Carsten Perka
- Department of Orthopaedic Surgery, Charité Hospital Universitätsmedizin, 10117 Berlin, Germany;
| | - Antonio Spinarelli
- UOC Ortopedia e Traumatologia, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Università degli Studi di Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Michael R. Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK;
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol BS8 1TH, UK
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
| | - Basilio J. De la Torre
- Department of Orthopaedic Surgery, Hospital Ramón y Cajal, University of Alcalá, 28034 Madrid, Spain;
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Wachholz PA, Stein AT, Melo DOD, Mello RGBD, Florez ID. Recommendations for the development of Clinical Practice Guidelines. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical practice guidelines are statements that include recommendations intended to optimize patient care, are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options, and ensure that the best available clinical knowledge is used to provide effective and quality care. They can reduce inappropriate care and variability in clinical practice and can support the translation of new research knowledge into clinical practice. Recommendations from clinical practice guidelines can support health professionals by facilitating the decision-making process, empowering them to make more informed health care choices, clarifying which interventions should be priorities based on a favorable trade-off, and discouraging the use of those that have proven ineffective, dangerous, or wasteful. This review aims to summarize the key components of high-quality and trustworthy guidelines. Articles were retrieved from various libraries, databases, and search engines using free-text term searches adapted for different databases, and selected according to author discretion. Clinical practice guidelines in geriatrics can have a major impact on prevention, diagnosis, treatment, rehabilitation, health care, and the management of diseases and conditions, but they should only be implemented when they have high-quality, rigorous, and unbiased methodologies that consider older adult priorities and provide valid recommendations.
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Ballengee LA, Zullig LL, George SZ. Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go? J Pain Res 2021; 14:3747-3757. [PMID: 34908873 PMCID: PMC8665872 DOI: 10.2147/jpr.s311973] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022] Open
Abstract
Low back pain continues to be a leading cause of disability and cost throughout the world. Evidence-based guidelines recommend use of non-pharmacological interventions to address decreases in physical function due to low back pain. Psychologically informed physical therapy (PIPT) is one way to effectively and efficiently address the need for non-pharmacological approaches. However, adoption of psychologically informed practice (PiP) by physical therapists has shown mixed results due to implementation challenges. In this perspective, we discuss the current state of PIPT training and implementation. We also propose a conceptual roadmap for future implementation needs related to increasing delivery of PIPT-informed approaches.
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Affiliation(s)
- Lindsay A Ballengee
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Division of Physical Therapy, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Beauchemin M, Weng C, Sung L, Pichon A, Abbott M, Hershman DL, Schnall R. Data Quality of Chemotherapy-Induced Nausea and Vomiting Documentation. Appl Clin Inform 2021; 12:320-328. [PMID: 33882585 PMCID: PMC8060070 DOI: 10.1055/s-0041-1728698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/02/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The objective of the study was to characterize the completeness and concordance of the electronic health record (EHR) documentation of cancer symptoms among multidisciplinary health care professionals. METHODS We examined the EHRs of children, adolescents, and young adults who received highly emetogenic chemotherapy and characterized the completeness and concordance of chemotherapy-induced nausea and vomiting (CINV) documentation by clinician type and by the International Classification of Diseases 10th Revision (ICD-10) coding choice. RESULTS The EHRs of 127 patients, comprising 870 patient notes, were abstracted and reviewed. A CINV assessment was documented by prescribers in 75% of patients, and by nurses in 58% of patients. Of the 60 encounters where both prescribers and nurses documented, 72% agreed on the presence/absence of CINV. CONCLUSION Most patients receiving highly emetogenic chemotherapy had a documented assessment of CINV; however, many had incomplete or discordant documentation of CINV from different providers by role, implying the importance of incorporating pragmatic knowledge of EHR documentation patterns among multidisciplinary health professionals for EHR phenotyping and clinical decision support systems directed toward cancer-related symptom management.
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Affiliation(s)
- Melissa Beauchemin
- School of Nursing, Columbia University, New York, New York, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | | | - Adrienne Pichon
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Maura Abbott
- School of Nursing, Columbia University, New York, New York, United States
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, United States
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Stephens M, Bartley C, Samuriwo R, Stubbs N. Evaluating the impact of the Tissue Viability Seating guidelines. J Tissue Viability 2021; 30:3-8. [PMID: 33390309 DOI: 10.1016/j.jtv.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/21/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Internationally, guidelines are developed to ensure safe, effective, person centred, timely, efficient, and effective practice. However, their use in clinical practice is found to be variable. The Tissue Viability Society (TVS) published updated seating guidelines in 2017, yet, little is known about how these guidelines are being used. METHODS The aim of this evaluation was to gauge the impact of the Tissue Viability Seating Guidelines on clinical practice and policy. A cross-sectional questionnaire was used to elicit the responses from anyone with an interest or role within seating and pressure ulcer prevention and management. The survey was distributed through a variety of methods including email to members of the Tissue Viability Society and social media platforms from September to December 2019. RESULTS and Discussion: There were thirty-nine responses, the bulk of which were from healthcare professionals across primary and secondary care. All but one respondent was from the United Kingdom. Eleven had incorporated the latest TVS seating guidance into policy and sixteen into practice. The results of our survey demonstrates congruence with the literature as the main themes that emerged included incorporating the guidance into everyday clinical practice, education, and training, and as a resource or dissemination tool. Barriers to implementation included being unaware of the guidelines and unaware of one's own professional and collective organisational responsibility to guideline dissemination. However, many respondents were planning to incorporate the guidelines using a variety of methods. CONCLUSION This survey has shown there are some examples of successful implementation of the TVS Seating guidelines. Future TVS guidelines should include implementation strategies, interventions, and goals for local champions to ensure barriers to implementation are both assessed and addressed. Future work could also include a trial of the guidelines within a pilot project.
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Affiliation(s)
- Melanie Stephens
- School of Health and Society, Mary Seacole Building, University of Salford, UK.
| | - Carol Bartley
- Occupational Therapist Rehab for Independence Ltd, Heskin, UK.
| | - Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Cardiff, UK; Wales Centre for Evidence Based Care, Cardiff University, Cardiff, UK.
| | - Nikki Stubbs
- Interim Professional Lead for Nursing and Clinical Project Lead -Integrated Wound Care Project Leeds Community Healthcare NHS Trust, UK.
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