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Destoop J, Vanhaecke C, Bani-Sadr F, Plenier Y, Viguier MA, Hentzien M. Significantly reduced duration of antibiotic prescription for erysipelas subsequent to the 2019 French guidelines on skin and soft tissue infection: A before-after study. Infect Dis Now 2024; 54:104887. [PMID: 38492802 DOI: 10.1016/j.idnow.2024.104887] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND New skin and soft tissue infections (SSTI) guidelines were published in 2019 in France, changing the recommended duration for antibiotic treatment. The objective of the present study was to assess the impact of the publication of the 2019 French guidelines on SSTIs on the duration of antibiotic prescription for erysipelas. METHODS In a before-after study (a year before and a year after April 1st, 2019), we included all adult patients diagnosed with erysipelas in Reims University Hospital medical wards and the emergency department. We retrospectively retrieved antibiotic prescription duration in the patients' medical files. RESULTS Among 50 patients in the "before" and 39 in the "after" group, the mean duration of antibiotic prescription was significantly shorter in the "after" group (9.4 ± 2.8 vs. 12.4 ± 3.8 days, p = 0.0001). CONCLUSIONS A 25% decrease in the duration of antibiotic prescription for erysipelas was observed following the implementation of these guidelines, providing useful information for an antibiotic stewardship policy.
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Affiliation(s)
- Justin Destoop
- Department of Dermatology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France.
| | - Clélia Vanhaecke
- Department of Dermatology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France
| | - Yannick Plenier
- Pediatric Emergency Department, American Memorial Hospital, 47 Rue Cognacq-Jay, 51100 Reims, France
| | - Manuelle-Anne Viguier
- Department of Dermatology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France
| | - Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France; University of Reims Champagne-Ardenne, Reims, France
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Yunus RA, Saeed S, Levy N, Di Fenza R, Sharkey A, Pobywajlo S, Liang P, Schermerhorn M, Mahmood F, Matyal R, Neves S. A Multidisciplinary Protocolized Approach for Ruptured Abdominal Aortic Aneurysm Management: A Retrospective Before-After Study. J Cardiothorac Vasc Anesth 2024; 38:755-770. [PMID: 38220517 DOI: 10.1053/j.jvca.2023.12.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES To investigate whether implementation of a multidisciplinary protocol for ruptured abdominal aortic aneurysm (rAAA) management reduces rates of adverse complications. DESIGN A retrospective before-after study. SETTING A tertiary-care academic hospital. PARTICIPANTS Adult patients who underwent open or endovascular rAAA repair; data were stratified into before-protocol implementation (group 1: 2015-2018) and after-protocol implementation (group 2: 2019-2022) groups. INTERVENTION The protocol details the workflow for vascular surgery, anesthesia, emergency department, and operating room staff for a rAAA case; training was accomplished through yearly workshops. MEASUREMENTS AND MAIN RESULTS The primary outcome was in-hospital mortality. Secondary outcomes included all-cause morbidity and other major complications. Differences in postoperative complication rates between groups were assessed using Pearson's χ2 test. Of the 77 patients included undergoing rAAA repair, 41 (53.2%) patients were in group 1, and 36 (46.8%) patients were in group 2. Patients in group 2 had a significantly shorter median time to incision (1.0 v 0.7 hours, p = 0.022) and total procedure time (180.0 v 160.5 minutes, p = 0.039) for both endovascular and open repair. After protocol implementation, patients undergoing endovascular repair exhibited significantly lower rates of mortality (46.2% v 20.0%, p = 0.048), all-cause morbidity (65.4% v 44.0%, p = 0.050), and renal complications (15.4% v 0.0%, p = 0.036); patients undergoing open repair for a rAAA exhibited significantly lower rates of mortality (53.3% v 27.3%, p = 0.018) and bowel ischemia (26.7% v 0.0%, p = 0.035). CONCLUSIONS Implementation of a multidisciplinary protocol for the management of a rAAA may reduce rates of adverse complications and improve the quality of care.
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Affiliation(s)
- Rayaan A Yunus
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shirin Saeed
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nadav Levy
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Raffaele Di Fenza
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Pobywajlo
- The CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - Patric Liang
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Marc Schermerhorn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Sara Neves
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
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Wefer F, Möhler R, Dichter MN, Mühring A, Gummert J, Köpke S. Nurse-based counselling on thirst in patients with advanced chronic heart failure : Study protocol for a pilot before-after study and process evaluation. Med Klin Intensivmed Notfmed 2024; 119:147-153. [PMID: 38097772 PMCID: PMC10902023 DOI: 10.1007/s00063-023-01091-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Many patients with chronic heart failure (CHF) are critically ill and experience increased thirst. Study aims are to develop and evaluate a nurse-based counselling intervention to promote self-care competencies related to thirst in hospitalised patients with advanced CHF eligible or listed for heart transplantation. METHODS A mixed-methods approach will be adapted with three study phases: (1) development of the nurse-based counselling intervention, (2) feasibility testing and training of nurses, and (3) implementation of the intervention and, evaluation of initial effects and process measures. In phase (1), interviews with hospitalised patients with advanced CHF listed for heart transplantation (n = 10), focus groups (n = 2) and a Germany-wide survey with nurses will be performed. In phase (2), experts experienced with caring for patients with advanced CHF and patients with advanced CHF will be consulted for content validation and pretest of the counselling intervention. The training concept for nurses will be evaluated using questionnaires. In phase (3), a pilot before-after study will be conducted (n = 60). Primary patient-related outcome for the pilot study is thirst intensity using a numeric rating scale. Furthermore, a process evaluation (interviews with patients [n = 10], survey with nurses and physicians) will be performed. Quantitative data will be analysed descriptively, and qualitative data will be analysed using content analysis. Mean values of thirst intensity of the individual measurement points will be evaluated as interrupted time-series analysis using regression analyses. CONCLUSION The development and implementation of a counselling intervention is influenced by various factors. Therefore, it is important to consider all factors throughout the process from development to evaluation.
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Affiliation(s)
- Franziska Wefer
- Care Development, Care Directorate, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany, Georgstr.11, 32545.
- Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Martin N Dichter
- Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Andrea Mühring
- Transplantation unit, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
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Liew JES, Chong Cheng Y, Tai NL, Pereira A, Manivannan V, Khoo SL, Wong WK, Lim HK, Ong SJ, Khairudin NBM, Lee KSF, Loh BCC, Chong KL, Lee YL. A before-after study to evaluate the effect of pharmacy workflow redesign to improve pharmacy waiting time and reduce medication near misses in Malaysia. Int J Pharm Pract 2024; 32:83-90. [PMID: 38289996 DOI: 10.1093/ijpp/riad083] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/22/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness of workflow redesign (eaST system) on pharmacy waiting time and near-missed events. We also investigated other factors that may potentially affect these study outcomes. METHODS A quasi-experimental (before-after) study design was adopted. Pre-intervention data were collected over 7 months (January-July 2017). Subsequently, the workflow redesign (eaST system) was implemented and the effect of the intervention (August 2017-February 2018) was evaluated. Univariate analysis was used to compare the differences between pre-intervention and post-intervention of pharmacy waiting time and near-missed events. Significant factors affecting study outcomes were analysed using linear regression analysis. KEY FINDINGS A total of 210,530 prescriptions were analysed. The eaST system significantly increases the percentage of prescriptions dispensed within 30 min per day (median = 68 (interquartile range (IQR) = 41) vs. median = 93 (IQR = 33), P < 0.001) and reduced the mean percentage of near-missed events (mean = 50.71 (standard deviation (SD) = 23.95) vs. mean = 27.87 (SD = 12.23), P < 0.001). However, the eaST system's effects on related outcomes were conditional on a three-way interaction effect. The eaST system's effects on pharmacy waiting time were influenced by the number of prescriptions received and the number of PhIS server disruptions. Conversely, the eaST system's effects on near-missed events were influenced by the number of pharmacy personnel and number of controlled medications. CONCLUSIONS Overall, the eaST system improved the pharmacy waiting time and reduced near-missed events.
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Affiliation(s)
- Jerry Ee Siung Liew
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Yew Chong Cheng
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Nyet Ling Tai
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Angeline Pereira
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Vinoth Manivannan
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Siok Luan Khoo
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Woei Kheen Wong
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Huey Kuen Lim
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Shi Jing Ong
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Nadia Bin Mohd Khairudin
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Kristine Sheh Fuen Lee
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Benjamin Chuan Ching Loh
- Pharmacy Department, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Kai Loon Chong
- Clinical Research Centre, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Yee Leng Lee
- Clinical Research Centre, Queen Elizabeth Hospital, Locked bag: 2029, 88586, Kota Kinabalu, Sabah, Malaysia
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Moradinejad M, Harrell RE, Mousavi SM, Alavi M, Basseri AD, Feiz A, Daryanavard H, Rakhshan V. Effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face: a preliminary retrospective before-after clinical trial. BMC Oral Health 2024; 24:234. [PMID: 38350970 PMCID: PMC10865655 DOI: 10.1186/s12903-024-03972-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Despite the popularity of clear aligners, their predictability has not been assessed adequately. Moreover, no study has investigated their effects on numerous dentomaxillary variables. Therefore, this study was conducted for the first time, assessing several new or controversial items. The aim of the study was to evaluate the effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face. METHODS This preliminary retrospective before-after non-randomized clinical trial was performed on 168 observations of 84 patients (33.60±9.28 years, 54 females) treated with 0.75mm Invisalign appliances. Pretreatment and posttreatment values were measured for: mandibular plane angle, occlusal plane angle, Y-Axis, ANB, facial angle, lower anterior facial height, overbite, and the distances of the molars from the palate and mandibular plane were measured. The alterations in parameters caused by treatment (delta values) were calculated for each measurement. Effects of treatment and some parameters on delta values were analyzed statistically (α=0.05). RESULTS Mean±SD of ΔMP-FH, ΔOP-FH, ΔY-Axis, ΔLAFH, ΔNPog-FH, ΔANB, ΔOverbite, ΔSNB, Δ6-PP, Δ7-PP, Δ6-MP, and Δ7-MP were respectively 0.11±1.61, 0.80±1.56, 0.15±1.18, 0.07±0.91, -0.22±1.25, 0.03±0.62, 0.04±1.15, -0.06±1.14, -0.36±0.94, -0.32±1.14, 0.19±0.96, 0.18±1.10. Only the alterations in OP-FH, 6-PP, and 7-PP were significant (P≤0.011). Age, sex, treatment duration, or pretreatment mandibular plane angle were not correlated with any delta values. However, the pretreatment occlusal plane angle was negatively correlated with ΔOP-FH and ΔY-Axis. Crowding was correlated negatively with ΔOP-FH and ΔY-Axis and positively with ΔNPog-FH. Overjet was negatively correlated with ΔANB and ΔOverbite (P≤0.035). CONCLUSIONS Invisalign intruded first/second maxillary molars and increased the occlusal plane angle. Age, sex, and treatment duration were not correlated with post-treatment anatomic alterations.
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Affiliation(s)
- Mehrnaz Moradinejad
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Sayed Mohammad Mousavi
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Georgia School of Orthodontics, Atlanta, GA, 30350, USA
| | - Minoo Alavi
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Darvish Basseri
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arman Feiz
- Oral and Maxillofacial Radiology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hanie Daryanavard
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Vahid Rakhshan
- Formerly, Department of Anatomy, Dental School, Azad University of Medical Sciences, Tehran, Iran
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Crealey GE, Hickey G, McGilloway S. A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme. BMC Health Serv Res 2024; 24:176. [PMID: 38331766 PMCID: PMC10851506 DOI: 10.1186/s12913-023-10492-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/18/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND This study assessed whether a relatively newly developed Parent and Infant (PIN) parenting support programme was cost-effective when compared to services as usual (SAU). METHODS The cost-effectiveness of the PIN programme versus SAU was assessed from an Irish health and social care perspective over a 24-month timeframe and within the context of a non-randomised, controlled before-and-after trial. In total, 163 parent-infant dyads were included in the study (86 intervention, 77 control). The primary outcome measure for the economic evaluation was the Parenting Sense of Competence Scale (PSOC). RESULTS The average cost of the PIN programme was €647 per dyad. The mean (SE) cost (including programme costs) was €7,027 (SE €1,345) compared to €4,811 (SE €593) in the control arm, generating a (non-significant) mean cost difference of €2,216 (bootstrap 95% CI -€665 to €5,096; p = 0.14). The mean incremental cost-effectiveness of the PIN service was €614 per PSOC unit gained (bootstrap 95% CI €54 to €1,481). The probability that the PIN programme was cost-effective, was 87% at a willingness-to-pay of €1,000 per one unit change in the PSOC. CONCLUSIONS Our findings suggest that the PIN programme was cost-effective at a relatively low willingness-to-pay threshold when compared to SAU. This study addresses a significant knowledge gap in the field of early intervention by providing important real world evidence on the implementation costs and cost-effectiveness of a universal early years parenting programme. The challenges involved in assessing the cost-effectiveness of preventative interventions for very young children and their parents are also discussed. TRIAL REGISTRATION ISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.
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Affiliation(s)
| | - Gráinne Hickey
- Barnardos Ireland, Christchurch Sq., Dublin 8, Dublin, D08DT63, Ireland
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, W23 F2H6, Co. Kildare, Ireland
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, W23 F2H6, Co. Kildare, Ireland.
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González Del Castillo J, Mirò E, Miguens I, Trenc P, Espinosa B, Piedrafita L, Pérez Elías MJ, Moreno S, García F, Villamor A, Carbó M, Gené E, Mirò Ò. Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study. Eur J Emerg Med 2024; 31:29-38. [PMID: 37729041 DOI: 10.1097/mej.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND AND IMPORTANCE The rates of hidden infection and late diagnosis of HIV still remain high in Western countries. Missed diagnostic opportunities represent the key point in changing the course of the epidemic. OBJECTIVE To evaluate the feasibility and results of implementation of a selective strategy to test for HIV in the emergency department (ED) in patients with six pre-defined medical situations: sexually transmitted infections, herpes zoster, community-acquired pneumonia, mononucleosis syndrome, practice of chemsex (CS) or request of post-exposure prophylaxis. DESIGN This quasi-experimental longitudinal study evaluated the pre- and post-implementation results of HIV testing in the six aforementioned clinical scenarios. SETTINGS AND PARTICIPANTS Patients attended 34 Spanish EDs. INTERVENTION OR EXPOSURE The intervention was an intensive educational program and pathways to facilitate and track orders and results were designed. We collected and compared pre- and post-implementation ED census and diagnoses, and HIV tests requested and results. OUTCOME MEASURES AND ANALYSIS The main outcome was adherence to the recommendations. Secondary outcomes were to evaluate the effectiveness of the program by the rate of positive test and the new HIV diagnoses. Differences between first and second periods were assessed. The magnitude of changes (absolute and relative) was expressed with the 95% confidence interval (CI). MAIN RESULTS HIV tests increasing from 7080 (0.42% of ED visits) to 13 436 (relative increase of 75%, 95% CI from 70 to 80%). The six conditions were diagnosed in 15 879 and 16 618 patients, and HIV testing was ordered in 3393 (21%) and 7002 (42%) patients (increase: 97%; 95% CI: 90-104%). HIV testing significantly increased for all conditions except for CS. The positive HIV test rates increased from 0.92 to 1.67%. Detection of persons with undiagnosed HIV increased from 65 to 224, which implied a 220% (95% CI: 143-322%) increase of HIV diagnosis among all ED comers and a 71% (95% CI: 30-125%) increase of positive HIV tests. CONCLUSION Implementation of a strategy to test for HIV in selective clinical situations in the ED is feasible and may lead to a substantial increase in HIV testing and diagnoses.
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Affiliation(s)
- Juan González Del Castillo
- Emergency Department, Instituto de Investigación Sanitaria (IdISSC), Hospital Clínico San Carlos, Madrid
| | | | - Iria Miguens
- Emergency Department, Hospital Universitario Gregorio Marañon, Madrid
| | - Patricia Trenc
- Emergency Department, Hospital Universitario Miguel Servet, Zaragoza
| | - Begoña Espinosa
- Emergency Department, Hospital General Universitario de Alicante Dr. Blamis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante
| | | | - María Jesús Pérez Elías
- Servicio de Enfermedades Infecciosas. Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERINFECC, Madrid
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas. Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERINFECC, Madrid
| | - Federico García
- Servicio de Microbiología Clínica. Hospital Universitario Clínico San Cecilio, Granada
| | | | - Míriam Carbó
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona
| | - Emili Gené
- Servicio de Urgencias, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Òscar Mirò
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona
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Lewis SR, McGarrigle L, Pritchard MW, Bosco A, Yang Y, Gluchowski A, Sremanakova J, Boulton ER, Gittins M, Spinks A, Rapp K, MacIntyre DE, McClure RJ, Todd C. Population-based interventions for preventing falls and fall-related injuries in older people. Cochrane Database Syst Rev 2024; 1:CD013789. [PMID: 38180112 PMCID: PMC10767771 DOI: 10.1002/14651858.cd013789.pub2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Around one-third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population-level interventions may be facilitated by different healthcare, social care, and community-level agencies. They aim to tackle the determinants that lead to risk of falling in older people, and include components such as community-wide polices for vitamin D supplementation for older adults, reducing fall hazards in the community or people's homes, or providing public health information or implementation of public health programmes that reduce fall risk (e.g. low-cost or free gym membership for older adults to encourage increased physical activity). OBJECTIVES To review and synthesise the current evidence on the effects of population-based interventions for preventing falls and fall-related injuries in older people. We defined population-based interventions as community-wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in December 2020, and conducted a top-up search of CENTRAL, MEDLINE, and Embase in January 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, trials with stepped-wedge designs, and controlled non-randomised studies evaluating population-level interventions for preventing falls and fall-related injuries in adults ≥ 60 years of age. Population-based interventions target entire communities. We excluded studies only targeting people at high risk of falling or with specific comorbidities, or residents living in institutionalised settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and used GRADE to assess the certainty of the evidence. We prioritised seven outcomes: rate of falls, number of fallers, number of people experiencing one or more fall-related injuries, number of people experiencing one or more fall-related fracture, number of people requiring hospital admission for one or more falls, adverse events, and economic analysis of interventions. Other outcomes of interest were: number of people experiencing one or more falls requiring medical attention, health-related quality of life, fall-related mortality, and concerns about falling. MAIN RESULTS We included nine studies: two cluster RCTs and seven non-randomised trials (of which five were controlled before-and-after studies (CBAs), and two were controlled interrupted time series (CITS)). The numbers of older adults in intervention and control regions ranged from 1200 to 137,000 older residents in seven studies. The other two studies reported only total population size rather than numbers of older adults (67,300 and 172,500 residents). Most studies used hospital record systems to collect outcome data, but three only used questionnaire data in a random sample of residents; one study used both methods of data collection. The studies lasted between 14 months and eight years. We used Prevention of Falls Network Europe (ProFaNE) taxonomy to classify the types of interventions. All studies evaluated multicomponent falls prevention interventions. One study (n = 4542) also included a medication and nutrition intervention. We did not pool data owing to lack of consistency in study designs. Medication or nutrition Older people in the intervention area were offered free-of-charge daily supplements of calcium carbonate and vitamin D3. Although female residents exposed to this falls prevention programme had fewer fall-related hospital admissions (with no evidence of a difference for male residents) compared to a control area, we were unsure of this finding because the certainty of evidence was very low. This cluster RCT included high and unclear risks of bias in several domains, and we could not determine levels of imprecision in the effect estimate reported by study authors. Because this evidence is of very low certainty, we have not included quantitative results here. This study reported none of our other review outcomes. Multicomponent interventions Types of interventions included components of exercise, environment modification (home; community; public spaces), staff training, and knowledge and education. Studies included some or all of these components in their programme design. The effectiveness of multicomponent falls prevention interventions for all reported outcomes is uncertain. The two cluster RCTs included high or unclear risk of bias, and we had no reasons to upgrade the certainty of evidence from the non-randomised trial designs (which started as low-certainty evidence). We also noted possible imprecision in some effect estimates and inconsistent findings between studies. Given the very low-certainty evidence for all outcomes, we have not reported quantitative findings here. One cluster RCT reported lower rates of falls in the intervention area than the control area, with fewer people in the intervention area having one or more falls and fall-related injuries, but with little or no difference in the number of people having one or more fall-related fractures. In another cluster RCT (a multi-arm study), study authors reported no evidence of a difference in the number of female or male residents with falls leading to hospital admission after either a multicomponent intervention ("environmental and health programme") or a combination of this programme and the calcium and vitamin D3 programme (above). One CBA reported no difference in rate of falls between intervention and control group areas, and another CBA reported no difference in rate of falls inside or outside the home. Two CBAs found no evidence of a difference in the number of fallers, and another CBA found no evidence of a difference in fall-related injuries. One CITS found no evidence of a difference in the number of people having one or more fall-related fractures. No studies reported adverse events. AUTHORS' CONCLUSIONS Given the very low-certainty evidence, we are unsure whether population-based multicomponent or nutrition and medication interventions are effective at reducing falls and fall-related injuries in older adults. Methodologically robust cluster RCTs with sufficiently large communities and numbers of clusters are needed. Establishing a rate of sampling for population-based studies would help in determining the size of communities to include. Interventions should be described in detail to allow investigation of effectiveness of individual components of multicomponent interventions; using the ProFaNE taxonomy for this would improve consistency between studies.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lisa McGarrigle
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Michael W Pritchard
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alessandro Bosco
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Yang Yang
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Ashley Gluchowski
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- School of Health & Society, University of Salford, Salford, UK
| | - Jana Sremanakova
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Elisabeth R Boulton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew Gittins
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Anneliese Spinks
- School of Population Health, University of Queensland, Queensland, Australia
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | | | - Chris Todd
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
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Leenen JPL, Ardesch V, Kalkman CJ, Schoonhoven L, Patijn GA. Impact of wearable wireless continuous vital sign monitoring in abdominal surgical patients: before-after study. BJS Open 2024; 8:zrad128. [PMID: 38235573 PMCID: PMC10794900 DOI: 10.1093/bjsopen/zrad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Technological advances have enabled continuous monitoring of vital signs (CMVS) by wearable, wireless devices on general hospital wards to facilitate early detection of clinical deterioration, which could potentially improve clinical outcomes. However, evidence on the impact of these CMVS systems on patient outcomes is limited. This research aimed to explore the effect of CMVS on the clinical outcomes in major abdominal surgery patients in a general surgery ward. METHODS A single-centre before-after study was conducted from October 2019 to June 2022. Patients in the intervention group received CMVS in addition to conventional intermittent vital sign monitoring (standard care for control group). With CMVS, heart rate and respiratory rate were measured every 5 min by a patch sensor. Proactive vital signs trends assessments and, when necessary, subsequent nursing activities were performed every nursing shift. The primary outcome of interest was the length of hospital stay (LOS); also, 12 patient-related outcomes were analysed. In the CMVS group, follow-up nursing activities of deviating vital signs trends were described and patient acceptability was measured. Post-hoc subgroup analysis was performed for colorectal and hepatopancreatobiliary surgery. RESULTS A total of 908 patients were included (colorectal: n = 650; hepatopancreatobiliary: n = 257). Overall, median LOS was lower in the CMVS group (5.0 versus 5.5 days; P = 0.012), respectively. Post-hoc subgroup analysis showed this reduction in LOS was mostly observed in the colorectal group and not in the hepatopancreatobiliary group. Apart from a decrease in nurse-to-house-officer calls (from 15.3% to 7.7%; P = 0.007), all secondary clinical outcomes were similar in CMVS and control groups. However, a non-significant trend towards less-severe complications and reduced ICU LOS was observed in the CMVS group. In CMVS patients, 109 additional nursing activities were performed and 83% of patients indicated CMVS was acceptable. CONCLUSION CMVS was associated with a significant reduction in LOS, while other clinical outcomes were unchanged. CMVS triggered additional nursing activities such as extra patient assessments and therapeutic interventions.
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Affiliation(s)
- Jobbe P L Leenen
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Centre, Isala, Zwolle, The Netherlands
- Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Vera Ardesch
- Flex pool department, Isala, Zwolle, The Netherlands
| | - Cor J Kalkman
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Gijs A Patijn
- Department of Surgery, Isala, Zwolle, The Netherlands
- Connected Care Centre, Isala, Zwolle, The Netherlands
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10
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Schwartz N, Smith BT, Fu SH, Myran D, Friesen EL, Hobin E. The Impacts of Selling Alcohol in Grocery Stores in Ontario, Canada: A Before-After Study. J Stud Alcohol Drugs 2024; 85:109-119. [PMID: 37650840 DOI: 10.15288/jsad.23-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE From 2015 to 2019, the Government of Ontario expanded privatized sales of alcohol, licensing 450 grocery stores to sell beer, cider, and wine. The impacts of a nearby grocery store gaining an alcohol license on adults' alcohol use in Ontario are examined, including whether impacts differed by gender. METHOD Data from 2015-2019 Canadian Community Health Survey participants in Ontario (age ≥ 20 years), living within 1,000 m and 1,500 m of grocery stores that gained a license to sell alcohol and propensity-matched controls were included (1,000 m n = 14,052, 1,500 m n = 30,486). Alcohol use outcomes included past-7-day number of standard drinks consumed, near-daily drinking (≥4 days/week), and heavy drinking (5+ drinks in men/4+ in women, at least once/month). Gender-specific difference-in-differences (DiD) analyses compared changes in alcohol use before and after intervention in intervention and control populations. RESULTS Decreases in past-7-day drinks, near-daily drinking, and heavy drinking were observed after intervention in both intervention and control populations. At the 1,000 m level, adjusted DiD analyses showed past-7-day drinking in women (risk ratio = 1.21, 95% CI [0.88, 1.60]) and heavy drinking in men (odds ratio = 1.38, 95% CI [0.92, 2.08]) had effect sizes above 1, a relative increase over controls, although confidence intervals crossed 1. Findings did not indicate significant differences in alcohol use in intervention relative to controls for other alcohol use measures and at 1,500 m. CONCLUSIONS Findings suggest no association between a partial alcohol deregulation initiative in Ontario and alcohol use from 2015 to 2019. It is important to monitor the impacts on alcohol use over time as further alcohol deregulation plans in Ontario and other jurisdictions are considered.
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Affiliation(s)
| | - Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sze Hang Fu
- Public Health Ontario, Toronto, Ontario, Canada
| | - Daniel Myran
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Erik Loewen Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
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11
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Marjanovic N, Autin M, Violeau M, Mimoz O, Guenezan J. Telemedicine for the management of patients calling an Emergency Medical Communication Center for dyspnea: a before-after study. Eur J Emerg Med 2023; 30:445-447. [PMID: 37883239 DOI: 10.1097/mej.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Nicolas Marjanovic
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
| | - Mathieu Autin
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
| | - Mathieu Violeau
- Emergency Department and Prehospital Care, General Hospital of Niort, Niort, France
| | - Olivier Mimoz
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
| | - Jérémy Guenezan
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
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12
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Boussat B, Gaillet M, Fournier J, Guyomard A, François P, Shankland R. Effects of a healthcare students' prevention intervention for school children on their own substance use: a before-after study. BMC Med Educ 2023; 23:841. [PMID: 37936175 PMCID: PMC10631018 DOI: 10.1186/s12909-023-04813-0] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Cognitive dissonance theory and research has suggested that engaging in prevention interventions for other students may be a means of reducing one's own problematic behaviors in order to reduce potential cognitive dissonance. This study assessed the effects of a new mandatory prevention intervention program for healthcare students in France. The aim was to measure the effects of engaging in a prevention program in schools on the usual increase in substance use in student populations. METHODS Healthcare students were trained in a French university to develop psychosocial competences as a health promotion means (FEPS training) or more specifically to prevent substance use in teenagers (Unplugged program training). The students (n = 314) who accepted to take part in the study from both groups completed questionnaires before their interventions in schools, and at the end of the year, measuring their representations and behaviors regarding psychoactive substances. RESULTS The results indicated a significant reduction in alcohol consumption in terms of quantity, but no significant reduction in tobacco and marijuana consumption. CONCLUSIONS This study showed that, contrary to the usual increase in substance use in students as they advance in their year, the students who took part in this study showed reduced self-reported consumption of alcohol after they had performed the prevention intervention in schools regardless of the type of training they had received (general health promotion vs. specific substance use prevention program). Limitations and future perspectives are discussed.
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Affiliation(s)
- Bastien Boussat
- Service d'épidémiologie Et Évaluation Médicale, CHU Grenoble-Alpes, Boulevard de La Chantourne, 38700, La Tronche, France.
- Laboratoire TIMC-IMAG, UMR 5525 CNRS, Université Grenoble Alpes, Grenoble, France.
| | - Mélanie Gaillet
- Service d'épidémiologie Et Évaluation Médicale, CHU Grenoble-Alpes, Boulevard de La Chantourne, 38700, La Tronche, France
- Laboratoire TIMC-IMAG, UMR 5525 CNRS, Université Grenoble Alpes, Grenoble, France
| | - Joey Fournier
- Service d'épidémiologie Et Évaluation Médicale, CHU Grenoble-Alpes, Boulevard de La Chantourne, 38700, La Tronche, France
- Laboratoire TIMC-IMAG, UMR 5525 CNRS, Université Grenoble Alpes, Grenoble, France
| | - Alizé Guyomard
- Service d'épidémiologie Et Évaluation Médicale, CHU Grenoble-Alpes, Boulevard de La Chantourne, 38700, La Tronche, France
| | - Patrice François
- Service d'épidémiologie Et Évaluation Médicale, CHU Grenoble-Alpes, Boulevard de La Chantourne, 38700, La Tronche, France
- Laboratoire TIMC-IMAG, UMR 5525 CNRS, Université Grenoble Alpes, Grenoble, France
| | - Rebecca Shankland
- Laboratoire DIPHE, Université Lumière Lyon 2, Lyon, France
- Institut Universitaire de France, Paris, France
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13
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Hermann M, Holt MD, Kjome RLS, Teigen A. Medication reconciliation -is it possible to speed up without compromising quality? A before-after study in the emergency department. Eur J Hosp Pharm 2023; 30:310-315. [PMID: 35086802 PMCID: PMC10647851 DOI: 10.1136/ejhpharm-2021-003071] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/03/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether it was possible to decrease the time used for medication reconciliation (MR) in the emergency department without compromising quality. A more efficient method will enable more patients to receive MR as early as possible after admission to hospital. METHODS Potential key factors for improvement of the standard method of MR by clinical pharmacists were identified through an observational period. A revised method was developed, focusing on decreasing time spent on the patient interview by use of a condensed checklist and probing questions based on information from a prescription database. Non-inferior quality (proportion of patients with at least one identified medication discrepancy and number of identified medication discrepancies per patient) of the revised method was evaluated using a before-after study design with 200 individuals in each group. Non-inferiority limit was set at 10%. The Mann-Whitney U test was used for statistical evaluation of the difference in time use per patient in the MR process between the before and after group. RESULTS Mean age of the included patients was 78 years in both groups. The time used for MR in the after group was 34% shorter (37 min vs 56 min, p<0.0001) compared with the before group. The revised method was shown to be non-inferior compared with the original method with respect to the proportion of patients with at least one identified discrepancy (81%, 95% CI 76% to 86% vs 79%, 95% CI 73% to 84%). Also, non-inferiority was shown for the number of identified discrepancies per patient, where the average number of discrepancies per patient was 1.9 (95% CI 1.7 to 2.1) in both groups. CONCLUSION This study showed that it was possible to speed up the MR process without compromising its effectiveness in identifying medication discrepancies.
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Affiliation(s)
- Monica Hermann
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences - Stord Campus, Stord, Norway
| | - Markus Dreetz Holt
- Western Norway Hospital Pharmacy in Stavanger, Stavanger, Rogaland, Norway
- Stavanger University Hospital, Stavanger, Norway
- Centre for Pharmacy, University of Bergen, Bergen, Norway
| | - Reidun L S Kjome
- Centre for Pharmacy, University of Bergen, Bergen, Norway
- Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Arna Teigen
- Western Norway Hospital Pharmacy in Stavanger, Stavanger, Rogaland, Norway
- Stavanger University Hospital, Stavanger, Norway
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Ben Natan O, Stein M, Reisfeld S. Audit and feedback as a tool to increase compliance with carbapenemase-producing Enterobacteriaceae (CPE) screening and decrease CPE transmission in the hospital. Infect Control Hosp Epidemiol 2023; 44:1788-1792. [PMID: 36081188 PMCID: PMC10665877 DOI: 10.1017/ice.2022.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/29/2022] [Accepted: 08/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To increase compliance with carbapenemase-producing Enterobacteriaceae (CPE) screening through real-time audit and feedback in our hospital and decrease CPE transmissions. DESIGN A before-and-after trial, using active enhanced surveillance of CPE carriers. SETTING A 500-bed, secondary, university-affiliated hospital that serves a population of 450,000 in a northern district in Israel. METHODS The study was conducted during 2016-2019 and included patients who were admitted to the hospital and fulfilled CPE screening criteria upon admission and during prolonged hospitalizations. On January 1, 2017, the infection control team implemented a new strategy of real-time feedback toward compliance with in-hospital screening guidelines. Other infection control measurements were performed without interventions. The primary outcome was compliance with appropriate CPE screening. Secondary outcomes included CPE acquisition and compliance with hand hygiene and contact precaution practices. Data were analyzed to calculate differences between compliance with CPE screening during the study period and to test the correlation between contact precautions and hand hygiene practices according to compliance with CPE screening. RESULTS During the study period, 3,131 patients were eligible for CPE screening. We detected a statistically significant increase in compliance to CPE screening from 74% during 2017 to 92% in 2018 and 95% in 2019 (P < .0001 for both comparisons). We detected a decrease in CPE transmission from 12% in 2017 to 2% in 2019 (P < .0001). We did not find any correlation between other infection control interventions and CPE screening and acquisition. CONCLUSION Audit and feedback can improve appropriate CPE screening and may reduce CPE transmission in the hospital.
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Affiliation(s)
- Orna Ben Natan
- Infectious Diseases and Infection Control Units, Hillel Yaffe Medical Center, Hadera, Israel
| | - Michal Stein
- Pediatric Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Reisfeld
- Infectious Diseases and Infection Control Units, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Ulvin OE, Skjærseth EÅ, Krüger AJ, Thorsen K, Nordseth T, Haugland H. Can video communication in the emergency medical communication centre improve dispatch precision? A before-after study in Norwegian helicopter emergency medical services. BMJ Open 2023; 13:e077395. [PMID: 37899141 PMCID: PMC10618992 DOI: 10.1136/bmjopen-2023-077395] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Dispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres (EMCC) could provide additional information for EMCC operators and HEMS physicians when assessing the need for HEMS dispatch. The aim of this study was to evaluate the impact from VC in the EMCC on HEMS dispatch precision. DESIGN An observational before-after study. SETTING The regional EMCC and one HEMS base in Mid-Norway. PARTICIPANTS EMCC operators and HEMS physicians at the EMCC and HEMS base in Trondheim, Norway. INTERVENTION In January 2022, VC became available in emergency calls in Trondheim EMCC. Data were collected from 2020 2021 (pre-intervention) and 2022 (post-intervention). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of seriously ill or injured HEMS patients, defined as a National Advisory Committee for Aeronautics (NACA) score between 4 and 7. The secondary outcome was the proportion of inappropriate dispatches, defined as missions with neither provision of additional competence nor any logistical contribution based on quality indicators for physician-staffed emergency medical services. RESULTS 811 and 402 HEMS missions with patient contact were included in the pre- and post-intervention group, respectively. The proportion of missions with NACA 4-7 was not significantly changed after the intervention (OR 1.21, 95% CI 0.92 to 1.61, p=0.17). There was no significant change in HEMS alarm times between the pre- and post-intervention groups (7.6 min vs 6.4 min, p=0.15). The proportion of missions with neither medical nor logistical benefit was significantly lower in the post-intervention group (28.4% vs 40.3%, p=0.007). CONCLUSION The results from this study indicate that VC is a promising, feasible and safe tool for EMCC operators in the complex HEMS dispatch process.
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Affiliation(s)
- Ole Erik Ulvin
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
| | - Andreas J Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
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Agnetti J, Büchler AC, Osthoff M, Helfenstein F, Weisser M, Siegemund M, Bassetti S, Bingisser R, Schaefer DJ, Clauss M, Hinic V, Tschudin-Sutter S, Bättig V, Khanna N, Egli A. Identification of microorganisms by a rapid PCR panel from positive blood cultures leads to faster optimal antimicrobial therapy - a before-after study. BMC Infect Dis 2023; 23:730. [PMID: 37884860 PMCID: PMC10601314 DOI: 10.1186/s12879-023-08732-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) detects microorganisms with high accuracy in positive blood cultures (BC) - a key step in the management of patients with suspected bacteraemia. We aimed to compare the time to optimal antimicrobial therapy (OAT) for the BF-FA-BCIP vs. standard culture-based identification. METHODS In this retrospective single-centre study with a before-after design, 386 positive BC cases with identification by BF-FA-BCIP were compared to 414 controls with culture-based identification. The primary endpoint was the time from BC sampling to OAT. Secondary endpoints were time to effective therapy, length of stay, (re-)admission to ICU, in-hospital and 30-day mortality. Outcomes were assessed using Cox proportional hazard models and logistic regressions. RESULTS Baseline characteristics of included adult inpatients were comparable. Main sources of bacteraemia were urinary tract and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7%, for cases and controls, respectively). Median (95%CI) time to OAT was 25.5 (21.0-31.2) hours with BF-FA-BCIP compared to 45.7 (37.7-51.4) hours with culture-based identification. We observed no significant difference for secondary outcomes. CONCLUSIONS Rapid microorganism identification by BF-FA-BCIP was associated with a median 20-h earlier initiation of OAT in patients with positive BC. No impact on length of stay and mortality was noted. TRIAL REGISTRATION Clinicaltrials.gov, NCT04156633, registered on November 5, 2019.
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Affiliation(s)
- Jessica Agnetti
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Andrea C Büchler
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Internal Medicine, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Fabrice Helfenstein
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Maja Weisser
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Plastic, Reconstructive, Aesthetic Surgery and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland
- Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Present Address: Institute for Medical Microbiology, University of Zurich, Gloriastrasse 28/30, CH-8006, Zurich, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Veronika Bättig
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Nina Khanna
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland.
- Present Address: Institute for Medical Microbiology, University of Zurich, Gloriastrasse 28/30, CH-8006, Zurich, Switzerland.
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Bouland C, Ngoa JJE, Nebo J, Djiele JFN. Impact of filtering face pieces (FFP3) respiratory protective mask usage on the respiratory functions of informal sector carpenters in Douala: a five-month before-after study. Pan Afr Med J 2023; 46:52. [PMID: 38223874 PMCID: PMC10787136 DOI: 10.11604/pamj.2023.46.52.41225] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction informal sector carpenters in Douala, Cameroon, face potential risks to their respiratory health due to daily exposure to fine particles and wood dust. The study aims to demonstrate the importance of preventing respiratory problems in this population through regular use of filtering face pieces (FFP3) respiratory masks. Methods the before-after study involved 37 carpenters who wore FFP3 masks during their professional activities for five months. Spirometry measurements were taken before and after the intervention to assess changes in respiratory function. Results significant improvements were observed in forced vital capacity (FVC) 89.6 % to 95.0 % (p<0.000), forced expiratory volume in one second (FEV1) 88.1 % to 95.0 % (p<0.000), Tiffeneau index 82.4 to 84.9 (p<0.000), and peak expiratory flow (PEF) 6.7 l/s to 7.9 l/s (p<0.000) after mask usage, indicating enhanced lung function. Conclusion the regular use of FFP3 masks had a positive impact on the respiratory health of informal sector carpenters in Douala, enhancing lung function and reducing airway obstruction. The study highlights the importance of preventive measures to safeguard the respiratory well-being of workers exposed to occupational hazards. Spell out Greek characters (i.e: alpha, beta).
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Affiliation(s)
- Catherine Bouland
- Center for Research in Environmental and Occupational Health, Environmental Health University of Brussels, School of Public Health, Route de Lennik, Brussels, Belgium
| | | | - Jules Nebo
- Cameroonian Society of General Practitioners, Yaounde, Cameroon
| | - Joseph Francis Nde Djiele
- Center for Research in Environmental and Occupational Health, Environmental Health University of Brussels, School of Public Health, Route de Lennik, Brussels, Belgium
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Lee H, Kim J, Joo S, Na SH, Lee S, Ko SB, Lee J, Oh SY, Ha EJ, Ryu HG. The effect of audiovisual feedback of monitor/defibrillators on percentage of appropriate compression depth and rate during cardiopulmonary resuscitation. BMC Anesthesiol 2023; 23:334. [PMID: 37798642 PMCID: PMC10552289 DOI: 10.1186/s12871-023-02304-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND High quality cardiopulmonary resuscitation (CPR) is one of the key elements of the survival chain in cardiac arrest. Audiovisual feedback of chest compressions have been suggested to be beneficial by increasing the quality of CPR in the simulated cardiac arrests. METHODS A prospective before and after study was performed to investigate the effect of a real-time audiovisual feedback system on CPR quality during in-hospital cardiac arrest in intensive care units from November 2018 to February 2022. In the feedback period, CPR was performed with the aid of the real-time audiovisual feedback system. The primary outcome was the percentage of compressions with both adequate depth (5.0-6.0 cm) and rate (100-120/minute). RESULTS A total of 27,295 compressions in 30 cardiac arrests in the no-feedback period and 27,965 compressions in 30 arrests in the feedback period were analyzed. The percentage of compressions with both adequate depth and rate was 11.8% in the feedback period and 16.8% in the no-feedback period (P < 0.01). The percentage of compressions with adequate rate in the feedback period was lower than that in the no-feedback period (67.3% vs. 75.5%, P < 0.01). The percentage of beyond-target depth with the feedback was significantly higher than that without feedback (64.2% vs. 51.4%, P < 0.01). CONCLUSION Real-time audiovisual feedback system did not increase CPR quality and was associated with a higher percentage of compression depth deeper than the recommended 5.0-6.0 cm. It is essential to explore more effective ways of implementing feedback in real clinical settings to improve of the quality of CPR. TRIAL REGISTRATION NCT03902873 (study start: Nov. 2018, initial release April 2019, retrospectively registered).
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Affiliation(s)
- Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-Ro 101, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jay Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Somin Joo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-Ro 101, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Sang-Hoon Na
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sangmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Young Oh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Eun Jin Ha
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-Ro 101, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Bergese S, Fox B, García-Allende N, Elisiri ME, Schneider AE, Ruiz J, Gonzalez-Fraga S, Rodriguez V, Fernandez-Canigia L. Impact of the multiplex molecular FilmArray Respiratory Panel on antibiotic prescription and clinical management of immunocompromised adults with suspected acute respiratory tract infections: A retrospective before-after study. Rev Argent Microbiol 2023; 55:337-344. [PMID: 37127474 DOI: 10.1016/j.ram.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/09/2022] [Revised: 12/17/2022] [Accepted: 03/27/2023] [Indexed: 05/03/2023] Open
Abstract
This study aimed to assess the impact of the implementation of a rapid multiplex molecular FilmArray Respiratory Panel (FRP) on the medical management of immunocompromised patients from a community general hospital. We conducted a single-center, retrospective, and before-after study. Two periods were evaluated: before the implementation of the FRP (pre-FRP) from April 2017 to May 2018 and after the implementation of the FRP (post-FRP) from January to July 2019. The inclusion criteria were immunocompromised patients over 18 years of age with suspected acute respiratory illness tested by conventional diagnostic methods (pre-FRP) or the FilmArray™ Respiratory Panel v1.7 (post-FRP). A total of 142 patients were included, 64 patients in the pre-FRP and 78 patients in the post-FRP. The positive detection rate was significantly higher in the post-FRP (63% vs. 10%, p<0.01). There were more patients receiving antimicrobial treatment in the pre-FRP compared with the post-FRP period (94% vs. 68%, p<0.01). A decrease in beta-lactam (89% vs. 61%, p<0.01) and macrolide (44% vs. 13%, p<0.01) prescriptions were observed in the post-FRP. No differences were observed in oseltamivir use (22% vs. 13%, p=0.14), changes in antimicrobial treatment, hospital admission rate, days-reduction in droplet isolation precautions, hospital length of stay (LOS), admission to intensive care unit (ICU), LOS in ICU, treatment failure and 30-day mortality. The implementation of the FRP impacted patient care by improving diagnostic yield and optimizing antimicrobial treatment in immunocompromised adult patients.
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Affiliation(s)
- Silvina Bergese
- Sector de Microbiología, Laboratorio Central Hospital Alemán, Ciudad de Buenos Aires, Argentina.
| | - Bárbara Fox
- Sector de Microbiología, Laboratorio Central Hospital Alemán, Ciudad de Buenos Aires, Argentina
| | - Natalia García-Allende
- Servicio de Infectología y Epidemiología Hospitalaria, Hospital Alemán, Ciudad de Buenos Aires, Argentina
| | - María Elisa Elisiri
- Sector de Microbiología, Laboratorio Central Hospital Alemán, Ciudad de Buenos Aires, Argentina
| | - Ana Elizabeth Schneider
- Sector de Microbiología, Laboratorio Central Hospital Alemán, Ciudad de Buenos Aires, Argentina
| | - Juan Ruiz
- Servicio de Clínica Médica, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina
| | - Sol Gonzalez-Fraga
- Sector de Microbiología, Laboratorio Central Hospital Alemán, Ciudad de Buenos Aires, Argentina
| | - Viviana Rodriguez
- Servicio de Infectología y Epidemiología Hospitalaria, Hospital Alemán, Ciudad de Buenos Aires, Argentina
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van de Pol I, Roescher N, Rigter S, Noordzij PG. Prolonged use of intravenous administration sets on central line associated bloodstream infection, nursing workload and material use: A before-after study. Intensive Crit Care Nurs 2023; 78:103446. [PMID: 37210225 DOI: 10.1016/j.iccn.2023.103446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/19/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES One of the interventions to reduce risk of central line associated bloodstream infection (CLABSI) is routine replacement of the intravenous administration sets. Guidelines advises a time interval that ranges between four and seven days. However many hospitals replace intravenous administration sets every four days to prevent CLABSI. RESEARCH METHODOLOGY In this single centre retrospective study we analysed whether the extension of the time interval from four to seven days for routine replacement of intravenous administration sets had impact on the incidence of CLABSI and colonization of the central venous catheter. Secondary outcomes were the effects on nursing workload, material use and costs. RESULTS In total, 1,409 patients with 1,679 central lines were included. During the pre-intervention period 2.8 CLABSI cases per 1,000 catheter days were found in comparison with 1.3 CLABSI cases per 1,000 catheter days during the post-intervention period. The rate difference between the groups was 1.52 CLABSI cases per 1,000 catheter days (95% CI: -0.50 to +4.13, p = 0.138). The intervention resulted in a saving of 345 intravenous single use plastic administration sets and 260 hours nursing time, and reduced cost with an estimate of at least 17.250 Euros. CONCLUSION Extension of the time interval from four to seven days for routine replacement of intravenous administration sets did not negatively affect the incidence of CLABSI. IMPLICATIONS FOR CLINICAL PRACTICE Additional benefits of the prolonged time interval were saving of nursing time by avoiding unnecessary routine procedures, the reducing of waste because of reducing the use of disposable materials and healthcare costs.
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Affiliation(s)
- Ineke van de Pol
- Intensive Care Unit, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Nienke Roescher
- Department of Clinical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sander Rigter
- Departments of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Peter G Noordzij
- Departments of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Anesthesiology and Intensive Care, UMC Utrecht, The Netherlands
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Mfinanga S, Kanyama C, Kouanfack C, Nyirenda S, Kivuyo SL, Boyer-Chammard T, Phiri S, Ngoma J, Shimwela M, Nkungu D, Fomete LN, Simbauranga R, Chawinga C, Ngakam N, Heller T, Lontsi SS, Aghakishiyeva E, Jalava K, Fuller S, Reid AM, Rajasingham R, Lawrence DS, Hosseinipour MC, Beaumont E, Bradley J, Jaffar S, Lortholary O, Harrison T, Molloy SF, Sturny-Leclère A, Loyse A. Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study. Lancet HIV 2023; 10:e663-e673. [PMID: 37802567 DOI: 10.1016/s2352-3018(23)00182-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 07/19/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. METHODS DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. FINDINGS From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference -23%, 95% CI -33 to -13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (-13%, -24 to -3; p=0·01). INTERPRETATION DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. FUNDING European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS For the French and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sayoki Mfinanga
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Cecilia Kanyama
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | - Sokoine Lesikari Kivuyo
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - Timothée Boyer-Chammard
- Unité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, Centre National de la Recherche Scientifique, Paris, France
| | | | | | | | | | | | - Rehema Simbauranga
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - Chimwemwe Chawinga
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | | | - Elnara Aghakishiyeva
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Sebastian Fuller
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Anne-Marie Reid
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | | | - David S Lawrence
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mina C Hosseinipour
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Emma Beaumont
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - John Bradley
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Shabbar Jaffar
- UCL Institute for Global Health, University College London, London, UK
| | - Olivier Lortholary
- Unité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, Centre National de la Recherche Scientifique, Paris, France; Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Institut Hospitalier Universitaire Imagine, Paris, France
| | - Thomas Harrison
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Síle F Molloy
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Aude Sturny-Leclère
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Angela Loyse
- Unité de Mycologie Moléculaire, Institut Pasteur, Université de Paris, Centre National de la Recherche Scientifique, Paris, France; Institute for Infection and Immunity, St George's University of London, London, UK.
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Litorp H, Målqvist M, Sunny AK, Gurung A, Gurung R, Kc A. Improved obstetric management after implementation of a scaled-up quality improvement intervention: A nested before-after study in three public hospitals in Nepal. Birth 2023; 50:616-626. [PMID: 36774588 DOI: 10.1111/birt.12709] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/28/2021] [Accepted: 01/12/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP). METHODS The Nepal Perinatal Quality Improvement Package was a stepped-wedge cluster-randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before-after analysis. We used bivariate and multivariate analyses to compare obstetric management in the control vs intervention group. RESULTS There were 25 977 deliveries in the three hospitals during the study period: 10 207 (39%) in the control and 15 770 (61%) in the intervention group. After adjusting for maternal age, ethnicity, education, gestational age, stage of labor at admission, complications during labor, and birthweight, the intervention group had a higher proportion of fetal heart rate monitoring performed as per protocol (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12-1.27), shorter time intervals between each fetal heart rate monitoring (aOR 2.09, 95% CI 1.96-2.23), a higher likelihood of abnormal fetal heart rate being detected (aOR 1.53, 95% CI 1.25-1.68), progress of labor more often being recorded immediately after per vaginal examination (aOR 2.73, 95% CI 2.55-2.93), and partograph filled as per standards (aOR 3.18, 95% CI 2.98-3.50). The cesarean birth rate was 2.5% in the control group and 8.2% in the intervention group (aOR 3.12, 95% CI 2.64-3.68). CONCLUSIONS The NePeriQIP intervention has potential to improve obstetric care, especially intrapartum fetal surveillance, in similar low-resource settings.
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Affiliation(s)
- Helena Litorp
- Department of Women's and Children's´ Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mats Målqvist
- Department of Women's and Children's´ Health, Uppsala University, Uppsala, Sweden
| | | | | | | | - Ashish Kc
- Department of Women's and Children's´ Health, Uppsala University, Uppsala, Sweden
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
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Gabaldón Figueira JC, Wagah MG, Adipo LB, Wanjiku C, Maia MF. Topical repellents for malaria prevention. Cochrane Database Syst Rev 2023; 8:CD015422. [PMID: 37602418 PMCID: PMC10440788 DOI: 10.1002/14651858.cd015422.pub2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Insecticide-based interventions, such as long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS), remain the backbone of malaria vector control. These interventions target mosquitoes that prefer to feed and rest indoors, but have limited capacity to prevent transmission that occurs outdoors or outside regular sleeping hours. In low-endemicity areas, malaria elimination will require that these control gaps are addressed, and complementary tools are found. The use of topical repellents may be particularly useful for populations who may not benefit from programmatic malaria control measures, such as refugees, the military, or forest goers. This Cochrane Review aims to measure the effectiveness of topical repellents to prevent malaria infection among high- and non-high-risk populations living in malaria-endemic regions. OBJECTIVES To assess the effect of topical repellents alone or in combination with other background interventions (long-lasting insecticide-treated nets, or indoor residual spraying, or both) for reducing the incidence of malaria in high- and non-high-risk populations living in endemic areas. SEARCH METHODS We searched the following databases up to 11 January 2023: the Cochrane Infectious Diseases Group Specialised Register; CENTRAL (in the Cochrane Library); MEDLINE; Embase; CAB Abstracts; and LILACS. We also searched trial registration platforms and conference proceedings; and contacted organizations and companies for ongoing and unpublished trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-randomized controlled trials (cRCTs) of topical repellents proven to repel mosquitoes. We also included non-randomized studies that complied with pre-specified inclusion criteria: controlled before-after studies (CBA), controlled interrupted time series (ITS), and controlled cross-over trials. DATA COLLECTION AND ANALYSIS Four review authors independently assessed trials for inclusion, and extracted the data. Two authors independently assessed the risk of bias (RoB) using the Cochrane RoB 2 tool. A fifth review author resolved any disagreements. We analysed data by conducting a meta-analysis, stratified by whether studies included populations considered to be at high-risk of developing malaria infection (for example, refugees, forest goers, or deployed military troops). We combined results from cRCTs with RCTs by adjusting for clustering and presented results using forest plots. We used the GRADE framework to assess the certainty of the evidence. We only included data on Plasmodium falciparum infections in the meta-analysis. MAIN RESULTS Thirteen articles relating to eight trials met the inclusion criteria and were qualitatively described. We included six trials in the meta-analysis (five cRCTs and one RCT). Effect on malaria incidence Topical repellents may slightly reduce P falciparum infection and clinical incidence when both outcomes are considered together (incidence rate ratio (IRR) 0.74, 95% confidence interval (CI) 0.56 to 0.98; 3 cRCTs and 1 RCT, 61,651 participants; low-certainty evidence); but not when these two outcomes were considered independently. Two cRCTs and one RCT (12,813 participants) evaluated the effect of topical repellents on infection incidence (IRR 0.76, 95% CI 0.56 to 1.02; low-certainty evidence). One cRCT (48,838 participants) evaluated their effect on clinical case incidence (IRR 0.66, 95% CI 0.32 to 1.36; low-certainty evidence). Three studies (2 cRCTs and 1 RCT) included participants belonging to groups considered at high-risk of being infected, while only one cRCT did not include participants at high risk. Adverse events Topical repellents are considered safe. The prevalence of adverse events among participants who used topical repellents was very low (0.6%, 283/47,515) and limited to mild skin reactions. Effect on malaria prevalence Topical repellents may slightly reduce P falciparum prevalence (odds ratio (OR) 0.81, 95% CI 0.67 to 0.97; 3 cRCTs and 1 RCT; 55,366 participants; low-certainty evidence). Two of these studies (1 cRCT and 1 RCT) were carried out in refugee camps, and included exclusively high-risk populations that were not receiving any other background vector control intervention. AUTHORS' CONCLUSIONS There is insufficient evidence to conclude that topical repellents can prevent malaria in settings where other vector control interventions are in place. We found the certainty of evidence for all outcomes to be low, primarily due to the risk of bias. A protective effect was suggested among high-risk populations, specially refugees, who might not have access to other standard vector control measures. More adequately powered clinical trials carried out in refugee camps could provide further information on the potential benefit of topical repellents in this setting. Individually randomized studies are also likely necessary to understand whether topical repellents have an effect on personal protection, and the degree to which diversion to non-protected participants affects overall transmission dynamics. Despite this, the potential additional benefits of topical repellents are most likely limited in contexts where other interventions are available.
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Affiliation(s)
| | - Martin G Wagah
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - Lawrence Babu Adipo
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Caroline Wanjiku
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Marta F Maia
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Kreitmann L, Jermoumi S, Vasseur M, Chabani M, Nourry E, Richard JC, Wallet F, Garçon P, Kachmar S, Zerbib Y, Van Grunderbeeck N, Vinsonneau C, Duhamel A, Labreuche J, Nseir S. Relationship between COVID-19 and ICU-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter before-after study. Intensive Care Med 2023; 49:796-807. [PMID: 37326645 DOI: 10.1007/s00134-023-07109-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Patients presenting the most severe form of coronavirus disease 2019 (COVID-19) pneumonia, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have a prolonged intensive care unit (ICU) stay and are exposed to broad-spectrum antibiotics, but the impact of COVID-19 on antimicrobial resistance is unknown. METHODS Observational prospective before-after study in 7 ICUs in France. All consecutive patients with an ICU stay > 48 h and a confirmed SARS-CoV-2 infection were included prospectively and followed for 28 days. Patients underwent systematic screening for colonization with multidrug-resistant (MDR) bacteria upon admission and every week subsequently. COVID-19 patients were compared to a recent prospective cohort of control patients from the same ICUs. The primary objective was to investigate the association of COVID-19 with the cumulative incidence of a composite outcome including ICU-acquired colonization and/or infection related to MDR bacteria (ICU-MDR-col and ICU-MDR-inf, respectively). RESULTS From February 27th, 2020 to June 2nd, 2021, 367 COVID-19 patients were included, and compared to 680 controls. After adjustment for prespecified baseline confounders, the cumulative incidence of ICU-MDR-col and/or ICU-MDR-inf was not significantly different between groups (adjusted sub-hazard ratio [sHR] 1.39, 95% confidence interval [CI] 0.91-2.09). When considering both outcomes separately, COVID-19 patients had a higher incidence of ICU-MDR-inf than controls (adjusted sHR 2.50, 95% CI 1.90-3.28), but the incidence of ICU-MDR-col was not significantly different between groups (adjusted sHR 1.27, 95% CI 0.85-1.88). CONCLUSION COVID-19 patients had an increased incidence of ICU-MDR-inf compared to controls, but the difference was not significant when considering a composite outcome including ICU-MDR-col and/or ICU-MDR-inf.
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Affiliation(s)
- Louis Kreitmann
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Sonia Jermoumi
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Margot Vasseur
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Myriam Chabani
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Emilie Nourry
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Jean-Christophe Richard
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital de la Croix Rousse, 69004, Lyon, France
| | - Florent Wallet
- Service de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, 69637, Pierre Bénite, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Pierre Garçon
- Réanimation, Grand Hôpital de l'Est Francilien, Site de Marne-la-Vallée, Jossigny, France
| | - Safaâ Kachmar
- Réanimation, Grand Hôpital de l'Est Francilien, Site de Marne-la-Vallée, Jossigny, France
| | - Yoann Zerbib
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | | | | | - Alain Duhamel
- Department of Biostatistics, CHU Lille, 59000, Lille, France
| | | | - Saad Nseir
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France.
- Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
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Balen F, Micaud A, Auboiroux PH, Lauque D, Charpentier S. Impact of a Rapid Assessment Zone after triage on time-to-physician delay: a before-after study. Eur J Emerg Med 2023; 30:207-208. [PMID: 37103899 DOI: 10.1097/mej.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Frederic Balen
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
| | | | | | - Dominique Lauque
- Emergency Department, Toulouse University Hospital
- Faculty of Medicine, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
- Faculty of Medicine, Toulouse III - Paul Sabatier University, Toulouse, France
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Bauza V, Ye W, Liao J, Majorin F, Clasen T. Interventions to improve sanitation for preventing diarrhoea. Cochrane Database Syst Rev 2023; 1:CD013328. [PMID: 36697370 PMCID: PMC9969045 DOI: 10.1002/14651858.cd013328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diarrhoea is a major contributor to the global disease burden, particularly amongst children under five years in low- and middle-income countries (LMICs). As many of the infectious agents associated with diarrhoea are transmitted through faeces, sanitation interventions to safely contain and manage human faeces have the potential to reduce exposure and diarrhoeal disease. OBJECTIVES To assess the effectiveness of sanitation interventions for preventing diarrhoeal disease, alone or in combination with other WASH interventions. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and Chinese language databases available under the China National Knowledge Infrastructure (CNKI-CAJ). We also searched the metaRegister of Controlled Trials (mRCT) and conference proceedings, contacted researchers, and searched references of included studies. The last search date was 16 February 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, non-randomized controlled trials (NRCTs), controlled before-and-after studies (CBAs), and matched cohort studies of interventions aimed at introducing or expanding the coverage and/or use of sanitation facilities in children and adults in any country or population. Our primary outcome of interest was diarrhoea and secondary outcomes included dysentery (bloody diarrhoea), persistent diarrhoea, hospital or clinical visits for diarrhoea, mortality, and adverse events. We included sanitation interventions whether they were conducted independently or in combination with other interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligible studies, extracted relevant data, assessed risk of bias, and assessed the certainty of evidence using the GRADE approach. We used meta-analyses to estimate pooled measures of effect, described results narratively, and investigated potential sources of heterogeneity using subgroup analyses. MAIN RESULTS Fifty-one studies met our inclusion criteria, with a total of 238,535 participants. Of these, 50 studies had sufficient information to be included in quantitative meta-analysis, including 17 cluster-RCTs and 33 studies with non-randomized study designs (20 NRCTs, one CBA, and 12 matched cohort studies). Most were conducted in LMICs and 86% were conducted in whole or part in rural areas. Studies covered three broad types of interventions: (1) providing access to any sanitation facility to participants without existing access practising open defecation, (2) improving participants' existing sanitation facility, or (3) behaviour change messaging to improve sanitation access or practices without providing hardware or subsidy, although many studies overlapped multiple categories. There was substantial heterogeneity amongst individual study results for all types of interventions. Providing access to any sanitation facility Providing access to sanitation facilities was evaluated in seven cluster-RCTs, and may reduce diarrhoea prevalence in all age groups (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.73 to 1.08; 7 trials, 40,129 participants, low-certainty evidence). In children under five years, access may have little or no effect on diarrhoea prevalence (RR 0.98, 95% CI 0.83 to 1.16, 4 trials, 16,215 participants, low-certainty evidence). Additional analysis in non-randomized studies was generally consistent with these findings. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.79, 95% CI 0.66 to 0.94; 15 studies, 73,511 participants; children < 5 years: RR 0.83, 95% CI 0.68 to 1.02; 11 studies, 25,614 participants). Sanitation facility improvement Interventions designed to improve existing sanitation facilities were evaluated in three cluster-RCTs in children under five and may reduce diarrhoea prevalence (RR 0.85, 95% CI 0.69 to 1.06; 3 trials, 14,900 participants, low-certainty evidence). However, some of these interventions, such as sewerage connection, are not easily randomized. Non-randomized studies across participants of all ages provided estimates that improving sanitation facilities may reduce diarrhoea, but may be subject to confounding (RR 0.61, 95% CI 0.50 to 0.74; 23 studies, 117,639 participants, low-certainty evidence). Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.65, 95% CI 0.55 to 0.78; 26 studies, 132,539 participants; children < 5 years: RR 0.70, 95% CI 0.54 to 0.91, 12 studies, 23,353 participants). Behaviour change messaging only (no hardware or subsidy provided) Strategies to promote behaviour change to construct, upgrade, or use sanitation facilities were evaluated in seven cluster-RCTs in children under five, and probably reduce diarrhoea prevalence (RR 0.82, 95% CI 0.69 to 0.98; 7 studies, 28,909 participants, moderate-certainty evidence). Additional analysis from two non-randomized studies found no effect, though with very high uncertainty. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (RR 0.85, 95% CI 0.73 to 1.01; 9 studies, 31,080 participants). No studies measured the effects of this type of intervention in older populations. Any sanitation intervention A pooled analysis of cluster-RCTs across all sanitation interventions demonstrated that the interventions may reduce diarrhoea prevalence in all ages (RR 0.85, 95% CI 0.76 to 0.95, 17 trials, 83,938 participants, low-certainty evidence) and children under five (RR 0.87, 95% CI 0.77 to 0.97; 14 trials, 60,024 participants, low-certainty evidence). Non-randomized comparisons also demonstrated a protective effect, but may be subject to confounding. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.74, 95% CI 0.67 to 0.82; 50 studies, 237,130 participants; children < 5 years: RR 0.80, 95% CI 0.71 to 0.89; 32 studies, 80,047 participants). In subgroup analysis, there was some evidence of larger effects in studies with increased coverage amongst all participants (75% or higher coverage levels) and also some evidence that the effect decreased over longer follow-up times for children under five years. There was limited evidence on other outcomes. However, there was some evidence that any sanitation intervention was protective against dysentery (RR 0.74, 95% CI 0.54 to 1.00; 5 studies, 34,025 participants) and persistent diarrhoea (RR 0.57, 95% CI 0.43 to 0.75; 2 studies, 2665 participants), but not against clinic visits for diarrhoea (RR 0.86, 95% CI 0.44 to 1.67; 2 studies, 3720 participants) or all-cause mortality (RR 0.99, 95% CI 0.89 to1.09; 7 studies, 46,123 participants). AUTHORS' CONCLUSIONS There is evidence that sanitation interventions are effective at preventing diarrhoea, both for young children and all age populations. The actual level of effectiveness, however, varies by type of intervention and setting. There is a need for research to better understand the factors that influence effectiveness.
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Affiliation(s)
- Valerie Bauza
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Wenlu Ye
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Jiawen Liao
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Fiona Majorin
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hicks KG, Downey L, Elketami A, Nielsen EL, Engelberg RA, Jennerich AL. Before-After Study of a Checklist to Improve Acute Care to ICU Handoffs. Am J Med Qual 2023; 38:37-46. [PMID: 36350159 PMCID: PMC9805500 DOI: 10.1097/jmq.0000000000000091] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transferring care of a patient is a critical process. The objective of this study was to evaluate a checklist to standardize handoffs from acute care to the intensive care unit (ICU). This was a single-center, before-after study of a checklist to standardize transfers of patients from acute care to the medical-cardiac ICU. Clinicians completed surveys about handoffs before and after checklist implementation. The association between study period and survey data was analyzed using multivariable logistic regression with cross-classified multilevel models. Surveys were completed by 179 clinicians. After checklist implementation, handoffs were more likely to occur in the ICU (OR 17.23; 95% CI, 1.81-164.19) and cover patient treatment preferences (OR 2.73; 95% CI, 1.12-6.66). However, checklist uptake was suboptimal (30% of responses indicated checklist use). Implementation of a checklist during acute care to ICU transfers is challenging. Signals suggesting process improvement warrant additional study.
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Affiliation(s)
- Katherine G. Hicks
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
| | - Lois Downey
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Addy Elketami
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Elizabeth L. Nielsen
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ruth A. Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ann L. Jennerich
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Luo G, Zou X, Zhou X, Gan J, Jiang C, Zhao Z, Zhao Y. Wearing N95 masks decreases the odor discrimination ability of healthcare workers: a self-controlled before-after study. PeerJ 2023; 11:e14979. [PMID: 36935919 PMCID: PMC10022507 DOI: 10.7717/peerj.14979] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/09/2023] [Indexed: 03/16/2023] Open
Abstract
Objective During the coronavirus disease 2019 (COVID-19) pandemic, the N95 mask is an essential piece of protective equipment for healthcare workers. However, the N95 mask may inhibit air exchange and odor penetration. Our study aimed to determine whether the use of N95 masks affects the odor discrimination ability of healthcare workers. Methods In our study, all the participants were asked to complete three olfactory tests. Each test involved 12 different odors. The participants completed the test while wearing an N95 mask, a surgical mask, and no mask. The score for each olfactory test was documented. Results The olfactory test score was significantly lower when the participants wore N95 masks than when they did not wear a mask (7 vs. 10, p < 0.01). The score was also lower when the participants wore N95 masks than surgical masks (7 vs. 8, p < 0.01). Conclusion Wearing N95 masks decreases the odor discrimination ability of healthcare workers. Therefore, we suggest that healthcare workers seek other clues when diagnosing disease with a characteristic odor.
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Affiliation(s)
- Guanguan Luo
- Emergency Department, Zhongnan Hospital of Wuhan University, China, Hubei, Wuhan
| | - Xingnan Zou
- Emergency Department, Zhongnan Hospital of Wuhan University, China, Hubei, Wuhan
| | - Xianlong Zhou
- Emergency Department, Zhongnan Hospital of Wuhan University, China, Hubei, Wuhan
| | - Jiaohong Gan
- Emergency Department, Zhongnan Hospital of Wuhan University, China, Hubei, Wuhan
| | - Cheng Jiang
- Emergency Department, Zhongnan Hospital of Wuhan University, China, Hubei, Wuhan
| | - Zhigang Zhao
- Emergency Department, Zhongnan Hospital of Wuhan University, China, Hubei, Wuhan
| | - Yan Zhao
- Emergency Department, Zhongnan Hospital of Wuhan University, China, Hubei, Wuhan
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Wang J, Zeng Z, Zhang S, Kang J, Jiang X, Huang X, Li J, Su J, Luo Z, Zhu P, Yuan J, Yu H, An P. Targeted labeling with tissue marking dyes guided by magnifying endoscopy of endoscopic submucosal dissection specimen improves the accuracy of endoscopic and histopathological diagnosis of early gastric cancer: a before–after study. Surg Endosc 2022; 37:2897-2907. [PMID: 36508008 DOI: 10.1007/s00464-022-09792-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although histopathological evaluation after endoscopic submucosal dissection (ESD) is critical to assess the accuracy of endoscopic diagnosis, it is still challenging to perform precise endoscopic to pathological evaluation. We evaluated the importance of tissue marking dye (TMD)-targeted marking for post-ESD specimen guided by magnificent endoscope on histopathological accuracy and endoscopic-to-histopathological reconstruction. STUDY DESIGN A total of 81 specimens resected by ESD [43 without TMD marking (N-TMD group), and 38 specimens with TMD-targeted cancerous areas marking guided by post-procedural magnifying endoscopy on resected specimens (TMD group)] between January 31, 2019, and January 31, 2022 at the Renmin Hospital of Wuhan University were included in the study. The baseline characteristics of patients, discrepancies between endoscopic and histopathological diagnosis, and the impact of TMD on histopathological diagnosis and reconstruction were analyzed. RESULTS Discrepancies between endoscopic (pre-ESD) and histopathological (post-ESD) diagnosis increased significantly in TMD group (68.4% (26/38) for tumor areas, 26.3% (10/38) for tumor margins, and 26.3% (10/38) for tumor differentiations) when compared with N-TMD group (p < 0.0001). Deeper sections were achieved in all TMD-marked resected lesions and 27.9% (12/43) lesions in the N-TMD group (p < 0.001). More pathological evaluations in TMD group were changed from curative resection to non-curative resection [6/38(15.8%) vs 1/43(2.3%)] compared with N-TMD group (p < 0.0001). TMD-targeted marking also improved the efficiency of histopathological reconstruction on pre-procedural endoscopic images and benefit endoscopists training. CONCLUSION TMD-targeted labeling on resected specimens could improve precise endoscopic-to-pathological diagnosis, reconstruction by point-to-point marking and benefit endoscopists training.
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Affiliation(s)
- Jing Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhi Zeng
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiying Zhang
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian Kang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoda Jiang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xu Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiao Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Juan Su
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zi Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peng Zhu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ping An
- Department of Gastroenterology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.
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Desantis M, Lichtenstern C, Hagenlocher JP, Bruckner T, Weigand MA, Kalenka A, Fiedler MO. Implementation of a spontaneous awakening/spontaneous breathing trial protocol in a surgical intensive care unit: a before and after study. Minerva Anestesiol 2022; 89:306-315. [PMID: 36475396 DOI: 10.23736/s0375-9393.22.16806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prolonged invasive mechanical ventilation (IMV) influences patient outcome in multiple ways. In this regard the early weaning from IMV is a major goal to be achieved in the treatment of ICU patients. Adopting a weaning protocol that incorporates a Spontaneous Awakening Trial (SAT) and a Spontaneous Breathing Trial (SBT) seems to be essential to reach this goal. Most studies investigating the effectiveness of SAT/SBT protocols in ICU patients' outcomes have focused mainly on medical or mixed (medical and surgical), but not on exclusively surgical patient populations. Surgical patients usually experience more complications and often undergo revision surgeries, therefore needing longer sedation periods and adequate analgo-sedation therapy. Moreover, the longer IMV times make the weaning process more arduous. METHODS Our retrospective data analysis therefore investigates the effectiveness of a SAT/SBT protocol implementation in the surgical ICU of Heidelberg University Hospital, focusing exclusively on surgical patients and their outcome related to the weaning process. The SAT/SBT protocol was adopted in Heidelberg ICU starting from 05/2019. We therefore analyzed the time period before and after the implementation between 03/2018 and 08/2020. Adult patients who required invasive ventilation for at least 48 hours were screened for study entry. Demographic data, clinical data and SOFA Score on admission, were collected to define the baseline characteristics of the two groups. Only patients with full adherence to the protocol were included. The primary outcome was defined as the successful extubation, intended as an extubation not followed by successive re-intubations until discharge from the ICU. We performed an univariate analysis to evaluate the rate of successful extubations between the two groups. RESULTS In total, 199 patients were included in the analysis, 98 of which before the SAT/SBT protocol implementation (control group) and 101 after the SAT/SBT protocol implementation (intervention group). The successful extubation rate in the intervention group resulted in 82% (83/101 patients) compared to 64% (63/98 patients) in the control group (P<0.004). CONCLUSIONS We conclude that even for an exclusively surgical patient population, the implementation of a SAT/SBT protocol could result in a higher rate of successful extubation.
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Affiliation(s)
- Marianna Desantis
- Department of Anesthesiology, Center for ARDS and Weaning, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Lichtenstern
- Department of Anesthesiology, Center for ARDS and Weaning, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan-Paul Hagenlocher
- Department of Anesthesiology, Center for ARDS and Weaning, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Center for ARDS and Weaning, Heidelberg University Hospital, Heidelberg, Germany
| | - Armin Kalenka
- Department of Anesthesiology and Intensive Care Medicine, District Hospital Bergstrasse, Heppenheim, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mascha O Fiedler
- Department of Anesthesiology, Center for ARDS and Weaning, Heidelberg University Hospital, Heidelberg, Germany -
- Translational Lung Research Center Heidelberg (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
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Zhang M, Huang F, Jiang F, Mai M, Guo X, Zhang Y, Xu Y, Zu H. Clinical efficacy and safety of low-dose doxepin in Chinese patients with generalized anxiety disorder: A before-after study. Medicine (Baltimore) 2022; 101:e31201. [PMID: 36281170 PMCID: PMC9592331 DOI: 10.1097/md.0000000000031201] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
Clinical and animal studies have reported that low-dose doxepin may have positive effects on generalized anxiety disorder (GAD); however, its effectiveness and clinical safety are less well understood. This study is a before-after study and aims to investigate the effectiveness and side effects of low-dose doxepin by evaluating Hamilton Anxiety Scale (HAMA) scores, hormones, blood glucose, serum lipids, body weight, and body mass index (BMI) in patients with GAD. Forty-nine patients (20 males and 29 females) with GAD were randomly assigned to receive low-dose doxepin (6.25 mg-12.5 mg per day) for 12 weeks between February 2015 and March 2016. HAMA scores, fasting blood glucose (FBG) body weight, BMI, and some serum biochemical indexes, such as adrenocorticotropic hormone (ACTH), free triiodothyronine (FT3), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDLC), and FBG, were assessed during pretreatment and post-treatment. Mean scores of HAMA decreased from 19.50 ± 1.22 to 8.50 ± 3.61 after low-dose doxepin treatment (P < .01). The serum levels of ACTH (4.33 ± 2.14 vs 6.12 ± 3.02 pmol/L), FT3 (4.78 ± 0.51 vs 5.15 ± 0.52 pg/mL), TC (4.55 ± 1.01 vs 5.93 ± 1.66 mmol/L), TG (1.69 ± 1.51 vs 3.39 ± 2.86 mmol/L), and LDLC (2.43 ± 0.88 vs 3.76 ± 1.25 mmol/L), and FBG (5.06 ± 0.43 vs 5.78 ± 0.81 mmol/L) were higher than that pretreatment with a significant difference (P < .01). Bodyweight (62.00 ± 7.45 vs 64.00 ± 6.44 kg, P = .23) and BMI (23.70 ± 2.35 vs 24.48 ± 2.11 kg/m2, P = .14) had no difference after treatment. These results suggest that low-dose doxepin has beneficial clinical efficacy and safety. Low-dose doxepin can ameliorate anxiety in GAD patients and has some effects on neuroendocrine systems and the metabolic activity of serum glucose and lipid.
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Affiliation(s)
- Mengqi Zhang
- Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Fengmin Huang
- Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Feiyu Jiang
- Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Meiting Mai
- Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiaorou Guo
- Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ying Zhang
- Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ying Xu
- Department of Geriatric Cognitive Disorders, Shanghai Jinshan Zhongren Geriatric Nursing Hospital, Shanghai, China
| | - Hengbing Zu
- Department of Neurology, Jinshan Hospital, Fudan University, Shanghai, China
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Kiely B, Croke A, O'Shea M, Boland F, O'Shea E, Connolly D, Smith SM. Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review. BMJ Open 2022; 12:e062951. [PMID: 36253037 PMCID: PMC9644316 DOI: 10.1136/bmjopen-2022-062951] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To establish the evidence base for the effects on health outcomes and costs of social prescribing link workers (non-health or social care professionals who connect people to community resources) for people in community settings focusing on people experiencing multimorbidity and social deprivation. DESIGN Systematic review and narrative synthesis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES Cochrane Database, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, EU Clinical Trials Register, CINAHL, Embase, Global Health, PubMed/MEDLINE, PsycInfo, LILACS, Web of Science and grey literature were searched up to 31 July 2021. A forward citation search was completed on 9 June 2022. ELIGIBILITY CRITERIA Controlled trials meeting the Cochrane Effectiveness of Practice and Organisation of Care (EPOC) guidance on eligible study designs assessing the effect of social prescribing link workers for adults in community settings on any outcomes. No language restrictions were applied. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data, evaluated study quality using the Cochrane EPOC risk of bias tool and judged certainty of the evidence. Results were synthesised narratively. RESULTS Eight studies (n=6500 participants), with five randomised controlled trials at low risk of bias and three controlled before-after studies at high risk of bias, were included. Four included participants experiencing multimorbidity and social deprivation. Four (n=2186) reported no impact on health-related quality of life (HRQoL). Four (n=1924) reported mental health outcomes with three reporting no impact. Two US studies found improved ratings of high-quality care and reduced hospitalisations for people with multimorbidity experiencing deprivation. No cost-effectiveness analyses were identified. The certainty of the evidence was low or very low. CONCLUSIONS There is an absence of evidence for social prescribing link workers. Policymakers should note this and support evaluation of current programmes before mainstreaming. PROSPERO REGISTRATION NUMBER CRD42019134737.
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Affiliation(s)
- Bridget Kiely
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Croke
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Muireann O'Shea
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eamon O'Shea
- School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
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Bronnert R, Nicolleau C, Bouhours G, Butrulle C, Rineau E, Lasocki S. Impact of the presence of a humanoid robot in the anesthesia visit waiting room on patient's satisfaction. The PEPPER before-after study. Minerva Anestesiol 2022; 89:273-278. [PMID: 36287394 DOI: 10.23736/s0375-9393.22.16771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The quality of information during a medical visit, such as a preoperative anesthesia visit, impacts patient's satisfaction. New digital supports, including humanoid robots, have been recently proposed to provide medical information to patients. We aimed to assess whether the presence of a PEPPER humanoid robot, programmed to deliver information about anesthesia and surgery and placed in the waiting room for a preoperative anesthesia visit, can improve patient overall satisfaction. METHODS We conducted a prospective, observational, before-after study. French-speaking adult patient global satisfaction (rated from 0 to 10) was measured after a scheduled preoperative anesthesia visit (for orthopedic, abdominal, urologic surgeries or for endoscopy), by direct interview with a research person, before modification of usual practices (information leaflets and brochure were given to the patients prior to the visit), and after the implementation in the waiting room of a PEPPER humanoid robot programmed to deliver information about anesthesia and surgery through short videos, designed by a group of healthcare workers and patients. RESULTS Two hundred ninety-six patients (237 [80%] ASA I-II) were included, 179 before and 117 after periods. Patient global satisfaction was not different (8.9±1.6 vs. 9.0±1.4/10, for before and after periods, P=0.53). However, the satisfaction on the information about risks was significantly improved in the after period (8.5±2.3 vs. 9.1±1.4/10, P=0.017). CONCLUSIONS The presence of a humanoid PEPPER robot in the waiting room did not improve patient's global satisfaction about anesthesia visit.
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Affiliation(s)
- Romain Bronnert
- Department of Anesthesia and Intensive Care, University Hospital of Angers, University of Angers, Angers, France
| | - Claire Nicolleau
- Department of Anesthesia and Intensive Care, University Hospital of Angers, University of Angers, Angers, France
| | - Guillaume Bouhours
- Department of Anesthesia and Intensive Care, University Hospital of Angers, University of Angers, Angers, France
| | - Calliope Butrulle
- Department of Anesthesia and Intensive Care, University Hospital of Angers, University of Angers, Angers, France
| | - Emmanuel Rineau
- Department of Anesthesia and Intensive Care, University Hospital of Angers, University of Angers, Angers, France
| | - Sigismond Lasocki
- Department of Anesthesia and Intensive Care, University Hospital of Angers, University of Angers, Angers, France -
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Londoño Agudelo EA, Battaglioli T, Soto A, Vásquez Gómez J, Aguilar Ramírez H, Pérez Ospina V, Rodríguez Salvá A, Ortiz Solórzano P, Pérez D, Gómez-Arias R, Van Der Stuyft P. Protocol for a controlled before-after quasi-experimental study to evaluate the effectiveness of a multi-component intervention to reduce gaps in hypertension care and control in low-income communes of Medellin, Colombia. BMJ Open 2022; 12:e056262. [PMID: 36002215 PMCID: PMC9413173 DOI: 10.1136/bmjopen-2021-056262] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Research on public health interventions to improve hypertension care and control in low-income and middle-income countries remains scarce. This study aims to evaluate the effectiveness and assess the process and fidelity of implementation of a multi-component intervention to reduce the gaps in hypertension care and control at a population level in low-income communes of Medellin, Colombia. METHODS AND ANALYSIS A multi-component intervention was designed based on international guidelines, cross-sectional population survey results and consultation with the community and institutional stakeholders. Three main intervention components integrate activities related to (1) health services redesign, (2) clinical staff training and (3) patient and community engagement. The effectiveness of the intervention will be evaluated in a controlled before-after quasi-experimental study, with two deprived communes of the city selected as intervention and control arms. We will conduct a baseline and an endline survey 2 years after the start of the intervention. The primary outcomes will be the gaps in hypertension diagnosis, treatment, follow-up and control. Effectiveness will be evaluated with the difference-in-difference measures. Generalised estimation equation models will be fitted considering the clustered nature of data and adjusting for potential confounding variables. The implementation process will be studied with mixed methods. Implementation fidelity will be documented to assess to which degree the intervention components were implemented as intended. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Research Committee of Metrosalud in Colombia (reference 1400/5.2), the Medical Ethics Committee of the Antwerp University Hospital (reference 18/40/424) and the Institutional Review Board of the Antwerp Institute of Tropical Medicine (reference 1294/19). We will share and discuss the study results with the community, institutional stakeholders and national health policymakers. We will publish them in national and international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05011838.
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Affiliation(s)
- Esteban Augusto Londoño Agudelo
- Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
- Facultad de Medicina, Universidad CES, Medellin, Colombia
| | | | - Alonso Soto
- Departamento de Medicina, Hospital Nacional Hipólito Unanue, Lima, Peru
| | | | | | | | - Armando Rodríguez Salvá
- Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), La Habana, Cuba
| | | | - Dennis Pérez
- Departamento de Vigilancia e Investigaciones Epidemiológicas, Instituto de Medicina Tropical Pedro Kourí, La Habana, Cuba
| | - Rubén Gómez-Arias
- Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Facultad de Medicina, Universidad CES, Medellin, Colombia
| | - Patrick Van Der Stuyft
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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Jerene D, Assefa D, Tesfaye K, Bayu S, Seid S, Aberra F, Bedru A, Khan A, Creswell J. Effectiveness of women-led community interventions in improving tuberculosis preventive treatment in children: results from a comparative, before-after study in Ethiopia. BMJ Open 2022; 12:e062298. [PMID: 35863840 PMCID: PMC9310159 DOI: 10.1136/bmjopen-2022-062298] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our objective was to evaluate the impact of a service delivery model led by membership-based associations called Iddirs formed by women on tuberculosis preventive treatment (TPT) initiation and completion rates among children. DESIGN Comparative, before-and-after study design. SETTING Three intervention and two control districts in Ethiopia. PARTICIPANTS Children who had a history of close contact with adults with infectious forms of tuberculosis (TB). Child contacts in whom active TB and contraindications to TPT regimens were excluded were considered eligible for TPT. INTERVENTIONS Between July 2020 and June 2021, trained women Iddir members visited households of index TB patients, screened child household contacts for TB, provided education and information on the benefits of TPT, linked them to the nearby health centre and followed them at home for TPT adherence and side effects. Two control zones received the standard of care, which comprised of facility-based provision of TPT to children. We analysed quarterly TPT data for treatment initiation and completion and compared intervention and control zones before and after the interventions and tested for statistical significance using Poisson regression. PRIMARY AND SECONDARY OUTCOME MEASURES There were two primary outcome measures: proportion of eligible children initiated TPT and proportion completed treatment out of those eligible. RESULTS TPT initiation rate among eligible under-15-year-old children (U15C) increased from 28.7% to 63.5% in the intervention zones, while it increased from 34.6% to 43.2% in the control zones, and the difference was statistically significant (p<0.001). TPT initiation rate for U5C increased from 13% (17 out of 131) to 93% (937 out of 1010). Of the U5C initiated, 99% completed treatment; two discontinued due to side effects; three parents refused to continue; and one child was lost to follow-up. CONCLUSION Women-led Iddirs contributed to significant increase in TPT initiation and completion rates. The model of TPT delivery should be scaled-up.
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Affiliation(s)
- Degu Jerene
- TB Elimination and Health Systems Innovation, KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Dawit Assefa
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Samuel Bayu
- KNCV Tuberculosis Foundation, Ethiopia Office, Addis Ababa, Ethiopia
| | - Samuel Seid
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Fikirte Aberra
- Southern Nations Nationalities and Peoples' Region Health Bureau, Hawassa, Ethiopia
| | - Ahmed Bedru
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Amera Khan
- Innovation & Grants, Stop TB Partnership, Geneva, Switzerland
| | - Jacob Creswell
- Innovation & Grants, Stop TB Partnership, Geneva, Switzerland
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Duvillier C, Gams J, Rousseau A, Rozenberg P. [Induction of labour with oral misoprostol versus vaginal misoprostol: A before-after study]. Gynecol Obstet Fertil Senol 2022; 50:475-480. [PMID: 35151915 DOI: 10.1016/j.gofs.2022.01.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The rate of induction of labor represented 22 % of deliveries in 2016 in France. Oral misoprostol (Angusta®) was marketed in France in the last quarter of 2018. The objective of our study was to compare the efficacy and safety of induction of labor with oral misoprostol compared to vaginal misoprostol in women with an unripe cervix. MATERIAL AND METHODS We carried out a retrospective study before and after the implementation of oral misoprostol including all women with an unripe cervix who benefited from an induction of labor with a viable infant in vertex presentation, without uterine scar. During the first two-year period, women received 50μg of misoprostol in the posterior fornix, repeated 6hours later if needed. If labor had not started after 24hours, women received another dose of 50μg, which was repeated every 4hours until labor was established, up to a total dose of 150μg. During the second two-year period, women received two tablets of oral misoprostol 25μg every four hours if necessary, up to a total dose of 200μg. The primary endpoints were mode of delivery and neonatal safety. RESULTS During the two study periods, 1199 women received vaginal misoprostol and 1199 women received oral misoprostol including. The cesarean delivery rate was 21.8% during the first period and 21,3% during the second period (P=0.83). A 5-minutes Apgar score<7 was observed in 23 (1.9%) and 14 (1.2%) newborns in the vaginal misoprostol and oral misoprostol groups (P=0.14), respectively. An arterial cord pH<7.00 was observed in 6 (0.5%) and 7 (0.6%) newborns (P=0.99), respectively. CONCLUSION Oral misoprostol administered at the dose of 50μg every 4hours (up to a total dose of 200μg) is as effective and safe as the vaginal misoprostol to induce labor in women with an unripe cervix.
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Affiliation(s)
- C Duvillier
- Université Paris Saclay, UVSQ, Inserm, équipe U1018, épidémiologie clinique, CESP, 78180 Montigny-le-Bretonneux, France; Centre Hospitalier Poissy/Saint-germain, service d'obstétrique et gynécologie, 10, rue du Champ Gaillard, 78300 Poissy, France.
| | - J Gams
- Centre Hospitalier Poissy/Saint-germain, service d'obstétrique et gynécologie, 10, rue du Champ Gaillard, 78300 Poissy, France
| | - A Rousseau
- Université Paris Saclay, UVSQ, Inserm, équipe U1018, épidémiologie clinique, CESP, 78180 Montigny-le-Bretonneux, France
| | - P Rozenberg
- Université Paris Saclay, UVSQ, Inserm, équipe U1018, épidémiologie clinique, CESP, 78180 Montigny-le-Bretonneux, France; Centre Hospitalier Poissy/Saint-germain, service d'obstétrique et gynécologie, 10, rue du Champ Gaillard, 78300 Poissy, France; Réseau maternité en Yvelines et périnatalité Active (MYPA), 20, rue Armagis, Pavillon Courtois, 78100 Saint-Germain-en-Laye, France
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Martin F, Vautrin N, Elnar AA, Goetz C, Bécret A. Evaluation of the impact of an enhanced recovery after surgery (ERAS) programme on the quality of recovery in patients undergoing a scheduled hysterectomy: a prospective single-centre before-after study protocol (RAACHYS study). BMJ Open 2022; 12:e055822. [PMID: 35393312 PMCID: PMC8990258 DOI: 10.1136/bmjopen-2021-055822] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The enhanced recovery after surgery (ERAS) programmes following hysterectomies have been studied since 2010, and their positive effects on clinical or economic criteria are now well established. However, the benefits on health outcomes, especially rapid recovery after surgery from patients' perspective is lacking in literature, leading to develop scores supporting person-centred and value-based care such as patient-reported outcome measures. The aim of this study is to assess the impact of an ERAS programme on patients' well-being after undergoing hysterectomy. METHODS AND ANALYSIS This is an observational, prospective single-centre before-after clinical trial. 148 patients are recruited and allocated into two groups, before and after ERAS programme implementation, respectively. The ERAS programme consists in optimising factors dealing with early rehabilitation, such as preoperative patient education, multimodal pain management, early postoperative fluid taken and mobilisation. A self-questionnaire quality of recovery-15 (QoR-15) on the preoperative day 1 (D-1), postoperative day 0 evening (D0) and the postoperative day 1 (D+1) is completed by patients. Patients scheduled to undergo hysterectomy, aged 18 years and above, whose physical status are classified as American Society of Anesthesiologists score 1-3 and who are able to return home after being discharged from hospital and contact their physician or the medical department if necessary are recruited for this study. The total duration of inclusion is 36 months. The primary outcome is the difference in QoR-15 scores measured on D+1 which will be compared between the 'before' and the 'after' group, using multiple linear regression model. ETHICS AND DISSEMINATION Approval was obtained from the Ethical Committee (Paris, France). Subjects are actually being recruited after giving their oral agreement or non-objection to participate in this clinical trial and following the oral and written information given by the anaesthesiologist practitioner.Trial registration number: ClinicalTrials.gov: NCT04268576 (Pre-result).
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Affiliation(s)
- Flora Martin
- Anesthesiology, CHR Metz-Thionville, Metz, France
- Faculté de médecine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | | | | | - Christophe Goetz
- Clinical Research Support Unit, CHR Metz-Thionville, Metz, France
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Kiesel EK, Drey M, Pudritz YM. Influence of a ward-based pharmacist on the medication quality of geriatric inpatients: a before-after study. Int J Clin Pharm 2022; 44:480-488. [PMID: 35076810 PMCID: PMC9007813 DOI: 10.1007/s11096-021-01369-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 01/25/2023]
Abstract
Background Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. Method The before-after study with a historic control group was conducted on the geriatric ward. During the control phase, patients received standard care without the involvement of a pharmacist. The intervention consisted of a clinical pharmacist providing pharmaceutical care from admission to discharge. Medication quality was measured on admission and discharge using the Medication Appropriateness Index (MAI). A linear regression analysis was conducted to calculate the influence of the intervention on the MAI. Results Patients in the intervention group (n = 152, mean 83 years) were older and took more drugs at admission compared to the control group (n = 159, 81 years). For both groups, the MAI per patient improved significantly from admission to discharge. Although the intervention did not influence the summated MAI score per patient, the intervention significantly reduced the MAI criteria Dosage (p = 0.006), Correct Directions (p = 0.016) and Practical Directions (p = 0.004) as well as the proportion of overall inappropriate MAI ratings (at least 1 of 9 criteria inappropriate) (p = 0.015). Conclusion Although medication quality was already high in the control group, a ward-based clinical pharmacist could contribute meaningfully to the medication quality on an acute geriatric ward.
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Affiliation(s)
- Esther Katharina Kiesel
- Technical University of Munich, Hospital Pharmacy, University Hospital rechts der Isar, Munich, Germany
- University Hospital, Doctoral Programme Clinical Pharmacy, LMU Munich, Munich, Germany
| | - Michael Drey
- University Hospital, Department of Medicine IV, LMU Munich, Munich, Germany
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Harrison SL, Dyer SM, Laver KE, Milte RK, Fleming R, Crotty M. Physical environmental designs in residential care to improve quality of life of older people. Cochrane Database Syst Rev 2022; 3:CD012892. [PMID: 35253911 PMCID: PMC8900466 DOI: 10.1002/14651858.cd012892.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The demand for residential aged care is increasing due to the ageing population. Optimising the design or adapting the physical environment of residential aged care facilities has the potential to influence quality of life, mood and function. OBJECTIVES To assess the effects of changes to the physical environment, which include alternative models of residential aged care such as a 'home-like' model of care (where residents live in small living units) on quality of life, behaviour, mood and depression and function in older people living in residential aged care. SEARCH METHODS CENTRAL, MEDLINE, Embase, six other databases and two trial registries were searched on 11 February 2021. Reference lists and grey literature sources were also searched. SELECTION CRITERIA Non-randomised trials, repeated measures or interrupted time series studies and controlled before-after studies with a comparison group were included. Interventions which had modified the physical design of a care home or built a care home with an alternative model of residential aged care (including design alterations) in order to enhance the environment to promote independence and well-being were included. Studies which examined quality of life or outcomes related to quality of life were included. Two reviewers independently assessed the abstracts identified in the search and the full texts of all retrieved studies. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data, assessed the risk of bias in each included study and evaluated the certainty of evidence according to GRADE criteria. Where possible, data were represented in forest plots and pooled. MAIN RESULTS Twenty studies were included with 77,265 participants, although one large study included the majority of participants (n = 74,449). The main comparison was home-like models of care incorporating changes to the scale of the building which limit the capacity of the living units to smaller numbers of residents and encourage the participation of residents with domestic activities and a person-centred care approach, compared to traditional designs which may include larger-scale buildings with a larger number of residents, hospital-like features such as nurses' stations, traditional hierarchical organisational structures and design which prioritises safety. Six controlled before-after studies compared the home-like model and the traditional environment (75,074 participants), but one controlled before-after study included 74,449 of the participants (estimated on weighting). It is uncertain whether home-like models improve health-related quality of life, behaviour, mood and depression, function or serious adverse effects compared to traditional designs because the certainty of the evidence is very low. The certainty of the evidence was downgraded from low-certainty to very low-certainty for all outcomes due to very serious concerns due to risk of bias, and also serious concerns due to imprecision for outcomes with more than 400 participants. One controlled before-after study examined the effect of home-like models on quality of life. The author stated "No statistically significant differences were observed between the intervention and control groups." Three studies reported on global behaviour (N = 257). One study found little or no difference in global behaviour change at six months using the Neuropsychiatric Inventory where lower scores indicate fewer behavioural symptoms (mean difference (MD) -0.04 (95% confidence interval (CI) -0.13 to 0.04, n = 164)), and two additional studies (N = 93) examined global behaviour, but these were unsuitable for determining a summary effect estimate. Two controlled before-after studies examined the effect of home-like models of care compared to traditional design on depression. After 18 months, one study (n = 242) reported an increase in the rate of depressive symptoms (rate ratio 1.15 (95% CI 1.02 to 1.29)), but the effect of home-like models of care on the probability of no depressive symptoms was uncertain (odds ratio 0.36 (95% CI 0.12 to 1.07)). One study (n = 164) reported little or no difference in depressive symptoms at six months using the Revised Memory and Behaviour Problems Checklist where lower scores indicate fewer depressive symptoms (MD 0.01 (95% CI -0.12 to 0.14)). Four controlled before-after studies examined function. One study (n = 242) reported little or no difference in function over 18 months using the Activities of Daily Living long-form scale where lower scores indicate better function (MD -0.09 (95% CI -0.46 to 0.28)), and one study (n = 164) reported better function scores at six months using the Interview for the Deterioration of Daily Living activities in Dementia where lower scores indicate better function (MD -4.37 (95% CI -7.06 to -1.69)). Two additional studies measured function but could not be included in the quantitative analysis. One study examined serious adverse effects (physical restraints), and reported a slight reduction in the important outcome of physical restraint use in a home-like model of care compared to a traditional design (MD between the home-like model of care and traditional design -0.3% (95% CI -0.5% to -0.1%), estimate weighted n = 74,449 participants at enrolment). The remaining studies examined smaller design interventions including refurbishment without changes to the scale of the building, special care units for people with dementia, group living corridors compared to a non-corridor design, lighting interventions, dining area redesign and a garden vignette. AUTHORS' CONCLUSIONS There is currently insufficient evidence on which to draw conclusions about the impact of physical environment design changes for older people living in residential aged care. Outcomes directly associated with the design of the built environment in a supported setting are difficult to isolate from other influences such as health changes of the residents, changes to care practices over time or different staff providing care across shifts. Cluster-randomised trials may be feasible for studies of refurbishment or specific design components within residential aged care. Studies which use a non-randomised design or cluster-randomised trials should consider approaches to reduce risk of bias to improve the certainty of evidence.
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Affiliation(s)
- Stephanie L Harrison
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate E Laver
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rachel K Milte
- Caring futures institute, Flinders University, Adelaide, Australia
| | - Richard Fleming
- School of Science Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Scaturro D, Guggino G, Terrana P, Vitagliani F, Falco V, Cuntrera D, Benedetti MG, Moretti A, Iolascon G, Letizia Mauro G. Rehabilitative interventions for ischaemic digital ulcers, pain, and hand functioning in systemic sclerosis: a prospective before-after study. BMC Musculoskelet Disord 2022; 23:193. [PMID: 35236311 PMCID: PMC8889643 DOI: 10.1186/s12891-022-05145-8] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/12/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vasculopathy, cellular inflammation, fibrosis of the skin associated with multiple internal organs involvement. Ischaemic digital ulcers (IDU) of the hands commonly occur in patients with SSc adversely affecting functional independence. PURPOSE Aim of the study is to investigate the effectiveness of a rehabilitation protocol based on the combined use of ultrasound (US) therapy and therapeutic exercise in terms of ulcers healing, pain relief, and hand functioning in patients affected by SSc with IDUs. Moreover, we also investigated the safety of the proposed intervention. STUDY DESIGN Prospective before-after study. METHODS We included 20 patients with IDUs secondary to SSc. All patients were treated with US combined with manual therapy, including McMennel joint manipulation, pompage mobilization technique and connective tissue massage, for 10 sessions. We evaluated softness, dyschromia, pain, and hand mobility using the Pressure Sore Status Tool (PSST), the Numerical Rating Scale (NRS), and the Duruoz Hand Index (DHI) at T0 and at the end of the treatment (T1). RESULTS Treatment with US combined with manual therapy significantly reduced ulcers depth, improved ulcers margins, and reduced periwound skin damage (median PSST score 16 at T1, p<0.0001). Moreover, significant benefits were reported in terms of pain relief (NRS 3 at T1; p<0.0005), and hand function (DHI score 19 at T1; p<0.0005). Finally, this approach seems to be safe, without side effects reported at the end of treatment, along with an optimal compliance. CONCLUSION Therapeutic US combined with manual therapy should be used as additional intervention to manage IDUs in SSc patients.
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Affiliation(s)
- Dalila Scaturro
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Giuliana Guggino
- grid.412510.30000 0004 1756 3088Rheumatology section, Biomedical department of Internal Medicine, University Hospital “P.Giaccone”, Palermo, Italy
| | - Pietro Terrana
- grid.10776.370000 0004 1762 5517University of Palermo, Palermo, Italy
| | - Fabio Vitagliani
- grid.8158.40000 0004 1757 1969University of Catania, Catania, Italy
| | - Vincenzo Falco
- grid.10776.370000 0004 1762 5517Department of Economics and Statistics, University of Palermo, Palermo, Italy
| | - Daniele Cuntrera
- grid.10776.370000 0004 1762 5517Department of Economics and Statistics, University of Palermo, Palermo, Italy
| | - Maria Grazia Benedetti
- grid.6292.f0000 0004 1757 1758IRCCS-Istituto Ortopedico Rizzoli- University of Bologna, Bologna, Italy
| | - Antimo Moretti
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Iolascon
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giulia Letizia Mauro
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
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Navarro B, Miranda-Moreno L, Saunier N, Labbe A, Fu T. Do stop-signs improve the safety for all road users? A before-after study of stop-controlled intersections using video-based trajectories and surrogate measures of safety. Accid Anal Prev 2022; 167:106563. [PMID: 35131654 DOI: 10.1016/j.aap.2021.106563] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
Converting minor-approach-only stop (MAS) intersections to all-way-stop (AWS) intersections is a prevailing safety countermeasure in North American urban areas. Although the general population positively perceives the installation of stop-signs in residential areas, little research has investigated the impact of AWS on road safety and road user behaviour. This paper investigated the safety effectiveness of converting MAS to AWS intersections using an observational before and after approach and surrogate measures of safety. More specifically, the safety impacts of AWS conversion were investigated using multiple indicators, including vehicle speed measures, vehicle-pedestrian, vehicle-cyclist, vehicles-vehicle interactions as well as yielding rates before and after the treatment implementation. A multi-level regression approach was adopted to determine the effect of stop signs controlling for built environments, traffic exposure, and intersection geometry factors as well as site-specific unobserved heterogeneity. A unique sample of 31 intersections were used in this before-after study. From this sample, video data were collected before and after implementing AWS. In total, 245 h of video were automatically processed and corrected using a specialized computer vision software. More than 68,000 (37,668 before and 31,305 after AWS treatment) road user trajectories were obtained from 104 approaches. The results show that the conversion of MAS to AWS intersections significantly decreased vehicle speed and increased post-encroachment time. This work also shows that implementing AWS significantly increased the yielding rates from 45.7% to 76.7% in MAS conditions and reduced the average speed of motor-vehicles. Using multi-level regression model, it is estimated that when the intersection was converted from MAS to AWS, the minimum speed in the major approaches was reduced by 60.0%.
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Affiliation(s)
- Bismarck Navarro
- Department of Civil Engineering and Applied Mechanics, McGill University, Macdonald Engineering Building, 817 Sherbrooke Street West, Montréal, Québec H3A 0C3, Canada.
| | - Luis Miranda-Moreno
- Department of Civil Engineering and Applied Mechanics, McGill University, Macdonald Engineering Building, 817 Sherbrooke Street West, Montréal, Québec H3A 0C3, Canada.
| | - Nicolas Saunier
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal, C.P. 6079, succ. Centre-Ville, Montréal, Québec H3C 3A7, Canada.
| | - Aurélie Labbe
- Department of Decision Sciences, HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 2A7, Canada.
| | - Ting Fu
- College of Transportation Engineering, Tongji University, Department of Civil and Environmental Engineering, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L3G1, Canada.
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Namatovu S, Balugaba BE, Muni K, Ningwa A, Nsabagwa L, Oporia F, Kiconco A, Kyamanywa P, Mutto M, Osuret J, Rehfuess EA, Burns J, Kobusingye O. Interventions to reduce pedestrian road traffic injuries: A systematic review of randomized controlled trials, cluster randomized controlled trials, interrupted time-series, and controlled before-after studies. PLoS One 2022; 17:e0262681. [PMID: 35073351 PMCID: PMC8786203 DOI: 10.1371/journal.pone.0262681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Road traffic injuries are among the top ten causes of death globally, with the highest burden in low and middle-income countries, where over a third of deaths occur among pedestrians and cyclists. Several interventions to mitigate the burden among pedestrians have been widely implemented, however, the effectiveness has not been systematically examined.
Objectives
To assess the effectiveness of interventions to reduce road traffic crashes, injuries, hospitalizations and deaths among pedestrians.
Methods
We considered studies that evaluated interventions to reduce road traffic crashes, injuries, hospitalizations and/or deaths among pedestrians. We considered randomized controlled trials, interrupted time-series studies, and controlled before-after studies. We searched MEDLINE, EMBASE, Web of Science, WHO Global Health Index, Health Evidence, Transport Research International Documentation and ClinicalTrials.gov through 31 August 2020, and the reference lists of all included studies. Two reviewers independently screened titles and abstracts and full texts, extracted data and assessed the risk of bias. We summarized findings narratively with text and tables.
Results
A total of 69123 unique records were identified through the searches, with 26 of these meeting our eligibility criteria. All except two of these were conducted in high-income countries and most were from urban settings. The majority of studies observed either a clear effect favoring the intervention or an unclear effect potentially favoring the intervention and these included: changes to the road environment (19/27); changes to legislation and enforcement (12/12); and road user behavior/education combined with either changes to the road environment (3/3) or with legislation and enforcement (1/1). A small number of studies observed either a null effect or an effect favoring the control.
Conclusions
Although the highest burden of road traffic injuries exists in LMICs, very few studies have examined the effectiveness of available interventions in these settings. Studies indicate that road environment, legislation and enforcement interventions alone produce positive effects on pedestrian safety. In combination with or with road user behavior/education interventions they are particularly effective in improving pedestrian safety.
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Affiliation(s)
- Stellah Namatovu
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
- * E-mail:
| | | | - Kennedy Muni
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Albert Ningwa
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
| | - Linda Nsabagwa
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
| | - Fredrick Oporia
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
| | - Arthur Kiconco
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
| | - Patrick Kyamanywa
- School of Health Sciences, Kampala International University, Bushenyi, Uganda
| | - Milton Mutto
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
| | - Jimmy Osuret
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
| | - Eva A. Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximillians Universitaet (LMU Munich), Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximillians Universitaet (LMU Munich), Munich, Germany
| | - Olive Kobusingye
- School of Public Health, Makerere University Kampala Uganda, Kampala, Uganda
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Mori K, Tsukamoto Y, Makino S, Takabayashi T, Kurosawa M, Ohashi W, Okumura M, Fujita Y, Fujiwara Y. Effect of intensive care provided by nurse practitioners for postoperative patients: A retrospective observational before-and-after study. PLoS One 2022; 17:e0262605. [PMID: 35061830 PMCID: PMC8782326 DOI: 10.1371/journal.pone.0262605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/29/2021] [Indexed: 11/20/2022] Open
Abstract
Nurse practitioners are increasingly now members of intensive care teams in Japan, but no data exist about their effect on the outcomes for critically ill patients. This study aimed to compare the outcomes of postoperative patients on mechanical ventilators before and after the participation of nurse practitioners in intensive care teams. We retrospectively identified 387 patients who underwent postoperative mechanical ventilation at a University Hospital in Japan, using data from medical records from 1 April 2015 to 31 March 2017. We extracted data and compared patients' length of stay in the intensive care unit and the hospital, mechanical ventilation days, postoperative rehabilitation start date, rehabilitation prescription, intensive care unit and hospital mortality, and intensive care unit readmission. Multiple regression analysis was used to analyze the factors affecting length of stay in the intensive care unit. Patients who received care from nurse practitioners and physicians had significantly shorter stays in intensive care (4.8 ± 4.8 days versus 6.7 ± 10.3 days, p < 0.021). Mechanical ventilation days, total length of hospital stay, rehabilitation prescription, mortality in intensive care and hospital, and readmission to intensive care were all similar to those who received care only from physicians. The multiple regression analysis suggests that participation of nurse practitioners in intensive care reduced the length of stay in the unit by 2.6 days (p = 0.003). These findings could help to increase use of non-physician healthcare providers in intensive care. Our results demonstrated that it is both effective and safe for nurse practitioners to participate in intensive care teams that provide care for postoperative patients receiving mechanical ventilation.
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Affiliation(s)
- Kazunao Mori
- Division of Nursing, Aichi Medical University Hospital, Aichi, Japan
| | - Yoko Tsukamoto
- Department of Nursing and Social Sciences, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Satoshi Makino
- Division of Nursing, Aichi Medical University Hospital, Aichi, Japan
| | | | | | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital, Aichi, Japan
| | - Masatoshi Okumura
- Department of Anesthesiology, Aichi Medical University, Aichi, Japan
| | - Yoshihito Fujita
- Department of Anesthesiology, Aichi Medical University, Aichi, Japan
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Bloemen B, Pijpers E, Cup E, Groothuis J, van Engelen B, van der Wilt GJ. Care for capabilities: Implementing the capability approach in rehabilitation of patients with neuromuscular diseases. Study protocol of the controlled before-after ReCap-NMD study. PLoS One 2021; 16:e0261475. [PMID: 34932590 PMCID: PMC8691629 DOI: 10.1371/journal.pone.0261475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background High quality care of patients with neuromuscular diseases requires a personalised approach that focuses on achieving and maintaining a level of functioning that enables them to be in a state of well-being. The capability approach states that well-being should be understood in terms of capabilities, the substantial opportunities that people have to be and do things they have reasons to value. In this Rehabilitation and Capability care for patients with Neuromuscular diseases (ReCap-NMD) study, we want to investigate whether providing care based on the capability approach (capability care) has an added value in the rehabilitation of patients with neuromuscular diseases (NMD). Methods Two groups of 30 adult patients with facioscapulohumeral muscular dystrophy or myotonic dystrophy type 1 will be included. The first group will receive rehabilitation care as usual with a follow-up period of 6 months. Then, based on theory, and experiences of patients and healthcare professionals, capability care will be developed. During the following 3 months, the multidisciplinary outpatient rehabilitation care team will be trained in providing this newly developed capability care. Subsequently, the second group will receive capability care, with a follow-up period of 6 months. A mixed methods approach is used with both qualitative and quantitative outcome measures to evaluate the effect of capability care and to perform a process evaluation. The primary outcome measure will be the Canadian Occupational Performance Measure. Discussion The ReCap-NMD study is the first study to design and implement a healthcare intervention based on the capability approach. The results of this study will expand our knowledge on how the capability approach can be applied in delivering and evaluating healthcare, and will show whether implementing such an intervention leads to a higher well-being for patients with NMD. Trial registration Registered at Trialregister.nl (Trial NL8946) on 12th of October, 2020.
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Affiliation(s)
- Bart Bloemen
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- * E-mail: (BB); (EP)
| | - Eirlys Pijpers
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- * E-mail: (BB); (EP)
| | - Edith Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Baziel van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Abstract
OBJECTIVE To characterise the extent to which health professionals perform SBAR (situation, background, assessment, recommendation) as intended (ie, with high fidelity) and the extent to which its use improves communication clarity or other quality measures. DATA SOURCES Medline, Healthstar, PsycINFO, Embase and CINAHL to October 2020 and handsearching selected journals. STUDY SELECTION AND OUTCOME MEASURES Eligible studies consisted of controlled trials and time series, including simple before-after design, assessing SBAR implementation fidelity or the effects of SBAR on communication clarity or other quality measures (eg, safety climate, patient outcomes). DATA EXTRACTION AND SYNTHESIS Two reviewers independently abstracted data according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses on study features, intervention details and study outcomes. We characterised the magnitude of improvement in outcomes as small (<20% relative increase), moderate (20%-40%) or large (>40%). RESULTS Twenty-eight studies (3 randomised controlled trials, 6 controlled before-after studies, and 19 uncontrolled before-after studies) met inclusion criteria. Of the nine studies assessing fidelity of SBAR use, four occurred in classroom settings and three of these studies reported large improvements. The five studies assessing fidelity in clinical settings reported small to moderate effects. Among eight studies measuring communication clarity, only three reported large improvements and two of these occurred in classroom settings. Among the 17 studies reporting impacts on quality measures beyond communication, over half reported moderate to large improvements. These improvements tended to involve measures of teamwork and culture. Improvements in patient outcomes occurred only with intensive multifaceted interventions (eg, early warning scores and rapid response systems). CONCLUSIONS High fidelity uptake of SBAR and improvements in communication clarity occurred predominantly in classroom studies. Studies in clinical settings achieving impacts beyond communication typically involved broader, multifaceted interventions. Future efforts to improve communication using SBAR should first confirm high fidelity uptake in clinical settings rather than assuming this has occurred. PROSPERO REGISTRATION NUMBER CRD42018111377.
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Affiliation(s)
- Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Kaveh Shojania
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Munro MG. Re: Aarts JWM, Thompson R, Alam SS, Dannenberg M, Elwyn G, Foster TC, Encounter decision aids to facilitate shared decision-making with women experiencing heavy menstrual bleeding or symptomatic uterine fibroids: a before-after study [Patient Education and Counseling (2021), doi: https://doi.org/10.1016/j.pec.2021.02.027]. Patient Educ Couns 2021; 104:2843-2844. [PMID: 34389226 DOI: 10.1016/j.pec.2021.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, 5011 Palomar Drive, Los Angeles, CA 91356, United States.
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Ehrman RR, Malik AN, Smith RK, Kalarikkal Z, Huang A, King RM, Green RD, O'Neil BJ, Sherwin RL. Serial use of existing clinical decisions aids can reduce computed tomography pulmonary angiography for pulmonary embolism. Intern Emerg Med 2021; 16:2251-2259. [PMID: 33742340 DOI: 10.1007/s11739-021-02703-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Pulmonary embolism (PE) remains a diagnostic challenge in emergency medicine. Clinical decision aids (CDAs) like the Pulmonary Embolism Rule-Out Criteria (PERC) are sensitive but poorly specific; serial CDA use may improve specificity. The goal of this before-and-after study was to determine if serial use of existing CDAs in a novel diagnostic algorithm safely decreases the use of CT pulmonary angiograms (CTPA). This was a retrospective before-and-after study conducted at an urban ED with 105,000 annual visits. Our algorithm uses PERC, Wells' score, and D-dimer in series, before moving to CTPA. The algorithm was introduced in January, 2017. Use of CDAs and D-dimer in the 24 months pre- and 12 months post-intervention were obtained by chart review. The algorithm's effect on CTPA ordering was assessed by comparing volume 5 years pre- and 3 years post-intervention, adjusted for ED volume. Mean CTPAs per 1000 adult ED visits was 11.1 in the 5 pre-intervention years and 9.9 in the 3 post-intervention years (p < 0.0001). Use of PERC, Wells' score and D-dimer increased from 1.1%, 1.1%, and 28% to 8.8% (p = 0.0002) 8.1% (p = 0.0005), and 35% (p = 0.0066), respectively. Pre-intervention, there were six potentially missed PEs compared to three in the post-intervention period. Introduction of our serial CDA diagnostic algorithm was associated with increased use of CDAs and D-dimer and reduced CTPA rate without an apparent increase in the number of missed PEs. Prospective validation is needed to confirm these results.
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Affiliation(s)
- Robert Russell Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA.
| | - Adrienne Nicole Malik
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Reid Kenneth Smith
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Zeid Kalarikkal
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Andrew Huang
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Ryan Michael King
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Rubin David Green
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
| | - Brian James O'Neil
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Detroit Receiving Hospital, Detroit, USA
| | - Robert Leigh Sherwin
- Department of Emergency Medicine, Wayne State University School of Medicine; Detroit Medical Center/Sinai-Grace Hospital, 4201 St. Antoine, Suite 6G, Detroit, MI, 48201, USA
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Jung E, Ro YS, Ryu HH, Kong SY, Lee SY. Effect of implementation of multi-tier response system and prolonged on-scene resuscitation for out-of-hospital cardiac arrest. Am J Emerg Med 2021; 51:79-84. [PMID: 34688965 DOI: 10.1016/j.ajem.2021.09.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/08/2021] [Revised: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The purpose of this study was to explain the process and results of implementing a bundle of two cardiopulmonary resuscitation (CPR) programs in Gwang-ju metropolitan city and to determine whether the use of these programs improved the clinical outcomes for out-of-hospital cardiac arrest (OHCA) patients. METHODS This was a before- and after-intervention study of the implementation of a bundle of two CPR programs in Gwang-ju. The main intervention was a multi-tier response (MTR) system, with an emphasis on prolonged on-scene resuscitation. The primary outcome was good neurological recovery, and secondary outcomes were survival to discharge and prehospital return of spontaneous circulation (ROSC). A multivariable logistic regression model was used to estimate the association between the study period and outcomes, after adjusting for potential confounders. Interaction analysis was conducted to determine whether the location of arrest and witness status modified the effect of the study period on the study outcomes. RESULTS The adjusted odds ratios (AORs) for the intervention were 1.35 (0.96-1.90) for pre-hospital ROSC, 1.19 (0.49-2.86) for survival to discharge, and 3.45 (1.01-11.80) for good CPC. The AORs for good neurological recovery of the after-intervention period were 2.93 (0.73-11.77) for a private place, 4.82 (1.04-22.39) for a public place, 5.88 (1.47-23.57) for a witnessed arrest, and 1.49 (0.28-7.86) for a non-witnessed arrest. CONCLUSIONS OHCA patients treated in the after-intervention period with the bundle of CPR programs including MTR and prolonged on-scene resuscitation showed better clinical outcomes, especially pre-hospital ROSC, and neurological recovery at hospital discharge than those treated in the before-intervention period.
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Affiliation(s)
- Eujene Jung
- Department of Emergency medicine, Chonnam National University Hospital, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency medicine, Chonnam National University Hospital, Republic of Korea; Chonnam National University College of Medicine, Republic of Korea.
| | | | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Republic of Korea
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Liu P, Ma S, Du G, Sun S, Zhang X, Tang P, Hou C, Liu Y, Zhao J, Zhang X, Chen L, Gu C, Zhang L, Chong L, Yang X, Li R. Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China. J Gen Intern Med 2021; 36:3064-3070. [PMID: 33501533 PMCID: PMC8481407 DOI: 10.1007/s11606-020-06475-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Single disciplinary management of patients with vertigo and dizziness is an important challenge for most physicians in China. OBJECTIVE To assess the impact of a new paradigm of practice (Clinic for Vertigo and Dizziness, CVD) performed by a multidisciplinary team (MDT) on diagnostic spectrum, medical costs, and patient satisfaction. DESIGN Retrospective before-after study. PARTICIPANTS Sample of 29,793 patients with vertigo/dizziness as primary complaint. MEASURES Changes in diagnostic spectrum, medical costs, and patient satisfaction before and after the establishment of a CVD based on a 4-year database in three tertiary hospitals in northwestern China. KEY RESULTS The most common diagnoses of patients with vertigo and dizziness were Meniere's disease (25.77%), cervical disease (25.00%), cerebral vascular disease (13.96%), vestibular syndrome (10.57%), and other etiologies (6.34%) before the CVD establishment. In contrast, after the CVD establishment, the most common diagnoses were BPPV (23.92%), vestibular migraine (15.83%), Meniere's disease (14.22%), CSD/PPPD (11.61%), and cerebral vascular diseases (4.45%). Extended implementation of a structured questionnaire for vertigo/dizziness and vestibular-oriented examinations (nystagmus, positional tests, HINTS) at the CVD resulted in a remarkable decline in the utility of CT/MRI and X-ray examination (p < 0.001). Meanwhile, medical costs in patients with vertigo/dizziness dropped by 11.5% (p < 0.001), with a significant improvement in patient satisfaction after the establishment of CVD (p < 0.001). CONCLUSIONS AND RELEVANCE Our study suggested that the MDT paradigm of CVD practice may facilitate the medical management of patients with vertigo/dizziness and improve patient satisfaction.
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Affiliation(s)
- Peng Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Shaolin Ma
- Clinic for Vertigo and Dizziness, Xinyuan Hospital of Yulin, Yulin, 719000 Shaanxi People’s Republic of China
| | - Guixiang Du
- Clinic for Vertigo and Dizziness, The First Municipal Hospital of Weinan, Weinan, 714000 Shaanxi People’s Republic of China
| | - Shengde Sun
- Otorhinolaryngology Head and Neck Surgery, Wuwei People’s Hospital, Wuwei, 733000 Gansu People’s Republic of China
| | - Xin Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Peng Tang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chen Hou
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Yue Liu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Jiaxing Zhao
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xiaohui Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chen
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Chaochao Gu
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Lina Zhang
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Li Chong
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Aerospace Clinical Medical College of Peking University, Beijing, 100049 People’s Republic of China
| | - Rui Li
- Vertigo and Dizziness Center, Shaanxi Provincial People’s Hospital, No. 256 Youyi Rd., Xi’an, 710068 Shaanxi People’s Republic of China
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Aarts JWM, Thompson R, Alam SS, Dannenberg M, Elwyn G, Foster TC. Encounter decision aids to facilitate shared decision-making with women experiencing heavy menstrual bleeding or symptomatic uterine fibroids: A before-after study. Patient Educ Couns 2021; 104:2259-2265. [PMID: 33632633 DOI: 10.1016/j.pec.2021.02.027] [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] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/19/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?. METHODS This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION5. Consultation transcripts in the 'after' group were checked for adherence to the steps required for intended use of decision aids. RESULTS 16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53-19.47). CONCLUSION The level of SDM was higher after the introduction of the package than before. PRACTICE IMPLICATIONS This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.
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Affiliation(s)
- Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, the Netherlands.
| | - Rachel Thompson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Shama S Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Michelle Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Tina C Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA; Department Obstetrics & Gynaecology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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