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Udelsman BV, Jang A, Muniappan A, Zhan PL, Bao X, Chen T, Gaissert HA. Perioperative morbidity and 3-year survival in non-intubated thoracoscopic surgery: a propensity matched analysis. J Thorac Dis 2024; 16:1180-1190. [PMID: 38505043 PMCID: PMC10944756 DOI: 10.21037/jtd-23-591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/04/2023] [Indexed: 03/21/2024]
Abstract
Background Non-intubated thoracoscopic surgery with spontaneous breathing is rarely utilized, but may have several advantages over standard intubation, especially in those with significant cardiopulmonary comorbidities. In this study we evaluate the safety, feasibility, and 3-year survival of thoracoscopic surgery without endotracheal intubation for oncologic and non-oncologic indications. Methods All consecutive patients [2018-2022] selected for lung resection or other pleural space intervention under local anesthesia and sedation were compared to a cohort undergoing elective thoracoscopic procedures with endotracheal intubation. A propensity-score matched cohort was used to compare perioperative outcomes and 3-year overall survival. Results A total of 72 patients underwent thoracoscopic surgery without intubation compared to 1,741 who were intubated. Non-intubated procedures included 19 lobectomies (26.4%), 9 segmentectomies (12.5%), 25 wedge resections (34.7%), and 19 pleural or mediastinal resections (26.4%). Non-intubated patients had a lower average body mass index (BMI; 24.6 vs. 27.1 kg/m2, P<0.001) and a higher comorbidity burden. Primary lung cancer was the indication in 30 (41.7%) non-intubated patients. The non-intubated cohort had no operative or 30-day mortality. After propensity-score matching, there was no significant difference in pre-operative factors. In propensity-score matched analysis, non-intubated patients had shorter median total operating room time (109 vs. 159 min, P<0.001) and procedure time (69 vs. 119 min, P<0.001). Peri-operative morbidity was rare and did not differ between intubated and non-intubated patients. There was no significant difference in 3-year survival associated with non-intubation in the propensity-score matched cohorts (95% vs. 89%, P=0.10) or in a Cox proportional hazard model [hazard ratio (HR), 1.15; 95% confidence interval (CI): 0.36-3.67; P=0.81]. Conclusions Non-intubated thoracoscopic surgery is safe and feasible in carefully selected patients for both benign and oncologic indications.
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Affiliation(s)
- Brooks V. Udelsman
- Division of Thoracic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Anna Jang
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Peter L. Zhan
- Division of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Xiaodong Bao
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tongyan Chen
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA, USA
| | - Henning A. Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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2
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Naidoo P, Frawley N, Mol BW. PRISM study-Pre-natal iron deficiency screening and management within an Australian regional centre. Aust J Rural Health 2023. [PMID: 37270709 DOI: 10.1111/ajr.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/05/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Current Australian guidelines differ in their recommendations on optimal iron deficiency anaemia screening and management during pregnancy. A more active approach to screening and treatment of iron deficiency in pregnancy has been beneficial within a tertiary population. However, this approach has not been evaluated within a regional healthcare setting. OBJECTIVE To evaluate the clinical impact of standardised screening and management for iron deficiency in pregnancy within a regional Australian centre. DESIGN Single centre, retrospective cohort observational study that audited medical records pre and post implementation of standardised screening and management for antenatal iron deficiency. We compared rates of anaemia at birth, rates of peripartum blood transfusions and rates of peripartum iron infusions. FINDINGS There were 2773 participants with 1372 participants in the pre-implementation group and 1401 in the post-implementation group. Participant demographics were similar. Anaemia at admission for birth decreased from 35% to 30% (RR 0.87, 95% CI (0.75, 1.00), p 0.043) Fewer blood transfusions were required (16 (1.2%) pre-implementation, 6 (0.4%) post-implementation, RR 0.40, 95% CI(0.16, 0.99), p 0.048). Antenatal iron infusions increased from 12% to 18% of participants post implementation (RR 1.47, 95% CI(1.22, 1.76), p 〈0.001).We audited compliance with the guidelines and found improvements post implementation. DISCUSSION This is the first study to show clinically useful and statistically significant reduction in rates of anaemia and blood transfusions, post implementation of routine ferritin screening and management within a regional Australian population. CONCLUSION The results of this study suggest there is benefit to implementation of standardised ferritin screening and management packages in Australian antenatal care. It also encourages RANZCOG to review current recommendations on screening for iron deficiency anaemia during pregnancy.
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Affiliation(s)
- Prashanth Naidoo
- Department of Obstetrics & Gynaecology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Natasha Frawley
- Department of Obstetrics & Gynaecology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Victoria, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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3
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McLucas M, King J, McGee M. Computed tomography Coronary angiography in rural referral hospitals: A single-Centre experience. Aust J Rural Health 2023. [PMID: 37078575 DOI: 10.1111/ajr.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To describe the first 9 months of a newly established computed tomography coronary angiogram (CTCA) over the period of the COVID-19 pandemic. METHODS A retrospective analysis of the first 9 months of a CT-CA program. DESIGN Data were collected for the period of June 2020 to March 2021. Information reviewed included demographics, risk factors, renal function, technical factors and outcomes including Calcium Score and Coronary Artery Disease Reporting and Data System (CAD-RADS). SETTING A single Rural Referral Hospital in regional New South Wales. PARTICIPANTS Ninety-six CTCAs were reviewed. Ages ranged from 29 to 81 years. 37 (39%) male, 59 (61%) female. 15 (15.6%) identified as Aboriginal and/or Torres Strait Islander. MAIN OBJECTIVE OUTCOMES CTCA is a viable alternative to invasive coronary angiogram in appropriate populations for regional areas. RESULTS Eighty-eight (91.6%) were considered technically satisfactory. Mean heart rate was 57 beats per minute with a range of 108. Cardiovascular risk factors included hypertension, dyslipidemia, smoking status, family history and diabetes mellitus. Of patients with CAD-RADS scores 3 or 4 who underwent subsequent invasive coronary angiogram (ICA), 80% were determined to have operator-defined significant stenosis. Significant cardiac and non-cardiac findings were extensive. CONCLUSIONS CTCA is a safe and efficacious imaging modality for low- to moderate-risk chest pain patients. There was acceptable diagnostic accuracy and the investigation was safe.
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Affiliation(s)
- Michael McLucas
- Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
| | - James King
- Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
| | - Michael McGee
- Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
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4
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Gardiner W, Brown K, Richardson H, Pretorius N, Heales L. The incidence, characteristics and in-hospital mortality of non-ventilator-associated hospital-acquired pneumonia in regional Queensland: A retrospective descriptive study. Aust J Rural Health 2023; 31:138-143. [PMID: 36106699 DOI: 10.1111/ajr.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 08/08/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the incidence, characteristics and in-hospital mortality of non-ventilator-associated hospital-acquired pneumonia (NV-HAP) in a regional (Modified Monash Model 2) Australian hospital. METHODS All cases with NV-HAP were obtained from the Business Analysis and Decision Support (BADS) Unit between 1st January 2013 and 31st December 2018. Medical records were reviewed, and data pertaining to incidence, characteristics (age and gender), length of stay, co-morbidities (measured using the Charlson Comorbidity Index) and in-hospital mortality were extracted. Incidence rate was calculated as a proportion of NV-HAP cases per 1000 bed-days. DESIGN A retrospective study design was used to review all cases of NV-HAP between 1 January 2013 and 31 December 2018 at a single regional Australian hospital. Using the Modified Monash Model (MMM), our regional setting is classified as a regional centre (MMM-2). SETTING Rockhampton Hospital, Australia. PARTICIPANTS Patient cases. MAIN OUTCOME MEASURES Incidence rate, Incidence proportion, mortality. RESULTS A total of 501 cases were identified with an incidence rate of 0.98 cases per 1000 bed-days over the study period 2013-2018. Cases with NV-HAP had a median age of 78.2 years (interquartile range 18.8), a median length of stay of 13.0 days (interquartile range 12.0) and a median Charlson Comorbidity Index score of 3.0 out of 39 (interquartile range 3.0), and a greater proportion was male (n = 297, 57%). The in-hospital mortality rate for NV-HAP cases was 18.9%. CONCLUSION This study revealed an overall incidence rate of 0.98 cases per 1000 bed-days from 2013 to 2018 in a regional Australian hospital. In addition, this study provided the descriptive characteristics for patients with NV-HAP at our regional hospital.
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Affiliation(s)
- Wenonah Gardiner
- Department of Speech Pathology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Kassandra Brown
- Department of Speech Pathology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Heather Richardson
- Aged Care, Clinical and Rehabilitation Services, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Nellie Pretorius
- Oral Health Department, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Luke Heales
- School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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5
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Shaw M, Anderson T, Sinclair T, Hutchings O, Dearing C, Raffan F, Jagers D, Greenfield D. rpavirtual: Key lessons in healthcare organisational resilience in the time of COVID-19. Int J Health Plann Manage 2022; 37:1229-1237. [PMID: 35146799 PMCID: PMC9087491 DOI: 10.1002/hpm.3430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 08/31/2021] [Accepted: 01/15/2022] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic is an unfolding crisis which is continually testing the resilience of healthcare organisations. In this context, a key requirement for executives, managers and frontline staff is continually adapting, learning and coping with complexity under pressure to deliver high quality and safe care. Sydney Local Health District has responded to the COVID-19 crisis, in part, through the pivoting of rpavirtual, a newly established virtual health service, to deliver an innovative model of care in a clinically rigorous and safe manner. Through reviewing the rapid evolution of rpavirtual's purpose, implementation challenges and impact, we investigate how it has displayed resilience and derive key lessons for health organisations.
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Affiliation(s)
- Miranda Shaw
- RPA Virtual Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Teresa Anderson
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Tim Sinclair
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Owen Hutchings
- RPA Virtual Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Cassandra Dearing
- RPA Virtual Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Freya Raffan
- RPA Virtual Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Dianna Jagers
- RPA Virtual Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
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6
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Pollak U, Feinstein Y, Mannarino CN, McBride ME, Mendonca M, Keizman E, Mishaly D, van Leeuwen G, Roeleveld PP, Koers L, Klugman D. The horizon of pediatric cardiac critical care. Front Pediatr 2022; 10:863868. [PMID: 36186624 PMCID: PMC9523119 DOI: 10.3389/fped.2022.863868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Pediatric Cardiac Critical Care (PCCC) is a challenging discipline where decisions require a high degree of preparation and clinical expertise. In the modern era, outcomes of neonates and children with congenital heart defects have dramatically improved, largely by transformative technologies and an expanding collection of pharmacotherapies. Exponential advances in science and technology are occurring at a breathtaking rate, and applying these advances to the PCCC patient is essential to further advancing the science and practice of the field. In this article, we identified and elaborate on seven key elements within the PCCC that will pave the way for the future.
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Affiliation(s)
- Uri Pollak
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Feinstein
- Pediatric Intensive Care Unit, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Candace N Mannarino
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Mary E McBride
- Divisions of Cardiology and Critical Care Medicine, Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Malaika Mendonca
- Pediatric Intensive Care Unit, Children's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Eitan Keizman
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - David Mishaly
- Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
| | - Grace van Leeuwen
- Pediatric Cardiac Intensive Care Unit, Sidra Medicine, Ar-Rayyan, Qatar.,Department of Pediatrics, Weill Cornell Medicine, Ar-Rayyan, Qatar
| | - Peter P Roeleveld
- Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Lena Koers
- Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Darren Klugman
- Pediatrics Cardiac Critical Care Unit, Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins Medicine, Baltimore, MD, United States
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7
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Niu L, Chen M, Chen X, Wu L, Tsai FS. Enterprise Food Fraud in China: Key Factors Identification From Social Co-governance Perspective. Front Public Health 2021; 9:752112. [PMID: 34869168 PMCID: PMC8639508 DOI: 10.3389/fpubh.2021.752112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/22/2021] [Indexed: 11/14/2022] Open
Abstract
Food fraud not only exacerbates human public health risks but also threatens the business development of food and related industries. Therefore, how to curb food fraud effectively becomes a crucial issue for governments, industries, and consumers. Previous studies have demonstrated that enterprise food fraud is subject to joint influences of factor at various hierarchical levels within a complex system of stakeholders. To address enterprise food fraud, it is necessary to identify the key such factors and elucidate the functional mechanisms, as well as systematic analysis of the interrelationships among clusters and factors. Hence, we grounded on a social co-governance perspective and investigated the food fraud key influencing factors and their interrelationships in an emerging food market – China, by using the DEMATEL-based analytic network process (DANP). Results showed that the identified key cluster was government regulation, social governance, and detection techniques. Four other key factors were also identified, including government regulatory capability and penalty intensity, expected economic benefits, maturity of market reputation mechanism, and transparency of supply chain. Policy implications from the social co-governance perspective for China and similar economies are discussed finally.
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Affiliation(s)
- Liangyun Niu
- School of Economics, Anyang Normal University, Anyang, China
| | - Mo Chen
- School of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Xiujuan Chen
- School of Business, Institute for Food Safety Risk Management, Jiangnan University, Wuxi, China
| | - Linhai Wu
- School of Business, Institute for Food Safety Risk Management, Jiangnan University, Wuxi, China
| | - Fu-Sheng Tsai
- Department of Business Administration, Cheng Shiu University, Kaohsiung, Taiwan.,Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung, Taiwan.,Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung, Taiwan
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8
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Xia P, Sintay BJ, Colussi VC, Chuang C, Lo YC, Schofield D, Wells M, Zhou S. Medical Physics Practice Guideline (MPPG) 11.a: Plan and chart review in external beam radiotherapy and brachytherapy. J Appl Clin Med Phys 2021; 22:4-19. [PMID: 34342124 PMCID: PMC8425907 DOI: 10.1002/acm2.13366] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 01/12/2023] Open
Abstract
A therapeutic medical physicist is responsible for reviewing radiation therapy treatment plans and patient charts, including initial treatment plans and new chart review, on treatment chart (weekly) review, and end of treatment chart review for both external beam radiation and brachytherapy. Task group report TG 275 examined this topic using a risk‐based approach to provide a thorough analysis and guidance for best practice. Considering differences in resources and workflows of various clinical practice settings, the Professional Council of the American Association of Physicists in Medicine assembled this task group to develop a practice guideline on the same topic to provide a minimum standard that balances an appropriate level of safety and resource utilization. This medical physics practice guidelines (MPPG) thus provides a concise set of recommendations for medical physicists and other clinical staff regarding the review of treatment plans and patient charts while providing specific recommendations about who to be involved, and when/what to check in the chart review process. The recommendations, particularly those related to the initial plan review process, are critical for preventing errors and ensuring smooth clinical workflow. We believe that an effective review process for high‐risk items should include multiple layers with collective efforts across the department. Therefore, in this report, we make specific recommendations for various roles beyond medical physicists. The recommendations of this MPPG have been reviewed and endorsed by the American Society of Radiologic Technologists and the American Association of Medical Dosimetrists.
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Affiliation(s)
- Ping Xia
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Benjamin J Sintay
- Department of Radiation Oncology, Cone Health, Greensboro, North Carolina, USA
| | - Valdir C Colussi
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Cynthia Chuang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Yeh-Chi Lo
- Department of Radiation Oncology, Mount Sinai Hospital- New York, New York, New York, USA
| | - Deborah Schofield
- Department of Radiation Oncology, AdventHealth Orlando, Orlando, Florida, USA
| | - Michelle Wells
- Department of Radiation Oncology, Piedmont Healthcare, Atlanta, Georgia, USA
| | - Sumin Zhou
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Li L, Childs AW. Using a Patient Safety/Quality Improvement Model to Assess Telehealth for Psychiatry and Behavioral Health Services Among Special Populations During COVID-19 and Beyond. J Psychiatr Pract 2021; 27:245-253. [PMID: 34398574 PMCID: PMC8318385 DOI: 10.1097/pra.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Telehealth has been rapidly deployed in the environment of the Coronavirus 2019 (COVID-19) pandemic to help meet critical mental health needs. As systems of care use telehealth during the pandemic and evaluate the future of telehealth services beyond the crisis, a quality and safety framework may be useful in weighing important considerations for using telehealth to provide psychiatric and behavioral health services within special populations. Examining access to care, privacy, diversity, inclusivity, and sustainability of telehealth to meet behavioral and psychiatric care needs in geriatric and disadvantaged youth populations can help highlight key considerations for health care organizations in an increasingly electronic health care landscape.
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Abstract
OBJECTIVES The challenges of implementing clinical practice changes are well recognised. Prevailing approaches to tackling them have largely relied on increasing control and standardisation, but with limited impact. We examine research from the behavioural sciences in an attempt to (a) build a clearer understanding of why the implementation of change in clinical settings has proved so elusive and (b) provide practical guidance on how organisations can create a climate that can nurture sustained behavioural change in their workforce. METHOD We undertook a review of the behavioural science literature to gain a better understanding of the circumstances under which staff might willingly pursue goals that are externally generated. Three studies, derived from the mental health literature, are outlined to illustrate how the manner in which change is introduced can have a significant effect on its uptake and sustainability. RESULTS Research suggests that human behaviour is not as unpredictable as it might at first appear; rather, there are some deeply rooted, psychological processes at play. Self-Determination Theory, a theory of human motivation with an extensive body of research supporting its effectiveness, suggests that the manner in which change is introduced and implemented is critical. CONCLUSION While improvement methodologies and the use of implementation strategies are necessary, experience would suggest that by themselves they are not sufficient. Overcoming the challenges of implementing change will require a significant shift in our thinking about organisational leadership and the way that change is introduced. Some practical ways leaders can foster staff buy-in for organisational change are proposed.
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Affiliation(s)
- Geoffrey P Smith
- Research and Strategy, Office of the Chief Psychiatrist of Western Australia, East Perth, WA, Australia.,Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Theresa M Williams
- Research and Strategy, Office of the Chief Psychiatrist of Western Australia, East Perth, WA, Australia.,Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
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11
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Bhonagiri D, Lander H, Green M, Straney L, Jones D, Pilcher D. Reduction of in-hospital cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system. Intern Med J 2021; 51:375-384. [PMID: 32133760 DOI: 10.1111/imj.14812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously. AIM To assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation. METHODS This is a prospective observational study of the BTF registry (August 2010 to June 2016) and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with an ICU. The primary outcome studied was the proportion of in-hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to the ICU and changes in the volume of rapid response calls. RESULTS The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality and length of stay for cardiac arrest patients admitted to the ICU (all P < 0.001). CONCLUSIONS The BTF programme was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU.
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Affiliation(s)
- Deepak Bhonagiri
- Liverpool Hospital, Sydney, NSW, Australia
- Campbelltown Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Macquarie University, Sydney, NSW, Australia
- Western Sydney University, Sydney, NSW, Australia
- Simpson Centre for Health Services Research, Sydney, NSW, Australia
| | - Harvey Lander
- Simpson Centre for Health Services Research, Sydney, NSW, Australia
- Clinical Excellence Commission, Sydney, NSW, Australia
- NSW Health, Sydney, New South Wales, Australia
| | - Malcolm Green
- Clinical Excellence Commission, Sydney, NSW, Australia
- NSW Health, Sydney, New South Wales, Australia
| | - Lahn Straney
- Monash University, Melbourne, Vic, Australia
- Australian National University, Melbourne, Vic, Australia
| | - Daryl Jones
- Monash University, Melbourne, Vic, Australia
- Austin Health, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
| | - David Pilcher
- Monash University, Melbourne, Vic, Australia
- Alfred Health, Melbourne, Vic, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Melbourne, Victoria, Australia
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12
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Luo L, Wang B, Jiang J, Fitzgerald M, Huang Q, Yu Z, Li H, Zhang J, Wei J, Yang C, Zhang H, Dong L, Chen S. Heavy Metal Contaminations in Herbal Medicines: Determination, Comprehensive Risk Assessments, and Solutions. Front Pharmacol 2021; 11:595335. [PMID: 33597875 PMCID: PMC7883644 DOI: 10.3389/fphar.2020.595335] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
Heavy metal contamination in herbal medicines is a global threat to human beings especially at levels above known threshold concentrations. The concentrations of five heavy metals cadmium (Cd), lead (Pb), arsenic (As), mercury (Hg) and copper (Cu) were investigated using Inductively Coupled Plasma Optical Mass Spectrometry (ICP-MS) with 1773 samples around the world. According to Chinese Pharmacopoeia, 30.51% (541) samples were detected with at least one over-limit metal. The over-limit ratio for Pb was 5.75% (102), Cd at 4.96% (88), As at 4.17% (74), Hg at 3.78% (67), and of Cu, 1.75% (31). For exposure assessment, Pb, Cd, As, and Hg have resulted in higher than acceptable risks in 25 kinds of herbs. The maximal Estimated Daily Intake of Pb in seven herbs, of Cd in five, of Hg in four, and As in three exceeded their corresponding Provisional Tolerable Daily Intakes. In total 25 kinds of herbs present an unacceptable risk as assessed with the Hazard Quotient or Hazard Index. Additionally, the carcinogenic risks were all under acceptable limits. Notably, As posed the highest risk in all indicators including Estimated Daily Intake, Hazard Index, and carcinogenic risks. Therefore further study on enrichment effect of different states of As and special attention to monitoring shall be placed on As related contamination.
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Affiliation(s)
- Lu Luo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bo Wang
- Hubei Institute for Drug Control, Wuhan, China
| | - Jingwen Jiang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Martin Fitzgerald
- Department of Life Sciences, University of Westminster, London, United Kingdom
| | - Qin Huang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zheng Yu
- College of Medical Information and Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Li
- Institute of Botany, Chinese Academy of Sciences, Beijing, China
| | - Jiqing Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianhe Wei
- Hainan Provincial Key Laboratory of Resources Conservation and Development of Southern Medicine, Hainan Branch of the Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Haikou, China
| | - Chenyuyan Yang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zhang
- Akupunktur Akademiet, Hovedgaard, Denmark
| | - Linlin Dong
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shilin Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
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13
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López-Hernández LB, Díaz BG, Zamora González EO, Montes-Hernández KI, Tlali Díaz SS, Toledo-Lozano CG, Bustamante-Montes LP, Vázquez Cárdenas NA. Quality and Safety in Healthcare for Medical Students: Challenges and the Road Ahead. Healthcare (Basel) 2020; 8:healthcare8040540. [PMID: 33291837 PMCID: PMC7768411 DOI: 10.3390/healthcare8040540] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 01/25/2023] Open
Abstract
Background: The development of skills, behaviors and attitudes regarding patient safety is of utmost importance for promoting safety culture for the next generation of health professionals. This study describes our experience of implementing a course on patient safety and quality improvement for fourth year medical students in Mexico during the COVID-19 outbreak. The course comprised essential knowledge based on the patient safety curriculum provided by the WHO. We also explored perceptions and attitudes of students regarding patient safety. Methods: Fourth year medical students completed a questionnaire regarding knowledge, skills, and attitudes on patient safety and quality improvement in medical care. The questionnaire was voluntarily answered online prior to and after the course. Results: In total, 213 students completed the questionnaires. Most students were able to understand medical error, recognize failure and the nature of causation, perform root-cause analysis, and appreciate the role of patient safety interventions. Conversely, a disapproving perspective prevailed among students concerning the preventability of medical errors, utility of reporting systems, just culture and infrastructure (p < 0.05). Conclusion: We found students had a positive perspective concerning learning quality in healthcare and patient safety during our course; nevertheless, their perception of the usefulness of reporting systems to prevent future adverse events and prevent medical errors is uncomplimentary. Medical education should promote error reporting and just culture to change the current perception of medical students.
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Affiliation(s)
- Luz Berenice López-Hernández
- Departamento de Calidad y Seguridad en la Atención Médica, Ciclo de vida, Universidad Autónoma de Guadalajara, Jalisco 45134, Mexico; (K.I.M.-H.); (S.S.T.D.); (L.P.B.-M.); (N.A.V.C.)
- Correspondence:
| | | | | | - Karen Itzel Montes-Hernández
- Departamento de Calidad y Seguridad en la Atención Médica, Ciclo de vida, Universidad Autónoma de Guadalajara, Jalisco 45134, Mexico; (K.I.M.-H.); (S.S.T.D.); (L.P.B.-M.); (N.A.V.C.)
| | - Stephanie Simone Tlali Díaz
- Departamento de Calidad y Seguridad en la Atención Médica, Ciclo de vida, Universidad Autónoma de Guadalajara, Jalisco 45134, Mexico; (K.I.M.-H.); (S.S.T.D.); (L.P.B.-M.); (N.A.V.C.)
| | | | - Lilia Patricia Bustamante-Montes
- Departamento de Calidad y Seguridad en la Atención Médica, Ciclo de vida, Universidad Autónoma de Guadalajara, Jalisco 45134, Mexico; (K.I.M.-H.); (S.S.T.D.); (L.P.B.-M.); (N.A.V.C.)
| | - Norma Alejandra Vázquez Cárdenas
- Departamento de Calidad y Seguridad en la Atención Médica, Ciclo de vida, Universidad Autónoma de Guadalajara, Jalisco 45134, Mexico; (K.I.M.-H.); (S.S.T.D.); (L.P.B.-M.); (N.A.V.C.)
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14
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Silva A, Silva SA, Lourenço-Lopes C, Jimenez-Lopez C, Carpena M, Gullón P, Fraga-Corral M, Domingues VF, Barroso MF, Simal-Gandara J, Prieto MA. Antibacterial Use of Macroalgae Compounds against Foodborne Pathogens. Antibiotics (Basel) 2020; 9:E712. [PMID: 33080894 PMCID: PMC7603221 DOI: 10.3390/antibiotics9100712] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/18/2022] Open
Abstract
The search for food resources is a constant in human history. Nowadays, the search for natural and safe food supplies is of foremost importance. Accordingly, there is a renewed interest in eco-friendly and natural products for substitution of synthetic additives. In addition, microbial contamination of food products during their obtaining and distribution processes is still a sanitary issue, and an important target for the food industry is to avoid food contamination and its related foodborne illnesses. These diseases are fundamentally caused by certain microorganisms listed in this review and classified according to their Gram negative or positive character. Algae have proven to possess high nutritional value and a wide variety of biological properties due to their content in active compounds. Among these capabilities, macroalgae are recognized for having antimicrobial properties. Thus, the present paper revises the actual knowledge of microbial contaminants in the food industry and proposes antimicrobial algal compounds against those pathogenic bacteria responsible for food contamination as valuable molecules for its growth inhibition. The capacity of algae extracts to inhibit some major food pathogen growth was assessed. Moreover, the main applications of these compounds in the food industry were discussed while considering their favorable effects in terms of food safety and quality control.
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Affiliation(s)
- Aurora Silva
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
- REQUIMTE/LAQV, Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida 431, 4200-072 Porto, Portugal; (V.F.D.); (M.F.B.)
| | - Sofia A. Silva
- Departamento de Química, Universidade de Aveiro, 3810-168 Aveiro, Portugal;
| | - C. Lourenço-Lopes
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
| | - C. Jimenez-Lopez
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Campus de Santa Apolonia, 5300-253 Bragança, Portugal
| | - M. Carpena
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
| | - P. Gullón
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
| | - M. Fraga-Corral
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Campus de Santa Apolonia, 5300-253 Bragança, Portugal
| | - V. F. Domingues
- REQUIMTE/LAQV, Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida 431, 4200-072 Porto, Portugal; (V.F.D.); (M.F.B.)
| | - M. Fátima Barroso
- REQUIMTE/LAQV, Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida 431, 4200-072 Porto, Portugal; (V.F.D.); (M.F.B.)
| | - J. Simal-Gandara
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
| | - M. A. Prieto
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, Ourense Campus, University of Vigo, E32004 Ourense, Spain; (A.S.); (C.L.-L.); (C.J.-L.); (M.C.); (P.G.); (M.F.-C.)
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15
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Overgaard-Steensen C, Poorisrisak P, Heiring C, Schmidt LS, Voldby A, Høi-Hansen C, Langkilde A, Sterns RH. Fatal case of hospital-acquired hypernatraemia in a neonate: lessons learned from a tragic error. Clin Kidney J 2020; 14:1277-1283. [PMID: 33841873 PMCID: PMC8023185 DOI: 10.1093/ckj/sfaa108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Indexed: 11/28/2022] Open
Abstract
A 3-week-old boy with viral gastroenteritis was by error given 200 mL 1 mmol/mL hypertonic saline intravenously instead of isotonic saline. His plasma sodium concentration (PNa) increased from 136 to 206 mmol/L. Extreme brain shrinkage and universal hypoperfusion despite arterial hypertension resulted. Treatment with glucose infusion induced severe hyperglycaemia. Acute haemodialysis decreased the PNa to 160 mmol/L with an episode of hypoperfusion. The infant developed intractable seizures, severe brain injury on magnetic resonance imaging and died. The most important lesson is to avoid recurrence of this tragic error. The case is unique because a known amount of sodium was given intravenously to a well-monitored infant. Therefore the findings give us valuable data on the effect of fluid shifts on the PNa, the circulation and the brain’s response to salt intoxication and the role of dialysis in managing it. The acute salt intoxication increased PNa to a level predicted by the Edelman equation with no evidence of osmotic inactivation of sodium. Treatment with glucose in water caused severe hypervolaemia and hyperglycaemia; the resulting increase in urine volume exacerbated hypernatraemia despite the high urine sodium concentration, because electrolyte-free water clearance was positive. When applying dialysis, caution regarding circulatory instability is imperative and a treatment algorithm is proposed.
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Affiliation(s)
| | - Porntiva Poorisrisak
- Department of Neonatology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christian Heiring
- Department of Neonatology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lisbeth Samsø Schmidt
- Department of Pediatrics, Herlev Hospital, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Anders Voldby
- Department of Pediatrics, Herlev Hospital, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christina Høi-Hansen
- Department of Pediatrics, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Annika Langkilde
- Department of Radiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Richard H Sterns
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,Rochester General Hospital, Rochester, NY, USA
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16
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Havers SM, Kate Martin E, Wilson A, Hall L. A systematic review and meta-synthesis of policy intervention characteristics that influence the implementation of government-directed policy in the hospital setting: implications for infection prevention and control. J Infect Prev 2020; 21:84-96. [PMID: 32494292 DOI: 10.1177/1757177420907696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/02/2020] [Indexed: 01/26/2023] Open
Abstract
Background Government-directed policy plays an important role in the regulation and supervision of healthcare quality. Effective implementation of these policies has the potential to significantly improve clinical practice and patient outcomes, including the prevention of healthcare-associated infections. A systematic review of research describing the implementation of government-directed policy in the hospital setting was performed with the aim to identify policy intervention characteristics that influence implementation. Methods A systematic search of four electronic databases was undertaken to identify eligible articles published between 2007 and 2017. Studies were included if published in the English language and described the implementation of government-directed policy in a high-income country hospital setting. Data on policy and implementation were extracted for each article and interpretive syntheses performed. Results A total of 925 articles were retrieved and titles and abstracts reviewed, with 69 articles included after review of abstract and full text. Qualitative synthesis of implementation data showed three overarching themes related to intervention characteristics associated with implementation: clarity; infrastructure; and alignment. Conclusion Better understanding and consideration of policy intervention characteristics during development and planning will facilitate more effective implementation although research describing implementation of government-directed policy in the hospital setting is limited and of variable quality. The findings of this study provide guidance to staff tasked with the development or implementation of government-directed policy in the hospital setting, infection prevention and control professionals seeking to maximise the impact of policy on practice and improve patient outcomes.
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Affiliation(s)
- Sally M Havers
- Queensland University of Technology Faculty of Health, Kelvin Grove, QLD, Australia
| | | | | | - Lisa Hall
- University of Queensland, Brisbane, QLD, Australia
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17
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McLean A, Gardner M, Perrin B. PodCast: A rural and regional service model for podiatrist-led total contact casting. Aust J Rural Health 2019; 27:433-437. [PMID: 31512329 DOI: 10.1111/ajr.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Diabetes-related foot disease causes significant health system costs and is a leading cause of morbidity and disproportionately affects rural populations. Total contact casts or instant total contact casts are gold standard for management of foot ulcerations resulting from diabetes-related foot disease. The aim of this study was to evaluate the impact of a podiatrist-led casting service model within a rural and regional setting. DESIGN The implementation of the service model was evaluated over a 12-month period using a quality improvement approach, informed by multiple methods. Quantitative and qualitative methods were used. SETTING An outpatient high-risk foot clinic and community-based podiatry services within a large regional health service. The location was central Victoria, servicing rural communities within the Loddon Mallee region. KEY MEASURES FOR IMPROVEMENT Patient-related data included information relating to demographics, diabetes and foot pathologies. Service-related data included occasions of service, locations and the number and type of casts applied. STRATEGIES FOR CHANGE Upskilling podiatrists to provide the service in a safe, supportive and sustainable manner and ensuring the podiatrist-led casting service model was sufficiently adaptable for patients to access at the rural sites. EFFECTS OF CHANGE Increased access to total contact casts and instant total contact casts, comparable wound healing times to other studies and the model was able to be sustained. LESSONS LEARNT Podiatrist-led casting resulted in increased utilisation of total contact casts and instant total contact casts. The increased use of instant total contact casts in particular may help address the lack of uptake of this treatment for people with diabetes-related foot disease, thereby improving rural health outcomes.
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Affiliation(s)
- Adam McLean
- Bendigo Health, Bendigo, Victoria, Australia
| | | | - Byron Perrin
- La Trobe Rural Health School, Bendigo, Victoria, Australia
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18
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Heslop L. Activity-based funding for safety and quality: A policy discussion of issues and directions for nursing-focused health services outcomes research. Int J Nurs Pract 2019; 25:e12775. [PMID: 31414554 PMCID: PMC9285712 DOI: 10.1111/ijn.12775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 06/25/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022]
Abstract
Aims A discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing‐focused health services outcomes research directed to improve the safety and quality of health care practices. Background National activity‐based funding in Australia is a policy‐focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research. Design Discussion paper Data Sources This paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee—the Clinical Advisory Committee of the Independent Hospital Pricing Authority—and is supported by relevant literature and theory. Implications for Nursing To date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity‐based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital‐acquired complications, and preventable readmissions. What is already known about this topic?
The advancement of research directed towards finding causal associations attributing nursing interventions to patient outcomes has been constrained by, amongst other things, methodological challenges The attribution of nursing care interventions to specific patient‐related outcomes is difficult to isolate Investigating how nursing care interventions contribute to safety and quality health care outcomes is often referred to as the “black box” of nursing‐focused health services outcomes research
What this paper adds?
Research into the impact of nursing interventions on patient outcomes, such as hospital‐acquired complications, remains immature Activity‐based funding data provide safety and quality measures relevant to nursing‐focused health services outcomes research Building clinical‐decision support, based on the Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures, may assist nurses engage with quality improvement as nurses are likely to act on data relevant to their practice
The implications of this paper:
The Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures have enhanced data specifications, useful to support development of nursing‐focused health services outcomes research The potential for benchmarking of hospital‐acquired complications is high at least in Australia and in other countries that apply activity‐based funding models linked to ICD‐10‐AM codes
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Affiliation(s)
- Liza Heslop
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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19
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Yang TWW, Islam MR. Quality of acute stroke care in a regional Victorian hospital, Australia. Aust J Rural Health 2019; 27:153-157. [PMID: 30945784 DOI: 10.1111/ajr.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The quality of acute stroke care in a regional Victorian hospital (study hospital) was assessed by comparing with selected standard indicators of Acute Stroke Clinical Care. DESIGN A retrospective review of records of patients with stroke was performed manually and by reviewing electronic database. SETTING The study was carried out in Goulburn Valley Health, one of the five regional referral and teaching hospitals in Victoria, Australia. PARTICIPANTS Patients with stroke who were discharged from the study hospital between October 2015 and March 2016. MAIN OUTCOME MEASURES Timeliness of brain imaging, proportion of patients thrombolysed if arrived within 4.5 hours of stroke and timeliness of thrombolysis. RESULTS A total of 66 patients' records was found. Brain imaging was completed for 45%, compared to 25.8% nationally, if arrived to the study hospital within 1 hour of stroke and 100% imaging completed within 24 hours of arrival, compared to 75.6% nationally. When patients arrived to the emergency department within 4.5 hours of stroke, 37.5% (23.6% nationally and 18.6% in similar- sized hospitals) of them were thrombolysed, while none was thrombolysed within 60 minutes of arrival. Door-to-thrombolysis time was 85 minutes, 7 minutes longer than national standard. Symptoms onset to thrombolysis time was 225 minutes, 55 minutes longer than national standard. CONCLUSION The timeliness of brain imaging and thrombolysis was comparable in the study hospital to that of the national standard, while other stroke management indicators still require improvement. Continuing efforts for improvement and revisiting possible areas of delay are warranted.
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Affiliation(s)
| | - Md Rafiqul Islam
- Goulburn Valley Health, Shepparton, Victoria, Australia.,Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia.,School of Health and Social Development, Deakin University, Burwood, Victoria, Australia.,Rumbalara Aboriginal Cooperative Limited, Shepparton, Victoria, Australia
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20
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Shepheard J. Ethical leadership and why health information management professionals need to be involved. Commentary on Health information is central to changes in healthcare: a clinician's view (Hoyle, 2019). Health Inf Manag 2018; 48:52-55. [PMID: 30295100 DOI: 10.1177/1833358318802955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Philip Hoyle presents a compelling argument for the significant and highly valued role that the management of health information plays in the Australian healthcare system and the delivery of health services in this country. However, he also brings to our attention the ill-defined nature of the ethical oversight of this very information. Hoyle uses words such as "honesty," "commitment to beneficence," "commitment to equity" and "respect for variation" when describing the characteristics of ethical leadership. He singles out health information management professionals - Health Information Managers (HIMs) and Clinical Coders (CCs) - as the key professional group who need to step up and seize the initiative, get conversations going, form partnerships, do research and publish findings, so the knowledge and insights that the health information management profession has the potential to offer are not only more widely known and understood but also more useful to others working in the healthcare arena. Hoyle calls on health information management professionals to step out from behind the scenes and take responsibility for the ethical use of the information they help produce. Hoyle's words resonated powerfully with me, particularly with respect to the clinical coding workforce in Australia, which is made up of trained CCs and qualified HIMs. In a truly ethical environment, HIMs and CCs would not be asked to meet performance indicators for increased funding metrics or to change codes to avoid triggering certain indicators; they would simply be asked to ensure complete, accurate coding for every episode of care. This is what ethical leadership would look like. I am concerned about our clinical coding workforce. I am now asking, are our CCs and HIMs up to the task of taking back absolute and unchallenged ownership of their particular skill set, which makes them the keepers of the clinical coding standards and the experts in accurate and complete code assignment?
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21
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Abstract
OBJECTIVE To analyse rural patients' and their families' experiences of open disclosure and offer recommendations to improve disclosure in rural areas. DESIGN Retrospective qualitative study based on a subset of 13 semistructured, in-depth interviews with rural patients from a larger dataset. The larger data set form a nationwide, multisite, retrospective-qualitative study that included 100 semistructured, in-depth interviews with 119 patients and family members who were involved in high-severity health care incidents and incident disclosure. The larger study is known as the '100 Patient Stories' study. Interviews were transcribed verbatim and analysed by one analyst (D.P.) for recurrent experiences and concerns. SETTING Acute care. PARTICIPANTS A sub-set of 13 of the 100 participants from the '100 Patient Stories' study who identified as experiencing an adverse incident in a rural or regional area. MAIN OUTCOME MEASURES Patients' and family members' perceptions and experiences of health care incident disclosure, as expressed in interviews. RESULTS Rural patients and clinicians experience additional challenges to metropolitan patients and clinicians in their experiences of health care incidents. These additional barriers include: a lack of resources at small hospitals; delays in diagnosis and transfer; distance between services; and a lack of communication between providers. These challenges impact not only upon how patients and their families experience incidents, but also how open disclosure is implemented. CONCLUSIONS This analysis of 13 of the 100 Patient Stories interviews provides guidance to rural health services on how to conduct open disclosure.
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Affiliation(s)
- Donella Piper
- School of Health, University of New England, Armidale, New South Wales, Australia
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22
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Abstract
OBJECTIVE Current management of hospitalised patients with community-acquired pneumonia (CAP) in an Australian regional hospital in accordance with the recommended guidelines is unknown. The prescription rate of inappropriate antibiotic therapy was measured and analysed. DESIGN A retrospective audit, December 2012 to November 2013. SETTING Regional Australian hospital in North East Victoria. INTERVENTIONS Interventions were the average of inpatient and intensive care unit length of stay, time to first antibiotic and to first chest X-ray, days of intravenous antibiotics, and extra intravenous therapy; proportion of intensive care unit admissions, average time to first antibiotic administration, patients with failed outpatient management of CAP, initial microbiological investigations, positive investigations, predominant microbiology, antibiotic choice, and concordance with guidelines; proportion of justifiable deviation from guidelines, ratio of patients switched to oral therapy appropriately, complications during therapy, clinical failure, inpatient mortality, mortality at 30 days, mortality at 6 months, and readmission with CAP in 30 days and in 3 months. MAIN OUTCOME MEASURES To improve the rates of concordance with guidelines by following a specified method to rate severity of CAP, to clearly document reasons for non-concordance with guidelines, and to rationalise investigations. RESULTS To improve antibiotic stewardship in the management of CAP. CONCLUSION In an Australian regional hospital, ceftriaxone and azithromycin were the predominant combination used at 56%, demonstrating that mild CAP was frequently overtreated. Mild CAP was eight times more likely to be treated as severe CAP (odds ratio = 8.2 (95% confidence interval, 1.7-40.3) P < 0.009). There is a need for a simple yet effective strategy to be introduced to rationalise treatment and investigation of CAP in this setting.
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Affiliation(s)
- Mohamad-Ali Trad
- Department of Infectious Diseases, Monash Health, Melbourne.,Northeast Health, Wangaratta, Victoria, Australia
| | - Andreas Baisch
- Northeast Health, Wangaratta, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Wangaratta, Victoria, Australia
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23
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Ayala-Zavala JF, Rosas-Domínguez C, Vega-Vega V, González-Aguilar GA. Antioxidant enrichment and antimicrobial protection of fresh-cut fruits using their own byproducts: looking for integral exploitation. J Food Sci 2010; 75:R175-81. [PMID: 21535513 PMCID: PMC3032914 DOI: 10.1111/j.1750-3841.2010.01792.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/15/2010] [Indexed: 12/17/2022]
Abstract
Fresh-cut fruit consumption is increasing due to the rising public demand for convenience and awareness of fresh-cut fruit's health benefits. The entire tissue of fruits and vegetables is rich in bioactive compounds, such as phenolic compounds, carotenoids, and vitamins. The fresh-cut fruit industry deals with the perishable character of its products and the large percentage of byproducts, such as peels, seeds, and unused flesh that are generated by different steps of the industrial process. In most cases, the wasted byproducts can present similar or even higher contents of antioxidant and antimicrobial compounds than the final produce can. In this context, this hypothesis article finds that the antioxidant enrichment and antimicrobial protection of fresh-cut fruits, provided by the fruit's own byproducts, could be possible.
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Affiliation(s)
- JF Ayala-Zavala
- Authors are with Centro de Investigación en Alimentación y Desarrollo, A.C. (CIAD, AC)Carretera a la Victoria Km 0.6, La Victoria. Hermosillo, Sonora (83000) Mexico. Direct inquiries to author Ayala-Zavala (E-mail: )
| | - C Rosas-Domínguez
- Authors are with Centro de Investigación en Alimentación y Desarrollo, A.C. (CIAD, AC)Carretera a la Victoria Km 0.6, La Victoria. Hermosillo, Sonora (83000) Mexico. Direct inquiries to author Ayala-Zavala (E-mail: )
| | - V Vega-Vega
- Authors are with Centro de Investigación en Alimentación y Desarrollo, A.C. (CIAD, AC)Carretera a la Victoria Km 0.6, La Victoria. Hermosillo, Sonora (83000) Mexico. Direct inquiries to author Ayala-Zavala (E-mail: )
| | - GA González-Aguilar
- Authors are with Centro de Investigación en Alimentación y Desarrollo, A.C. (CIAD, AC)Carretera a la Victoria Km 0.6, La Victoria. Hermosillo, Sonora (83000) Mexico. Direct inquiries to author Ayala-Zavala (E-mail: )
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