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Van den Wyngaert I, Van Pottelbergh G, Coteur K, Vaes B, Van den Bulck S. Developing a questionnaire to evaluate an automated audit & feedback intervention: a Rand-modified Delphi method. BMC Health Serv Res 2024; 24:433. [PMID: 38581009 PMCID: PMC10998400 DOI: 10.1186/s12913-024-10915-2] [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: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a widely used implementation strategy to evaluate and improve medical practice. The optimal design of an A&F system is uncertain and structured process evaluations are currently lacking. This study aimed to develop and validate a questionnaire to evaluate the use of automated A&F systems. METHODS Based on the Clinical Performance Feedback Intervention Theory (CP-FIT) and the REFLECT-52 (REassessing audit & Feedback interventions: a tooL for Evaluating Compliance with suggested besT practices) evaluation tool a questionnaire was designed for the purpose of evaluating automated A&F systems. A Rand-modified Delphi method was used to develop the process evaluation and obtain validation. Fourteen experts from different domains in primary care consented to participate and individually scored the questions on a 9-point Likert scale. Afterwards, the questions were discussed in a consensus meeting. After approval, the final questionnaire was compiled. RESULTS A 34-question questionnaire composed of 57 items was developed and presented to the expert panel. The consensus meeting resulted in a selection of 31 questions, subdivided into 43 items. A final list of 30 questions consisting of 42 items was obtained. CONCLUSION A questionnaire consisting of 30 questions was drawn up for the assessment and improvement of automated A&F systems, based on CP-FIT and REFLECT-52 theory and approved by experts. Next steps will be piloting and implementation of the questionnaire.
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Affiliation(s)
- Ine Van den Wyngaert
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
| | - Gijs Van Pottelbergh
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Kristien Coteur
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Bert Vaes
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Steve Van den Bulck
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
- Research Group Healthcare and Ethics, Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
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Mwakisha J, Adika B, Nyawade S, Phori PM, Nidjergou NN, Silouakadila C, Fawcett S. Kenya's Experience: Factors Enabling and Impeding the COVID-19 Response. Health Promot Pract 2024; 25:220-226. [PMID: 36734323 PMCID: PMC9899671 DOI: 10.1177/15248399221117566] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This case study describes the country-level response to the COVID-19 pandemic in Kenya between February 2020 and May 2021. We organize the presentation of COVID-19 response strategies across the five stages of (a) engagement, (b) assessment, (c) planning, (d) action/implementation, and (e) evaluation. We describe the participatory monitoring and evaluation (M&E) process implemented in collaboration with the WHO Regional Office for Africa Monitoring and Evaluation Team. The M&E system was used to organize and make sense of emerging data regarding specific response activities and changing COVID incidence. We share the results of that collaborative sensemaking, with particular attention to our analysis of the factors that facilitated and those that impeded our pandemic response. We conclude with lessons learned and practical implications from Kenya's experience to help guide future country-level responses to rapidly changing public health crises.
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Affiliation(s)
| | - Ben Adika
- World Health Organization, Kenya
Country Office Nairobi, Kenya
| | | | | | | | - Cleph Silouakadila
- World Health Organization Regional
Office for Africa, Brazzaville, Congo
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3
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Mitchell R, Fang W, Tee QW, O'Reilly G, Romero L, Mitchell R, Bornstein S, Cameron P. Systematic review: What is the impact of triage implementation on clinical outcomes and process measures in low- and middle-income country emergency departments? Acad Emerg Med 2024; 31:164-182. [PMID: 37803524 DOI: 10.1111/acem.14815] [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: 07/12/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Triage is widely regarded as an essential function of emergency care (EC) systems, especially in resource-limited settings. Through a systematic search and review of the literature, we investigated the effect of triage implementation on clinical outcomes and process measures in low- and middle-income country (LMIC) emergency departments (EDs). METHODS Structured searches were conducted using MEDLINE, CENTRAL, EMBASE, CINAHL, and Global Health. Eligible articles identified through screening and full-text review underwent risk-of-bias assessment using the Newcastle-Ottawa Scale. The quality of evidence for each effect measure was summarized using GRADE. RESULTS Among 10,394 articles identified through the search strategy, 58 underwent full-text review and 16 were included in the final synthesis. All utilized pre-/postintervention methods and a majority were single center. Effect measures included mortality, waiting time, length of stay, admission rate, and patient satisfaction. Of these, ED mortality and time to clinician assessment were evaluated most frequently. The majority of studies using these outcomes identified a positive effect, namely a reduction in deaths and waiting time among patients presenting for EC. The quality of the evidence was moderate for these measures but low or very low for all other outcomes and process indicators. CONCLUSIONS There is moderate quality of evidence supporting an association between the introduction of triage and a reduction in deaths and waiting time. Although the available data support the value of triage in LMIC EDs, the risk of confounding and publication bias is significant. Future studies will benefit from more rigorous research methods.
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Affiliation(s)
- Rob Mitchell
- Alfred Health, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wendy Fang
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Qiao Wen Tee
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gerard O'Reilly
- Alfred Health, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Peter Cameron
- Alfred Health, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Kong H, Rong J, Bain C, Zhang X, Parsons S, Chen G, Bassed R. Pericardial Effusion Detection on Post-Mortem Computed Tomography Images Using Convolutional Neural Networks. Stud Health Technol Inform 2024; 310:745-749. [PMID: 38269908 DOI: 10.3233/shti231064] [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] [Indexed: 01/26/2024]
Abstract
Pericardial effusion can be a sign of significant underlying diease and, in some cases, may lead to death. Post-mortem computed tomography (PMCT) is a well-established tool to assist death investigation processes in the forensic setting. In practice, the scarcity of well-trained radiologists is a challenge in processing raw whole-body PMCT images for pericardial effusion detection. In this work, we propose a Pericardial Effusion Automatic Detection (PEAD) framework to automatically process raw whole-body PMCT images to filter out the irrelevant images with heart organ absent and focus on pericardial effusion detection. In PEAD, the standard convolutional neural network architectures of VGG and ResNet are carefully modified to fit the specific characteristics of PMCT images. The experimental results prove the effectiveness of the proposed framework and modified models. The modified VGG and ResNet models achieved superior detection accuracy than the standard architecture with reduced processing speed.
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Affiliation(s)
- Haoyu Kong
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Australia
| | - Jia Rong
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Australia
| | - Chris Bain
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Australia
| | - Xinyu Zhang
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Australia
| | - Sarah Parsons
- Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
- Victorian Institute of Forensic Medicine, Australia
| | - Guanliang Chen
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Australia
| | - Richard Bassed
- Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
- Victorian Institute of Forensic Medicine, Australia
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Atkins E, Kellar I, Birmpili P, Waton S, Li Q, Johal AS, Boyle JR, Pherwani AD, Chetter I, Cromwell DA. The symptom to assessment pathway for suspected chronic limb-threatening ischaemia (CLTI) affects quality of care: a process mapping exercise. BMJ Open Qual 2024; 13:e002605. [PMID: 38267216 PMCID: PMC10824038 DOI: 10.1136/bmjoq-2023-002605] [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: 09/14/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Delays in the pathway from first symptom to treatment of chronic limb-threatening ischaemia (CLTI) are associated with worse mortality and limb loss outcomes. This study examined the processes used by vascular services to provide urgent care to patients with suspected CLTI referred from the community. METHODS Vascular surgery units from various regions in England were invited to participate in a process mapping exercise. Clinical and non-clinical staff at participating units were interviewed, and process maps were created that captured key staff and structures used to create processes for referral receipt, triage and assessment at the units. RESULTS Twelve vascular units participated, and process maps were created after interviews with 45 participants. The units offered multiple points of access for urgent referrals from general practitioners and other community clinicians. Triage processes were varied, with units using different mixes of staff (including medical staff, podiatrists and s) and this led to processes of varying speed. The organisation of clinics to provide slots for 'urgent' patients was also varied, with some adopting hot clinics, while others used dedicated slots in routine clinics. Service organisation could be further complicated by separate processes for patients with and without diabetes, and because of the organisation of services regionally into vascular networks that had arterial and non-arterial centres. CONCLUSIONS For referred patients with symptoms of CLTI, the points of access, triage and assessment processes used by vascular units are diverse. This reflects the local context and ingenuity of vascular units but can lead to complex processes. It is likely that benefits might be gained from simplification.
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Affiliation(s)
- Eleanor Atkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England, UK
- Hull York Medical School, Hull, England, UK
| | - Ian Kellar
- University of Sheffield, Sheffield, England, UK
| | - Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England, UK
- Hull York Medical School, Hull, England, UK
| | - Sam Waton
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England, UK
| | - Qiuju Li
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Amundeep S Johal
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England, UK
| | - Jon R Boyle
- Department of Vascular Surgery, Cambridge University Hospitals, Cambridge, England, UK
| | - Arun D Pherwani
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, England, UK
| | | | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England, UK
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Ballart X, Rico G. How much convergence exists between registered process measures and patient reported experience measures? A study on Catalan primary healthcare. Int J Health Plann Manage 2023; 38:1772-1788. [PMID: 37653581 DOI: 10.1002/hpm.3701] [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: 01/11/2023] [Revised: 07/22/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
The use of quality measures is important for transparency and the continuous improvement of performance. However, we do not know enough about the relationship between registered process measures and patient reported experience measures (PREMs) in primary healthcare. Recent studies point to areas of convergence that run contrary anticipated trends. This is a relevant question for healthcare management and governments as their position is stronger when system's guidelines and targets also matter to patients or, vice versa, when patient-centered measures are used to develop new process measures. Our aim is to study both type of measures, their logic and their level of convergence. We also assess the relationship between PREMs, patients' demographic characteristics and area socioeconomic level. We estimated pairwise correlations with patient experience aggregated at the health-center level and a series of multilevel regression models to assess the adjusted effect of four registered process measures on ratings of patient experience at the patient level. We use patient experience as measured by survey data, two composite quality indices and two single indicators regularly computed by the Catalan Health Service. Continuity of care with the same doctor and accessibility are positively associated with patient experience. No relationship was observed in the index created to measure quality of assistance. The index measuring the quality of prescriptions was positively associated with patient experience but only when analyzed separately. We conclude that registered process measures and PREMs are not entirely independent, hence improvements of the management side have the potential to impact patient experience.
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Affiliation(s)
- Xavier Ballart
- Departament de Ciència Política, Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Guillem Rico
- Departament de Ciència Política, Universitat Autonoma de Barcelona, Bellaterra, Spain
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Miller A, Skoranski AK, Prior B, Fitzpatrick R, Morgan C, Hepschmidt P, Smith BA, Cella M, Brown McGlotten D, Pitt K, Polomano RC. An "Engage to Sustain" Intervention to Improve Process Performance Measures in Ambulatory Care. J Ambul Care Manage 2023; 46:284-297. [PMID: 37540113 DOI: 10.1097/jac.0000000000000474] [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: 08/05/2023]
Abstract
In ambulatory care, monitoring process performance measures (PPMs) is essential to meet regulatory requirements, establish targets for care, seek reimbursement, and evaluate patient care responsibilities. We implemented a comprehensive program, "Engage to Sustain," for licensed practical nurses (LPNs) and certified medical assistants (CMAs) to practice at the top of their licensure/certification. Screening rates for 4 key PPMs (depression screening, fall risk screening, and tobacco use screening and counseling) markedly increased following this intervention across 18 ambulatory departments with more than 2 million patient visits. These results suggest that shifting responsibilities for patient screening from physicians and advanced practitioners to LPNs and CMAs may improve screening rates.
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Affiliation(s)
- Angela Miller
- Penn Medicine Clinical Practices of the University of Pennsylvania, Philadelphia (Drs Miller and Fitzpatrick and Mss Prior and Pitt); Penn Medicine Medical Group, Penn Primary Care & Penn Specialty Practices, Philadelphia, Pennsylvania (Mr Skoranski); Corporate Information Services (Dr Brown McGlotten), Penn Medicine, Philadelphia, Pennsylvania (Mss Morgan and Hepschmidt); Hospital of the University of Pennsylvania, Philadelphia (Ms Smith); Primary Care and Penn Specialty Practices, Bala Cynwyd, Pennsylvania (Mr Cella); and University of Pennsylvania School of Nursing, Philadelphia (Dr Polomano)
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Johnson L, Kirk H, Clark B, Heath S, Royse C, Adams C, Portillo MC. Improving personalised care, through the development of a service evaluation tool to assess, understand and monitor delivery. BMJ Open Qual 2023; 12:e002324. [PMID: 37669810 PMCID: PMC10481846 DOI: 10.1136/bmjoq-2023-002324] [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: 02/17/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Systematically implementing personalised care has far reaching benefits to individuals, communities and health and social care systems. If done well, personalised care can result in better health outcomes and experiences, more efficient use of health services and reduced health inequalities. Despite these known benefits, implementation of personalised care has been slow. Evaluation is an important step towards achieving the ambition of universally delivered personalised care. There are currently few comprehensive assessments or tools that are designed to understand the implementation of personalised care at a service or system level, or the cultural, practical and behavioural factors influencing this. The aim of this paper is to describe the development and testing of a system-wide evaluation tool. The tool offers a process through which healthcare systems can better understand the current delivery of personalised care and the factors influencing this. With a focus on implementation, the development of the tool was informed by the Consolidated Framework for Implementation Research, and its content is structured using behaviour change theory (COM-B Theory of Behaviour Change Model). The tool consists of four mirrored surveys, which were developed using an iterative exploratory design. This included a series of testing cycles, in which its structure and content were continually refined. To date, it has been used by 24 clinical services, involving 397 service users, 313 front-line practitioners, 73 service managers and 40 commissioners. These services have used the evaluation process to initiate quality improvement, targeted at one of the more aspects of personalised care. The use of the COM-B model increases the likelihood of those improvements being sustained, through identification of the core factors that enable or limit personalised care behaviours among healthcare staff. We have shown this process to be applicable in a wide range of settings, thus it potentially has broad applicability as a tool for cultural change and quality improvement. The next stage of this work will focus on implementation and evaluation, to fully understand if and how the tool can be used to drive improvements in personalised care delivery.
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Affiliation(s)
- Louise Johnson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Hayden Kirk
- Adult Services, Solent NHS Trust, Southampton, UK
| | - Beth Clark
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | | | - Carolyn Royse
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Carl Adams
- Academy of Research and Improvement, Solent NHS Trust, Southampton, UK
| | - Mari Carmen Portillo
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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Pini JDS, Nacamura PAB, Harmuch C, Costa MAR, Giacon-Arruda BCC, Radovanovic CAT, Salci MA, Paiano M. Assessment of the Psychosocial Care Center multidisciplinary team from users' and family members' perspective. Rev Bras Enferm 2023; 76:e20220645. [PMID: 37610952 PMCID: PMC10441209 DOI: 10.1590/0034-7167-2022-0645] [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: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES to assess the multidisciplinary team of a Psychosocial Care Center I from users' and family members' perspective. METHODS an evaluative study, anchored in the fourth generation evaluation theoretical-methodological framework, carried out in a Psychosocial Care Center I, from September 2021 to March 2022. Eleven users and 06 family members participated. Data were collected through non-participant observation, individual interviews and negotiation sessions, and analyzed using the Constant Comparative Method, using the MAXQDA software. RESULTS the team develops its care based on individual and collective care, with integrated and complementary work by professionals. They seek to facilitate treatment initiation and continuation, considering health needs and offering support, understanding and guidance to users and their families. FINAL CONSIDERATIONS the multidisciplinary team's work is based on the psychosocial paradigm, which can qualify care and strengthen the service role in the mental health network.
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Affiliation(s)
- Jéssica dos Santos Pini
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
- Universidade Estadual do Paraná. Paranavaí, Paraná, Brazil
| | | | - Camila Harmuch
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
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Shah TA, Knapp L, Cohen ME, Brethauer SA, Wick EC, Ko CY. Truth of Colorectal Enhanced Recovery Programs: Process Measure Compliance in 151 Hospitals. J Am Coll Surg 2023; 236:543-550. [PMID: 36852926 DOI: 10.1097/xcs.0000000000000562] [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] [Indexed: 03/01/2023]
Abstract
BACKGROUND Commonly cited studies have reported substantial improvements (defined as >20%) in process measure compliance after implementation of colorectal enhanced recovery programs (ERPs). However, hospitals have anecdotally reported difficulties in achieving similar improvement gains. This study evaluates improvement uniformity among 151 hospitals exposed to an 18-month implementation protocol for 6 colorectal ERP process measures (oral antibiotics, mechanical bowel preparation, multimodal pain control, early mobilization, early liquid intake, and early solid intake). STUDY DESIGN One hundred fifty-one hospitals implemented a colorectal ERP with pathway, educational and supporting materials, and data capture protocols; 906 opportunities existed for process compliance improvement across the cohort (151 hospitals × 6 process measures). However, 240 opportunities were excluded due to high starting compliance rates (ie compliance >80%) and 3 opportunities were excluded because compliance rates were recorded for fewer than 2 cases. Thus, 663 opportunities for improvement across 151 hospitals were studied. RESULTS Of 663 opportunities, minimal improvement (0% to 20% increase in compliance) occurred in 52% of opportunities, substantial improvement (>20% increase in compliance) in 20%, and worsening compliance occurred in 28%. Of the 6 processes, multimodal pain control and use of oral antibiotics improved the most. CONCLUSIONS Contrary to published ERP literature, the majority of study hospitals had difficulty improving process compliance with 80% of the opportunities not achieving substantial improvement. This discordance between ERP implementation success rates reported in the literature and what is observed in a large sample could reflect differences in hospitals' culture or characteristics, or a publication bias. Attention needs to be directed toward improving ERP adoption across the spectrum of hospital types.
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Affiliation(s)
- Tejen A Shah
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Shah, Brethauer)
| | - Leandra Knapp
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
| | - Mark E Cohen
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
| | - Stacy A Brethauer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Shah, Brethauer)
| | - Elizabeth C Wick
- Department of Surgery, University of California, San Francisco, San Francisco, CA (Wick)
| | - Clifford Y Ko
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Ko)
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11
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Dyrbye LN, Gordon J, O'Horo J, Belford SM, Wright M, Satele DV, West CP. Relationships Between EHR-Based Audit Log Data and Physician Burnout and Clinical Practice Process Measures. Mayo Clin Proc 2023; 98:398-409. [PMID: 36868747 DOI: 10.1016/j.mayocp.2022.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 08/23/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To explore the relationship of electronic health record (EHR)-based audit log data with physician burnout and clinical practice process measures. METHODS From September 4 to October 7, 2019, we surveyed physicians in a larger academic medical department and matched responses to August 1 through October 31, 2019, EHR-based audit log data. Multivariable regression analysis evaluated the relationship between log data and burnout and the interrelationship between log data and turnaround time for In Basket messages and percentage of encounters closed within 24 hours. RESULTS Of the 537 physicians surveyed, 413 (77%) responded. On multivariable analysis, number of In Basket messages received per day (each additional message: odds ratio, 1.04 [95% CI, 1.02 to 1.07]; P<.001) and time spent in the EHR outside scheduled patient care (each additional hour: odds ratio, 1.01 [95% CI, 1.00 to 1.02]; P=.04) were associated with burnout. Time spent doing In Basket work (each additional minute: parameter estimate, -0.11 [95% CI, -0.19 to -0.03]; P=.01) and in the EHR outside scheduled patient care (each additional hour: parameter estimate, 0.04 [95% CI, 0.01 to 0.06]; P=.002) were associated with turnaround time (days per message) for In Basket messages. None of the variables explored were independently associated with percentage of encounters closed within 24 hours. CONCLUSION Electronic health record-based audit log data of workload relate to odds of burnout and responsiveness to patient-related inquiries and results. Further study is needed to determine whether interventions that reduce the number of and time spent doing In Basket messages or time spent in the EHR outside scheduled patient care reduce physician burnout and improve clinical practice process measures.
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Affiliation(s)
- Liselotte N Dyrbye
- Department of Medicine. University of Colorado School of Medicine, Denver, CO.
| | - Joel Gordon
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN; Deparment of Medicine, Division of Public Health, Infectious Disease, and Occupational Medicine
| | - John O'Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Rochester, MN
| | | | | | - Daniel V Satele
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Colin P West
- Department of Medicine, Division of General Internal Medicine
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Sun P, Zhou S, Cao H, Cai G, Zhang S, Gao Q, Cheng G, Liu B, Liu G, Zhang X, Liu Y, Wu D, Ding Z, Zeng L, Liao G, Liu L, Wang X, Xiao T, Jin J, Yang H. Design and Implementation of a Chain-Type Direct Push Drilling Rig for Contaminated Sites. Int J Environ Res Public Health 2023; 20:3757. [PMID: 36834448 PMCID: PMC9962342 DOI: 10.3390/ijerph20043757] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
For sites where volatile organic compounds are present, the direct push method, in combination with other sensors for investigation, is a powerful method. The investigation process is an integrated drilling and sensing process, but the trajectory of the probe carrying the sensor is ambiguous. This paper explores and introduces the application of a chain-type direct push drilling rig by designing and building a chain-type direct push miniature drilling rig. This rig allows for indoor experimental studies of direct push trajectories. The chain-type direct push drilling model is proposed based on the mechanism of chain transmission. The drilling rig provides a steady direct thrust through the chain, which is driven by a hydraulic motor. In addition, the drilling tests and results described prove that the chain could be applied to direct push drilling. The chain-type direct push drilling rig can drill to a depth of 1940 mm in single-pass and up to 20,000 mm in multiple passes. The test results also indicate that it drills a total length of 462.461 mm and stops after 87.545 s of operation. The machine can provide a drilling angle of 0-90° and keep the borehole angle fluctuating within 0.6° with the characteristics of strong adjustability, flexibility, continuity, stability, and low disturbance, which is of great value and significance for studying the drilling trajectory of direct push tools and obtaining more accurate investigation data.
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Affiliation(s)
- Pinghe Sun
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Shengwei Zhou
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Han Cao
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Guojun Cai
- School of Civil Engineering, Anhui Jianzhu University, Hefei 230601, China
| | - Shaohe Zhang
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Qiang Gao
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Gongbi Cheng
- Jiangsu Gaiya Environmental Science and Technology Co., Ltd., Suzhou 215000, China
| | - Biao Liu
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Gongping Liu
- College of Chemical Engineering, Nanjing Tech University, Nanjing 211189, China
| | - Xinxin Zhang
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Yun Liu
- Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China
| | - Dongyu Wu
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Zhenyu Ding
- Chinese Academy of Environmental Planning, Ministry of Environmental Protection of China, Beijing 100012, China
| | - Lan Zeng
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Guangdong Liao
- Suntime Environmental Remediation Co., Ltd., Changzhou 213000, China
| | - Leilei Liu
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Xiaokang Wang
- Jiangsu Gaiya Environmental Science and Technology Co., Ltd., Suzhou 215000, China
| | - Ting Xiao
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
| | - Jing Jin
- Suntime Environmental Remediation Co., Ltd., Changzhou 213000, China
| | - Hanhan Yang
- Key Laboratory of Metallogenic Prediction of Nonferrous Metals and Geological Environment Monitoring, Ministry of Education, Changsha 410083, China
- School of Geosciences and Info-Physics, Central South University, Changsha 410083, China
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13
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Grundgeiger T, Hohm A, Michalek A, Egenolf T, Markus C, Happel O. The Validity of the SEEV Model as a Process Measure of Situation Awareness: The Example of a Simulated Endotracheal Intubation. Hum Factors 2022; 64:1181-1194. [PMID: 33596693 PMCID: PMC9574898 DOI: 10.1177/0018720821991651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE In the context of anesthesiology, we investigated whether the salience effort expectancy value (SEEV) model fit is associated with situation awareness and perception scores. BACKGROUND The distribution of visual attention is important for situation awareness-that is, understanding what is going on-in safety-critical domains. Although the SEEV model has been suggested as a process situation awareness measure, the validity of the model as a predictor of situation awareness has not been tested. METHOD In a medical simulation, 31 senior and 30 junior anesthesiologists wore a mobile eye tracker and induced general anesthesia into a simulated patient. When inserting a breathing tube into the mannequin's trachea (endotracheal intubation), the scenario included several clinically relevant events for situation awareness and general events in the environment. Both were assessed using direct awareness measures. RESULTS The overall SEEV model fit was good with no difference between junior and senior anesthesiologists. Overall, the situation awareness scores were low. As expected, the SEEV model fits showed significant positive correlations with situation awareness level 1 scores. CONCLUSION The SEEV model seems to be suitable as a process situation awareness measure to predict and investigate the perception of changes in the environment (situation awareness level 1). The situation awareness scores indicated that anesthesiologists seem not to perceive the environment well during endotracheal intubation. APPLICATION The SEEV model fit can be used to capture and assess situation awareness level 1. During endotracheal intubation, anesthesiologists should be supported by technology or staff to notice changes in the environment.
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Affiliation(s)
- Tobias Grundgeiger
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Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Würzburg,
Germany
| | - Anna Hohm
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Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Würzburg,
Germany
| | - Annabell Michalek
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Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Würzburg,
Germany
| | - Timo Egenolf
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University Hospital Würzburg, Würzburg, Germany
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14
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Hartasanchez SA, Grande SW, Montori VM, Kunneman M, Brito JP, McCarthy S, Hargraves IG. Shared decision making process measures and patient problems. Patient Educ Couns 2022; 105:2457-2465. [PMID: 34802881 PMCID: PMC9079183 DOI: 10.1016/j.pec.2021.11.001] [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] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Purposeful SDM posits four modes of shared decision making (SDM). The use of each mode depends on the type of problem of care that is being addressed. We sought to identify how current observer-based SDM measures apply to each mode of Purposeful SDM. METHODS Four coders, working independently, evaluated 192 items pertaining to 12 observer-based SDM process measures. They classified the items into 6 themes that vary across Purposeful SDM modes and then into one of the four modes (weighing, negotiating, problem-solving, developing insight). Disagreements were resolved by consensus. RESULTS The items were classified as pertaining to the following themes: problem (28), roles/participation (84), options (62), preferences (21), decision (15), and evaluation (6). They were then classified as pertaining particularly to the SDM modes of weighing (54), negotiating (5), problem-solving (0), and developing insight (0) modes, with 191 items applying broadly to all modes of Purposeful SDM. CONCLUSIONS Observer-based SDM measures describe behaviors pertinent to all modes but lack items sensitive to behaviors particular to some modes of SDM. PRACTICE IMPLICATIONS New or revised observer-based measures of the SDM process could help estimate the extent to which the appropriate SDM mode is being used to address the patient's problem.
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Affiliation(s)
- Sandra A Hartasanchez
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stuart W Grande
- Division of Health Policy and Management, School of Public Health, University of Minnesota, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sarah McCarthy
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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15
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Thomas AC, Campbell BT, Subacius H, Bilimoria KY, Stey AM, Hamad D, Nasca B, Nathens AB. Time to OR for patients with abdominal gunshot wounds: A potential process measure to assess the quality of trauma care? J Trauma Acute Care Surg 2022; 92:708-716. [PMID: 35001021 DOI: 10.1097/ta.0000000000003511] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal gunshot wounds (GSWs) require rapid assessment and operative intervention to reduce the risk of death and complications. We sought to determine if time to the operating room (OR) might be a useful process measure for the assessment of trauma care quality. We evaluated the facility benchmark time to OR for patients with serious injury and whether this was associated with lower rates of complications and mortality. METHODS We evaluated time to OR for adult patients with an abdominal GSW presenting in shock to American College of Surgeons Trauma Quality Improvement Program centers from 2015 to 2020. We calculated the 75th percentile time to the OR for each center and characterized centers as average, slow, or fast. We compared patient and facility characteristics across outlier status, as well as risk-adjusted complications and mortality using hierarchical multivariable logistic regression models. RESULTS There were 4,027 patients in 230 centers that met the inclusion criteria. Mortality was 28%. There were 61 (27%) fast and 52 (23%) slow centers. The median time for slow centers was 83 minutes (68-94 minutes) compared with fast centers, 35 minutes (32-38 minutes). Injury Severity Score and emergency department vital signs were similar across centers. Fast hospitals had higher total case volumes, more cases per surgeon, and were more likely to be Level I centers. Patients cared for in these centers had similar risk-adjusted rates of complications and mortality. CONCLUSION Time to OR for patients with abdominal GSWs and shock might be a useful process measure to evaluate rapid decision making and OR access. Surgeon and center experience as measured by annual case volumes, coupled with a rapid surgical response required through Level I trauma center standards might be contributory. There was no association between outlier status and complications or mortality suggesting other factors apart from time to the OR are of greater significance. LEVEL OF EVIDENCE Therapeutic/care management, Level IV.
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Affiliation(s)
- Arielle C Thomas
- From the Department of Surgery, Feinberg School of Medicine (A.T., K.B., A.M.S., B.N.), Northwestern University; Committee on Trauma, American College of Surgeons (A.T., H.S., K.B., A.B.N.), Chicago, Illinois; Department of Surgery (B.C.), University of Connecticut, Mansfield, Connecticut; and Department of Surgery (D.H., A.B.N.), Sunnybrook Health Sciences Center and the University of Toronto, Canada
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16
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Hayes H. Cracking delayed discharges will need local innovation and bold national action. BMJ 2022; 376:o547. [PMID: 35236712 DOI: 10.1136/bmj.o547] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Ingle MP, Check D, Slack DH, Cross SH, Ernecoff NC, Matlock DD, Kavalieratos D. Use of Theoretical Frameworks in the Development and Testing of Palliative Care Interventions. J Pain Symptom Manage 2022; 63:e271-e280. [PMID: 34756957 PMCID: PMC8854360 DOI: 10.1016/j.jpainsymman.2021.10.011] [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: 06/03/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Palliative care (PC) research has grown over the last 20 years. Yet, the causal components and pathways of PC interventions remain unclear. OBJECTIVES To document the prevalence and application of theoretical frameworks in developing and testing PC interventions. METHODS We conducted a secondary analysis of previously published systematic reviews of PC randomized clinical trials. Trials were evaluated for explicit mention of a theoretical framework, process or delivery model, or clinical practice guideline that supported the development of the intervention. We used a structured data extraction form to document study population, outcomes, and whether and how authors used a theoretical framework, process/delivery model, or clinical practice guideline. We applied an adapted coding scheme to evaluate use of theoretical frameworks. RESULTS We reviewed 85 PC trials conducted between 1984 and 2021. Thirty-eight percent (n = 32) of trials explicitly mentioned a theoretical framework, process or delivery model, or clinical practice guideline as a foundation for the intervention design. Only nine trials included a theoretical framework, while the remaining 23 cited a process/delivery model or clinical practice guideline. CONCLUSION Most PC trials do not cite a theoretical foundation for their intervention design. Future work should focus on developing and validating new theoretical frameworks and modifying existing theories and models to better explain the mechanisms of the variety of PC interventions.
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Affiliation(s)
- Mary Pilar Ingle
- Graduate School of Social Work (M.P.I.), University of Denver, Denver, Colorado, USA
| | - Devon Check
- Department of Population Health Sciences (D.C.), Duke University School of Medicine and Duke Cancer Institute, Durham, North Carolina, USA
| | - Daniel Hogan Slack
- Department of Internal Medicine (D.H.S.), University of California Davis School of Medicine, Davis, California, USA
| | - Sarah H Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine (S.H.C., D.K.), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Natalie C Ernecoff
- Division of General Internal Medicine (N.C.E.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel D Matlock
- Division of Geriatrics (D.D.M.), University of Colorado School of Medicine, Aurora, Colorado, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center (D.D.M.), Denver, Colorado, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine (S.H.C., D.K.), Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology (D.K.), Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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18
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Zogg CK, Metcalfe D, Judge A, Perry DC, Costa ML, Gabbe BJ, Schoenfeld AJ, Davis KA, Cooper Z, Lichtman JH. Learning From England's Best Practice Tariff: Process Measure Pay-for-Performance Can Improve Hip Fracture Outcomes. Ann Surg 2022; 275:506-514. [PMID: 33491982 PMCID: PMC9233527 DOI: 10.1097/sla.0000000000004305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate England's Best Practice Tariff (BPT) and consider potential implications for Medicare patients should the US adopt a similar plan. SUMMARY BACKGROUND DATA Since the beginning of the Affordable Care Act, Medicare has renewed efforts to improve the outcomes of older adults through introduction of an expanding set of alternative-payment models. Among trauma patients, recommended arrangements met with mixed success given concerns about the heterogeneous nature of trauma patients and resulting outcome variation. A novel approach taken for hip fractures in England could offer a viable alternative. METHODS Linear regression, interrupted time-series, difference-in-difference, and counterfactual models of 2000 to 2016 Medicare (US), HES-APC (England) death certificate-linked claims (≥65 years) were used to: track US hip fracture trends, look at changes in English hip fracture trends before-and-after BPT implementation, compare changes in US-versus-English mortality, and estimate total/theoretical lives saved. RESULTS A total of 806,036 English and 3,221,109 US hospitalizations were included. After BPT implementation, England's 30-day mortality decreased by 2.6 percentage-points (95%CI: 1.7-3.5) from a baseline of 9.9% (relative reduction 26.3%). 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000 to 2016, US outcomes were stagnant (P > 0.05), resulting in an inversion of the countries' mortality and >38,000 potential annual US lives saved. CONCLUSIONS Process measure pay-for-performance led to significant improvements in English hip fracture outcomes. As efforts to improve US older adult health continue to increase, there are important lessons to be learned from a successful initiative like the BPT.
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Affiliation(s)
- Cheryl K. Zogg
- Yale School of Medicine, New Haven, Connecticut
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Center for Surgery and Public Health: Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Yale School of Public Health, New Haven, Connecticut
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Daniel C. Perry
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew L. Costa
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew J. Schoenfeld
- Center for Surgery and Public Health: Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Boston, Massachusetts
| | | | - Zara Cooper
- Center for Surgery and Public Health: Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Zaid S, Sparr M, Peplinski K, Denmark N, Curtin PG. Using a Developmental Approach to Evaluation Capacity Building in Home Visiting. Eval Rev 2022; 46:58-73. [PMID: 33595355 DOI: 10.1177/0193841x21992196] [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] [Indexed: 06/12/2023]
Abstract
The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, administered by the Health Resources and Service Administration in collaboration with the Administration for Children and Families, provides evidence-based home visiting services across 50 states, the District of Columbia, and five U.S. territories. MIECHV invests in comprehensive technical assistance (TA) to support and build the capacity of awardees to conduct rigorous evaluations of their programs. Throughout the course of the evaluation process, awardees received TA from the Design Options for Home Visiting Evaluation project. Between 2011 and 2020, over 173 state-led evaluations have been conducted. Individual technical assistance (TA) modalities included conference calls, emails, interactive and individualized webinars, developing and sharing resources, and involvement of content experts. When issues and challenges were identified across multiple awardees, Design Options for Home Visiting Evaluation (DOHVE) delivered targeted group TA to awardees with common needs that may benefit from peer-to-peer learning. When cross-cutting issues and challenges were identified, DOHVE used universal approaches such as webinars and guidance documents that were made available to all awardees.Through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, efforts have been taken to promote awardee capacity by targeting all phases of the evaluation process, including planning, implementing, and disseminating findings and providing TA that is responsive and tailored to meet awardee-specific needs. This approach enabled DOHVE to support MIECHV awardees in expanding knowledge of their programs and the evidence base on home visiting. Lessons learned from TA provision highlight the importance of developing feasible plans and providing ongoing support during implementation.
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Affiliation(s)
- Susan Zaid
- 49330James Bell Associates, Arlington, VA, USA
| | | | - Kyle Peplinski
- Division of Home Visiting and Early Childhood Systems, Maternal and Child Health Bureau, 17225Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Nicole Denmark
- Office of Planning, Research, and Evaluation, 17222Administration for Children and Families, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Pooja Gupta Curtin
- Office of Planning, Research, and Evaluation, 17222Administration for Children and Families, U.S. Department of Health and Human Services, Washington, DC, USA
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20
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Srinivasan R, Marathe A, Sane AA, Krishnamurthy V. Adaptation of the Measure of Processes of Care for the Evaluation of Family-Centeredness of Services in India. J Dev Behav Pediatr 2022; 43:e79-e86. [PMID: 34387248 DOI: 10.1097/dbp.0000000000000990] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to (1) adapt the Measure of Processes of Care (MPOC-20) for use in India and (2) evaluate family-centered services for children with disabilities and their caregivers in an urban Indian context. METHODS In this cross-sectional observational study, we translated the MPOC-20 into Hindi. Caregivers of children diagnosed with developmental disabilities who read and/or understood Hindi and had received services for ≥6 months were recruited. The psychometric properties of the Hindi MPOC-20 were assessed using factor analysis followed by reliability analyses. The Hindi MPOC-20 was used to assess caregiver perceptions about the family-centeredness of services delivered between October 2016 and February 2017 at Ummeed Child Development Center. RESULTS Of the 170 eligible children, 141 (83%) comprised the study sample. Most were boys (66%) with a median age of 67 months. Factor analyses yielded a 4-factor scale with items loading differently from the original measure. The resulting Hindi MPOC-20 had acceptable to good internal consistency (Cronbach's alpha of scales: 0.71-0.86). On the Hindi MPOC-20, Respectful and Coordinated Care, Enabling Partnership, and Providing Specific Information were identified as strengths and Providing General Information as a relative limitation of the service by caregivers across different income and education groups. CONCLUSION The Hindi MPOC-20 shows acceptable psychometric properties for use with caregivers of children with disabilities in India. The availability of Hindi MPOC-20 paves the way for the assessment of the family-centeredness of services in India and provides a roadmap for adaptations in other low- and middle-income countries.
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Xu J, Cai B, Huang Y, Sun W. [Implementation of a WeChat small program assisted process assessment system in "Experiment of Inorganic Chemistry" for Biological Engineering undergraduates]. Sheng Wu Gong Cheng Xue Bao 2021; 37:4430-4438. [PMID: 34984887 DOI: 10.13345/j.cjb.200780] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The convenience of "no installation, available at your fingertips" of the WeChat small program makes it unique in the application of mobile terminal auxiliary experimental teaching. In order to optimize the assessment system and improve the quality and outcomes of experimental teaching, a self-designed WeChat small program was used to assist the development of the process assessment system. This system was applied to the teaching practice of "Experiment of Inorganic Chemistry" course for the first-year undergraduates majored in Biological Engineering, with the aim to promote teaching and learning by assessment. The results showed that course scores of the students who used this small program were superior to the control group and the correlation between the process assessment and final examination results was significant. These results indicated the WeChat small program assisted process assessment could effectively improve the learning outcomes of students, enable them to grasp the knowledge of Experiment of Inorganic Chemistry efficiently. The results of the questionnaire for the teachers and students also showed a high recognition of the WeChat small program assisted teaching.
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Affiliation(s)
- Jing Xu
- College of Materials Science and Engineering, Huaqiao University, Xiamen 361021, Fujian, China
| | - Bin Cai
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, China
| | - Yunfang Huang
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, China
| | - Weihai Sun
- College of Materials Science and Engineering, Huaqiao University, Xiamen 361021, Fujian, China
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22
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Ghanbari F, Yaghoot-Nezhad A, Wacławek S, Lin KYA, Rodríguez-Chueca J, Mehdipour F. Comparative investigation of acetaminophen degradation in aqueous solution by UV/Chlorine and UV/H 2O 2 processes: Kinetics and toxicity assessment, process feasibility and products identification. Chemosphere 2021; 285:131455. [PMID: 34273698 DOI: 10.1016/j.chemosphere.2021.131455] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 03/24/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
The degradation of acetaminophen (ACM) was comparatively studied by UV/chlorine and UV/H2O2 systems. An apparent reduction in the removal rate was observed above the optimum pH levels of 7.0 and 3.0 in UV/chlorine and UV/H2O2 processes, respectively. The relative contribution of each oxidizing agent in ACM removal using the two advanced oxidation processes (AOPs) was evaluated. Even though hydroxyl radicals, with the contribution percentage of 90.1%, were determined as the primary oxidizing species in ACM removal using the UV/H2O2 process, reactive chlorine species (RCS), with 43.8% of contribution percentage, were also found to play a pivotal role in ACM removal using the UV/chlorine process. For instance, dichlorine radical (Cl2•-) showed an acceptable contribution percentage of 32.2% in the degradation of ACM by the UV/chlorine process. The rate of ACM degradation significantly rose to 99.9% and 75.6%, as higher amounts of oxidants were used in the UV/chlorine and UV/H2O2 processes, respectively, within 25 min. The introduction of HCO3- ions and humic acid remarkably decreased the rate of ACM degradation in both techniques used in this study. The presence of NO3- and Cl- ions did not considerably affect the removal rate in the UV/chlorine process. The acute toxicity analysis revealed that a more pronounced reduction in the ACM solution toxicity could be achieved by the UV/H2O2 process compared to the UV/chlorine process, which should be ascribed to the formation of chlorinated products in the UV/chlorine treatment. Eventually, plausible oxidation pathways were proposed for each process.
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Affiliation(s)
- Farshid Ghanbari
- Department of Environmental Health Engineering, Abadan University of Medical Sciences, Abadan, Iran.
| | - Ali Yaghoot-Nezhad
- Department of Chemical Engineering, Abadan Faculty of Petroleum Engineering, Petroleum University of Technology, Abadan, 63187-14331, Iran
| | - Stanisław Wacławek
- Institute for Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Studentská 1402/2, 461 17, Liberec 1, Czech Republic.
| | - Kun-Yi Andrew Lin
- Department of Environmental Engineering & Innovation and Development Center of Sustainable Agriculture & Research Center of Sustainable Energy and Nanotechnology, National Chung Hsing University, 250 Kuo-Kuang Road, Taichung, Taiwan.
| | - Jorge Rodríguez-Chueca
- Universidad Politécnica de Madrid (UPM), E.T.S. de Ingenieros Industriales, Departamento de Ingeniería Química Industrial y del Medio Ambiente, c/ de José Gutiérrez Abascal 2, Madrid, 28006, Spain
| | - Fayyaz Mehdipour
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vranas KC, Golden SE, Mathews KS, Schutz A, Valley TS, Duggal A, Seitz KP, Chang SY, Nugent S, Slatore CG, Sullivan DR, Hough CL. The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences: A Qualitative Study. Chest 2021; 160:1714-1728. [PMID: 34062115 PMCID: PMC8164514 DOI: 10.1016/j.chest.2021.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 03/08/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally. RESEARCH QUESTIONS Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists? STUDY DESIGN AND METHODS Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system. RESULTS Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff. INTERPRETATION We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
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Affiliation(s)
- Kelly C Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amanda Schutz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin P Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Steven Y Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Catherine L Hough
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
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Muzaffar H, Nickols-Richardson SM. Using Process Evaluation Results to Compare Peer and Adult Leader Delivery of the PAWS (Peer-Education about Weight Steadiness) Club Program. Nutrients 2021; 13:3901. [PMID: 34836156 PMCID: PMC8621535 DOI: 10.3390/nu13113901] [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] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
To date, there is limited published literature on process evaluation of adolescent health promotion programs. In this paper, we describe the methods and results of PAWS Club process evaluation over 2 years of implementation to compare the effectiveness of delivery by peer and adult leaders. PAWS (Peer-education About Weight Steadiness) Club was a 12-week healthy lifestyle program, delivered to 6th and 7th graders by peer and adult educators, using cluster randomized controlled design. Peer educators were 8th graders in the program schools and adult educators were staff/teachers in the program schools. Trained university students filled out fidelity logs at each session led by peer and adult educators to assess program delivery. The fidelity logs included questions to collect information about the number of participants, duration of the session, percent of activities completed, and if lessons started on time, lesson objectives were clearly stated, lesson objectives were emphasized, demonstrations were visible to participants, all activities were completed, the leader was familiar with lessons, the leader maintained an appropriate pace, the leader kept participants on track, and the leader asked if participants had any questions. Adult educators had a higher mean performance for all questions compared to peer leaders. Significant differences were observed for emphasizing lesson objectives (p = 0.005), making demonstrations visible to participants (p = 0.031), being familiar with the lesson plan (p = 0.000), maintaining an appropriate pace (p = 0.000), keeping participants on track (p = 0.000), and asking if participants had any questions (p = 0.000). Significance was set at p < 0.05. Findings from the current study have implications for designing and conducting a process evaluation of complex healthy lifestyle programs with adolescents in schools. Additional training of peer educators may be needed to enhance program delivery.
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Affiliation(s)
- Henna Muzaffar
- College of Health and Human Sciences, School of Health Studies, Northern Illinois University, DeKalb, IL 60115, USA
| | - Sharon M. Nickols-Richardson
- College of Agricultural, Consumer & Environmental Sciences, Food Science & Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61802, USA;
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Sotto KT, Burian BK, Brindle ME. Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis. J Am Coll Surg 2021; 233:794-809.e8. [PMID: 34592406 DOI: 10.1016/j.jamcollsurg.2021.08.692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. STUDY DESIGN We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes-Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture-pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes-Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices-are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. CONCLUSIONS The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.
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Affiliation(s)
| | - Barbara K Burian
- Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA
| | - Mary E Brindle
- Cumming School of Medicine, University of Calgary, Calgary, AB; Ariadne Labs, Harvard TH Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
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Wenzel L, Heesen C, Scheiderbauer J, van de Loo M, Köpke S, Rahn AC. Evaluation of an interactive web-based programme on relapse management for people with multiple sclerosis (POWER@MS2): study protocol for a process evaluation accompanying a randomised controlled trial. BMJ Open 2021; 11:e046874. [PMID: 34598981 PMCID: PMC8488740 DOI: 10.1136/bmjopen-2020-046874] [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: 11/11/2022] Open
Abstract
INTRODUCTION Process evaluations accompanying complex interventions examine the implementation process of the underlying intervention, identify mechanisms of impact and assess contextual factors. This paper presents the protocol for a process evaluation conducted alongside the randomised controlled trial POWER@MS2. The trial comprises the evaluation of a web-based complex intervention on relapse management in 188 people with multiple sclerosis conducted in 20 centres. The web-based intervention programme focuses on relapse treatment decision making and includes a decision aid, a nurse-led webinar and an online chat. With the process evaluation presented here, we aim to assess participants' responses to and interactions with the intervention to understand how and why the intervention produces change. METHODS AND ANALYSIS A mixed methods design is used to explore the acceptance of the intervention as well as its use and impact on participants. Participants are people with multiple sclerosis, neurologists, nurses and stakeholders. Quantitative semistandardised evaluation forms will be collected throughout the study. Qualitative semistructured telephone interviews will be conducted at the end of the study with selected participants, especially people with multiple sclerosis and neurologists. Quantitative data will be collected and analysed descriptively. Based on the results, the qualitative interviews will be conducted and analysed thematically, and the results will be merged in a joint display table. ETHICS AND DISSEMINATION The process evaluation has received ethical approval from the Ethical Committee of the University of Lübeck (reference 19-024). Findings will be disseminated in peer-reviewed journals, at conferences, meetings and on relevant patient websites. TRIAL REGISTRATION NUMBER NCT04233970.
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Affiliation(s)
- Lisa Wenzel
- Institute of Nursing Science, University of Cologne, Cologne, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jutta Scheiderbauer
- Stiftung für Selbstbestimmung und Selbstvertretung von MS-Betroffenen, Trier, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Self-help Society, Federal Association, Hannover, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Cologne, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
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Visigalli S, Turolla A, Bellandi G, Bellucci M, Clagnan E, Brusetti L, Jia M, Di Cosmo R, Menin G, Bargna M, Bergna G, Canziani R. Autotrophic nitrogen removal for decentralized treatment of ammonia-rich industrial textile wastewater: process assessment, stabilization and modelling. Environ Sci Pollut Res Int 2021; 28:46643-46654. [PMID: 33078358 PMCID: PMC8384811 DOI: 10.1007/s11356-020-11231-y] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
Digital textile printing (DTP) is a game-changer technology that is rapidly expanding worldwide. On the other hand, process wastewater is rich in ammoniacal and organic nitrogen, resulting in relevant issues for discharge into sewer system and treatment in centralized plants. The present research is focused on the assessment of the partial nitritation/anammox process in a single-stage granular sequencing batch reactor for on-site decentralized treatment. The technical feasibility of the process was assessed by treating wastewater from five DTP industries in a laboratory-scale reactor, in one case investigating long-term process stabilization. While experimental results indicated nitrogen removal efficiencies up to about 70%, complying with regulations on discharge in sewer system, these data were used as input for process modelling, whose successful parameter calibration was carried out. The model was applied to the simulation of two scenarios: (i) the current situation of a DTP company, in which wastewater is discharged into the sewer system and treated in a centralized plant, (ii) the modified situation in which on-site decentralized treatment for DTP wastewater is implemented. The second scenario resulted in significant improvements, including reduced energy consumption (- 15%), reduced greenhouse gases emission, elimination of external carbon source for completing denitrification at centralized WWTP and reduced sludge production (- 25%).
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Affiliation(s)
- Simone Visigalli
- Department of Civil and Environmental engineering - Environmental section, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Andrea Turolla
- Department of Civil and Environmental engineering - Environmental section, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | | | - Micol Bellucci
- Department of Civil and Environmental engineering - Environmental section, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Elisa Clagnan
- Faculty of Science and Technology, Free University of Bolzano, Piazza Università 1, 39100, Bolzano, Italy
| | - Lorenzo Brusetti
- Faculty of Science and Technology, Free University of Bolzano, Piazza Università 1, 39100, Bolzano, Italy
| | - Mingsheng Jia
- Department of Civil and Environmental engineering - Environmental section, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | | | - Glauco Menin
- Department of Civil and Environmental engineering - Environmental section, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Martina Bargna
- Lariana Depur, Via Laghetto 1, 22073, Fino Mornasco, Italy
| | | | - Roberto Canziani
- Department of Civil and Environmental engineering - Environmental section, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
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Thomas N, McDonald C, de Boer K, Brand RM, Nedeljkovic M, Seabrook L. Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychol Psychother 2021; 94:854-883. [PMID: 33620133 PMCID: PMC8451850 DOI: 10.1111/papt.12332] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.
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Affiliation(s)
- Neil Thomas
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- Alfred HospitalMelbourneVictoriaAustralia
| | - Caity McDonald
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Kathleen de Boer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Rachel M. Brand
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQldAustralia
| | - Maja Nedeljkovic
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Liz Seabrook
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
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Abstract
Making rapid change during covid-19 has lessons for how to improve healthcare, argue Amar Shah and colleagues
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Affiliation(s)
- Amar Shah
- East London NHS Foundation Trust, London, UK
- University of Leicester, Leicester, UK
| | | | - Paula Tuma
- Hospital Israelita Albert Einstein, Brazil
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Furlong M, McGilloway S, Mulligan C, McGuinness C, Whelan N. Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA-Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial. Trials 2021; 22:243. [PMID: 33794971 PMCID: PMC8015312 DOI: 10.1186/s13063-021-05199-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/09/2020] [Accepted: 03/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness. METHODS The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5-18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up. DISCUSSION Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings. TRIAL REGISTRATION ISRCTN Registry, ISRCTN13365858 . Registered 5th February 2019.
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Affiliation(s)
- Mairead Furlong
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Christine Mulligan
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Colm McGuinness
- Department of Business, Technological University Dublin, Blanchardstown Campus, Dublin, Ireland
| | - Nuala Whelan
- Department of Sociology, Maynooth University, Maynooth, Co. Kildare Ireland
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Heidenreich PA, Estes NAM, Fonarow GC, Jurgens CY, Kittleson MM, Marine JE, McManus DD, McNamara RL. 2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2021; 77:326-341. [PMID: 33303319 DOI: 10.1016/j.jacc.2020.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Low LL, A. B. Rahim FI, Hamzah NAR, Ismail MS. Process evaluation of enhancing primary health care for non-communicable disease management in Malaysia: Uncovering the fidelity & feasibility elements. PLoS One 2021; 16:e0245125. [PMID: 33428645 PMCID: PMC7799751 DOI: 10.1371/journal.pone.0245125] [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: 02/12/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In combating the increasing trend of non-communicable diseases (NCDs) over the last two decades in the country, the Ministry of Health Malaysia developed the Enhanced Primary Health Care (EnPHC) initiative to improve care management across different levels of the public service delivery network. An evaluation research component was embedded to explore the implementation issues in terms of fidelity, feasibility, adaptation and benefit of the initiative's components which were triage, care coordination, screening, risk management and referral system. METHODS A mixed methods study was conducted at 20 participating EnPHC clinics in Johor and Selangor, two months after the intervention was initiated. Data collected from self-reported forms and a structured observation checklist were descriptively analysed. In-depth interviews were also conducted with 20 participants across the clinics selected to clarify any information gaps observed in each clinic, and data were thematically analysed. RESULTS Evaluation showed that all components of EnPHC intervention had been successfully implemented except for the primary triage counter and visit checklist. The challenges were mainly discovered in terms of human resource and physical structure. Although human resource was a common implementation challenge across all interventions, clinic-specific issues could still be identified. Among the adaptive measures taken were task sharing among staff and workflow modification to match the clinic's capacity. Despite the challenges, early benefits of implementation were highlighted especially in terms of service outcomes. CONCLUSIONS The evaluation study disclosed issues of human resource and physical infrastructure when a supplementary intervention is implemented. To successfully achieve a scaled-up PHC service delivery model based on comprehensive management of NCDs patient-centred care, the adaptive measures in local clinic context highlight the importance of collaboration between good organisational process and good clinical practice and process.
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Affiliation(s)
- Lee Lan Low
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Putrajaya, Malaysia
- * E-mail:
| | - Fathullah Iqbal A. B. Rahim
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Nur Aqlili Riana Hamzah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohd Safiee Ismail
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
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Ghanbari F, Giannakis S, Lin KYA, Wu J, Madihi-Bidgoli S. Acetaminophen degradation by a synergistic peracetic acid/UVC-LED/Fe(II) advanced oxidation process: Kinetic assessment, process feasibility and mechanistic considerations. Chemosphere 2021; 263:128119. [PMID: 33297111 DOI: 10.1016/j.chemosphere.2020.128119] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 05/16/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 06/12/2023]
Abstract
Application of peracetic acid (PAA) in Advanced Oxidation Processes (AOPs) has seen an increase in the last few years. In this study, PAA/UVC-LED/transition metal was used to degrade acetaminophen (ACT) in an aqueous solution. Amongst tested transition metals (Fe, Cu, Co, Mn, Ag), Fe(II) demonstrated the highest efficiency. The effect of pH, PAA dosage, initial concentration of ACT and Fe(II) concentration was investigated on ACT removal. More than 95% removal efficiency was obtained in 30 min employing pH = 5.0, PAA 4 mM and 0.5 mM Fe(II) (kapp = 0.0993 min-1). Scavenging experiments highlighted the contribution of oxygen-centered radicals; however, the dominant mechanism is hydroxyl radical-induced, while the superoxide radicals had a negligible role. The effect of anions in water showed that carbonate, (dihydrogen) phosphate and nitrite ions had a strong inhibitory effect, while a neutral effect was observed by sulfate, nitrate and chloride ions. Seven intermediates of ACT oxidation were determined and the ACT degradation pathway by the PAA/UVC-LED/Fe(II) is presented. The efficacy of the PAA/UVC-LED/Fe(II) process was also verified for the degradation of other contaminants of emerging concern and disinfection of fecal indicator microorganisms in real matrix (secondary WW). In conclusion, the studied PAA/UVC-LED/Fe(II) process opens a new perspective as a promising application of advanced oxidation for the degradation of organic pollutants.
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Affiliation(s)
- Farshid Ghanbari
- Department of Environmental Health Engineering, Abadan Faculty of Medical Sciences, Abadan, Iran.
| | - Stefanos Giannakis
- Universidad Politécnica de Madrid, E.T.S. Ingenieros de Caminos, Canales y Puertos, Departamento de Ingeniería Civil: Hidráulica, Energía y Medio Ambiente, Unidad Docente Ingeniería Sanitaria, C/ Profesor Aranguren, S/n, ES, 28040, Madrid, Spain
| | - Kun-Yi Andrew Lin
- Department of Environmental Engineering & Innovation and Development Center of Sustainable Agriculture & Research Center of Sustainable Energy and Nanotechnology, National Chung Hsing University, 250, Kuo-Kuang Road, Taichung, Taiwan
| | - Junxue Wu
- Institute of Plant and Environment Protection, Beijing Academy of Agriculture and Forestry Sciences, Beijing, 100097, China
| | - Soheila Madihi-Bidgoli
- Department of Environmental Health Engineering, Abadan Faculty of Medical Sciences, Abadan, Iran
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Koetter P, Pelton M, Gonzalo J, Du P, Exten C, Bogale K, Buzzelli L, Connolly M, Edel K, Hoffman A, Legro NR, Medina D, Sood N, Blaker J, Kearcher K, Sciamanna C. Implementation and Process of a COVID-19 Contact Tracing Initiative: Leveraging Health Professional Students to Extend the Workforce During a Pandemic. Am J Infect Control 2020; 48:1451-1456. [PMID: 32798633 PMCID: PMC7425552 DOI: 10.1016/j.ajic.2020.08.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/24/2023]
Abstract
Background The Centers for Disease Control and Prevention recommends aggressive contact tracing to control the COVID-19 pandemic. In this work, we (1) describe the development of a COVID-19 contact tracing initiative that includes medical, nursing, and public health students, and is led by clinicians and infectious disease epidemiologists within our health system, and, (2) articulate process steps for contact tracing including workflows and telephone scripts, and, (3) highlight the key challenges and strategies to overcome these challenges. Methods A single academic institution-based contact tracing initiative was rapidly scaled to 110 health professional students, four physicians, two epidemiologists, and a research team. Following training, students called patients who were COVID-19 positive and the individuals they were in contact with to ensure proper isolation and quarantine measures. Students also assisted those who faced barriers to quarantine. Implications In total, between March 24 and May 28 – this initiative completed contact tracing for 536 confirmed cases, which resulted in the identification of 953 contacts. We aim to disseminate this process, including telephone scripts and workflow, to other health systems for use in their initiatives to respond to the COVID-19 pandemic and future public health emergencies.
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Affiliation(s)
- Paige Koetter
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA.
| | - Matthew Pelton
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Jed Gonzalo
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Ping Du
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Cara Exten
- College of Nursing, Pennsylvania State University, State College, PA
| | - Kaleb Bogale
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Lindsay Buzzelli
- Penn State College of Medicine, University Park Regional Campus, State College, PA
| | - Mary Connolly
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Katelyn Edel
- Penn State College of Medicine, University Park Regional Campus, State College, PA
| | - Amy Hoffman
- Penn State College of Medicine, University Park Regional Campus, State College, PA
| | - Nicole R Legro
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Daniela Medina
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Natasha Sood
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Joshua Blaker
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Kalen Kearcher
- Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
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Santens T, Hannes K, Levy S, Diamond G, Bosmans G. Barriers and Facilitators to Implementing Attachment-based Family Therapy into a Child Welfare Setting: A Qualitative Process Evaluation. Fam Process 2020; 59:1483-1497. [PMID: 31823356 DOI: 10.1111/famp.12504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers' experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers' belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.
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Affiliation(s)
- Tara Santens
- Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
| | - Karin Hannes
- Center for Sociological Research, Faculty of Social Sciences, KU Leuven, Leuven, Belgium
| | - Suzanne Levy
- Center for Family Intervention Science, Drexel University, Philadelphia, PA
| | - Guy Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, PA
| | - Guy Bosmans
- Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
- Clinical Psychology, KU Leuven, Leuven, Belgium
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Reynolds MS, Spencer SP, Dunaway A, Buckingham D, Bartman T. Scientific Approach to Assess if Change Led to Improvement-Methods for Statistical Process Control Analysis in Quality Improvement. J Emerg Nurs 2020; 47:198-205. [PMID: 33397579 DOI: 10.1016/j.jen.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
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Yapa HM, De Neve JW, Chetty T, Herbst C, Post FA, Jiamsakul A, Geldsetzer P, Harling G, Dhlomo-Mphatswe W, Moshabela M, Matthews P, Ogbuoji O, Tanser F, Gareta D, Herbst K, Pillay D, Wyke S, Bärnighausen T. The impact of continuous quality improvement on coverage of antenatal HIV care tests in rural South Africa: Results of a stepped-wedge cluster-randomised controlled implementation trial. PLoS Med 2020; 17:e1003150. [PMID: 33027246 PMCID: PMC7540892 DOI: 10.1371/journal.pmed.1003150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 09/15/2019] [Accepted: 06/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. METHODS AND FINDINGS We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing CQI to usual standard of antenatal care (ANC) in 7 nurse-led, public-sector primary care clinics-combined into 6 clusters-over 8 steps and 19 months. Clusters randomly switched from comparator to intervention on pre-specified dates until all had rolled over to the CQI intervention. Investigators and clusters were blinded to randomisation until 2 weeks prior to each step. The intervention was delivered by trained CQI mentors and included standard CQI tools (process maps, fishbone diagrams, run charts, Plan-Do-Study-Act [PDSA] cycles, and action learning sessions). CQI mentors worked with health workers, including nurses and HIV lay counsellors. The mentors used the standard CQI tools flexibly, tailored to local clinic needs. Health workers were the direct recipients of the intervention, whereas the ultimate beneficiaries were pregnant women attending ANC. Our 2 registered primary endpoints were viral load (VL) monitoring (which is critical for elimination of mother-to-child transmission of HIV [eMTCT] and the health of pregnant women living with HIV) and repeat HIV testing (which is necessary to identify and treat women who seroconvert during pregnancy). All pregnant women who attended their first antenatal visit at one of the 7 study clinics and were ≥18 years old at delivery were eligible for endpoint assessment. We performed intention-to-treat (ITT) analyses using modified Poisson generalised linear mixed effects models. We estimated effect sizes with time-step fixed effects and clinic random effects (Model 1). In separate models, we added a nested random clinic-time step interaction term (Model 2) or individual random effects (Model 3). Between 15 July 2015 and 30 January 2017, 2,160 participants with 13,212 ANC visits (intervention n = 6,877, control n = 6,335) were eligible for ITT analysis. No adverse events were reported. Median age at first booking was 25 years (interquartile range [IQR] 21 to 30), and median parity was 1 (IQR 0 to 2). HIV prevalence was 47% (95% CI 42% to 53%). In Model 1, CQI significantly increased VL monitoring (relative risk [RR] 1.38, 95% CI 1.21 to 1.57, p < 0.001) but did not improve repeat HIV testing (RR 1.00, 95% CI 0.88 to 1.13, p = 0.958). These results remained essentially the same in both Model 2 and Model 3. Limitations of our study include that we did not establish impact beyond the duration of the relatively short study period of 19 months, and that transition steps may have been too short to achieve the full potential impact of the CQI intervention. CONCLUSIONS We found that CQI can be effective at increasing quality of primary care in rural Africa. Policy makers should consider CQI as a routine intervention to boost quality of primary care in rural African communities. Implementation research should accompany future CQI use to elucidate mechanisms of action and to identify factors supporting long-term success. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov under registration number NCT02626351.
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Affiliation(s)
- H. Manisha Yapa
- The Kirby Institute, University of New South Wales Sydney, NSW, Australia
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- * E-mail:
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Terusha Chetty
- Health systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - Carina Herbst
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Frank A. Post
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Awachana Jiamsakul
- The Kirby Institute, University of New South Wales Sydney, NSW, Australia
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Guy Harling
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Wendy Dhlomo-Mphatswe
- School of Clinical Medicine, Discipline of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
| | - Mosa Moshabela
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Philippa Matthews
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Islington GP Federation, London, United Kingdom
| | - Osondu Ogbuoji
- Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Frank Tanser
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Sally Wyke
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Institute for Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Till Bärnighausen
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute for Global Health, University College London, London, United Kingdom
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Coller RJ, Kelly MM, Sklansky DJ, Shadman KA, Ehlenbach ML, Barreda CB, Chung PJ, Zhao Q, Edmonson MB. Ambulatory quality, special health care needs, and emergency department or hospital use for US children. Health Serv Res 2020; 55:671-680. [PMID: 32594526 PMCID: PMC7518884 DOI: 10.1111/1475-6773.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study examined family-reported ambulatory care quality and its association with emergency department and hospital utilization, and how these relationships differed across levels of medical complexity. DATA SOURCES The 2006-2013 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN Secondary analysis of MEPS data. Variables fitting the National Quality Measures Clearinghouse clinical quality measures domain framework were selected. Exploratory factor analysis grouped ambulatory quality into 12 access, experience, or process measures. Weighted negative binomial regression stratified by health status identified associations between ambulatory quality and ED visits or hospitalizations. DATA COLLECTION 41,497 children ≤18 years were included. The 5-item special health care needs (SHCN) screener categorized health status as complex, less complex, or no SHCN. PRINCIPAL FINDINGS Weighted SHCN proportions were 1.6 Percent complex, 18.2 Percent less complex, and 80.0 Percent no SHCN. Mean ED visits were 130 and 335 visits/1000 children/year for no/ complex SHCN, respectively. Mean hospitalizations were 20 and 175 hospitalizations/1000 children/year for no/complex SHCN, respectively. ED visits were associated with 8 of 12 quality measures for no/less complex SHCN. For example, usually/always receiving needed care right away was associated with 22 Percent lower ED visit rate (95% CI 0.64-0.96). Hospitalizations were associated with 4 of 12 quality measures for less complex SHCN. In complex SHCN, associations between ambulatory quality and ED/hospital use were weak and inconsistent. CONCLUSIONS Ambulatory quality may best predict ED and hospital use for children with no or less complex SHCN. Whether and how ambulatory care predicts emergency and hospital care in complex SHCN remains an important question.
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Affiliation(s)
- Ryan J. Coller
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Michelle M. Kelly
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Daniel J. Sklansky
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kristin A. Shadman
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Mary L Ehlenbach
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Christina B. Barreda
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Paul J. Chung
- Departments of Pediatrics and Health Policy & Management, Health Systems ScienceKaiser Permanente School of MedicinePasadenaCaliforniaUSA
| | - Qianqian Zhao
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Marshall Bruce Edmonson
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China in December 2019 and has subsequently escalated exponentially worldwide. As this virus has never been experienced previously, it poses a significant challenge to healthcare systems who are poorly equipped to handle the large number of gravely ill patients who seek medical attention. Additionally, treating providers are placing their own lives at risk due to the lack of adequate personal protective equipment. We are reporting the proactive measures that were implemented at our healthcare system in a metropolitan community in Kentucky to address COVID-19. The primary goal was to maintain a safe environment for providers, staff, and patients. Three key strategies were incorporated at our healthcare system, including.
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Affiliation(s)
| | | | - Paul S. Schulz
- Norton Medical Group, Norton Healthcare, Louisville, KY, U.S.A
| | - Craig Johnson
- Norton Medical Group, Norton Healthcare, Louisville, KY, U.S.A
| | - Randy Hamilton
- Norton Medical Group, Norton Healthcare, Louisville, KY, U.S.A
| | - Ashley M. Wilde
- Norton Medical Group, Norton Healthcare, Louisville, KY, U.S.A
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Hughes RB, Robinson-Whelen S, Goe R, Schwartz M, Cesal L, Garner KB, Arnold K, Hunt T, McDonald KE. "I really want people to use our work to be safe"…Using participatory research to develop a safety intervention for adults with intellectual disability. J Intellect Disabil 2020; 24:309-325. [PMID: 30101664 DOI: 10.1177/1744629518793466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
People with intellectual disability experience disproportionately high rates of interpersonal violence (IPV) due, in part, to disability-related risks that often can be minimized through targeted intervention. In this article, we describe using an academic and community participatory research approach to develop and test the feasibility of an accessible IPV prevention program for people with intellectual disability. The Safety Class, which is an interactive, structured, eight-session, weekly face-to-face group program, was found feasible for implementation in an efficacy study. Working in partnership with the intellectual disability community through all phases of the project helps ensure the relevance, inclusion, and accessibility of The Safety Class.
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Di Lorito C, Bosco A, Goldberg SE, Nair R, O'Brien R, Howe L, van der Wardt V, Pollock K, Booth V, Logan P, Godfrey M, Dunlop M, Horne J, Harwood RH. Protocol for the process evaluation of the Promoting Activity, Independence and Stability in Early Dementia (PrAISED), following changes required by the COVID-19 pandemic. BMJ Open 2020; 10:e039305. [PMID: 32859666 PMCID: PMC7453764 DOI: 10.1136/bmjopen-2020-039305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 04/10/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) randomised controlled trial (RCT) is evaluating a home-based, face-to-face, individually tailored, activity and exercise programme for people living with dementia. Social distancing requirements following the COVID-19 pandemic necessitated rapid changes to intervention delivery. METHODS AND ANALYSIS A mixed-methods process evaluation will investigate how the changes were implemented and the impact that these have on participants' experience. An implementation study will investigate how the intervention was delivered during the pandemic. A study on the mechanisms of impact and context will investigate how these changes were experienced by the PrAISED participants, their carers and the therapists delivering the intervention. The study will commence in May 2020. ETHICS AND DISSEMINATION The PrAISED RCT and process evaluation have received ethical approval number 18/YH/0059. The PrAISED process evaluation will enable us to understand how distancing and isolation affected participants, their activity and exercise routines and whether the therapy programme could be continued with remote support. This will be valuable both in explaining trial results and also contribute to understanding and designing new ways of delivering home-based services and rehabilitation interventions for people with dementia and their carers. TRIAL REGISTRATION NUMBER ISRCTN15320670; Pre-results.
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Affiliation(s)
- Claudio Di Lorito
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Alessandro Bosco
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roshan Nair
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Rebecca O'Brien
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Louise Howe
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Vicky Booth
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Pip Logan
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Maureen Godfrey
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Marianne Dunlop
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Jane Horne
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Odberg KR, Hansen BS, Aase K, Wangensteen S. A work system analysis of the medication administration process in a Norwegian nursing home ward. Appl Ergon 2020; 86:103100. [PMID: 32342890 DOI: 10.1016/j.apergo.2020.103100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/29/2019] [Revised: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements - tools & technology, organisation and tasks - and occur early in the medication administration process.
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Affiliation(s)
- Kristian Ringsby Odberg
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
| | | | - Karina Aase
- University of Stavanger, Department of Health Studies, Centre Director, SHARE - Centre for Resilience in Healthcare, Norway
| | - Sigrid Wangensteen
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
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Fuentes-Rivera E, Heredia-Pi I, Andrade-Romo Z, Alcalde-Rabanal J, Bravo L, Jurkiewicz L, Darney BG. Evaluating process fidelity during the implementation of Group Antenatal Care in Mexico. BMC Health Serv Res 2020; 20:559. [PMID: 32552889 PMCID: PMC7301482 DOI: 10.1186/s12913-020-05430-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/15/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND CenteringPregnancy (CP) is a group antenatal care (G-ANC) model that has proven beneficial for mothers and their newborns. We conducted a feasibility study beginning in 2016 as part of the Mexican effort to implement G-ANC locally. This study reports on fidelity to the essential elements of CP during its implementation in Mexico. METHODS We collected prospective data using a standardized checklist at four primary-care centers that implemented our adapted G-ANC model. We performed a descriptive analysis of fidelity to 28 processes per G-ANC session (71 sessions made up of 10 groups and 129 women across 4 health centers). We calculated fidelity to each process as a proportion with 95% confidence intervals. We present overall results and stratified by health center and by facilitation team. RESULTS Overall fidelity to the G-ANC intervention was 82%, with variability by health center (78-88%). The elements with the highest fidelity were having space for activities such as checking vital signs, conversation in a circle, and medical check-ups (100% each) and the element with the lowest fidelity was using music to enhance privacy (27.3%). Fidelity was not significantly different by center. CONCLUSIONS Our study suggests good model fidelity during the implementation of G-ANC in Mexico. Our findings also contribute useful information about where to focus efforts in the future to maintain and improve G-ANC model fidelity.
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Affiliation(s)
- Evelyn Fuentes-Rivera
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Ileana Heredia-Pi
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Zafiro Andrade-Romo
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Jacqueline Alcalde-Rabanal
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Lourdes Bravo
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Laurie Jurkiewicz
- Department of ObGyn & Reproductive Sciences, UCSF/SFGH, San Francisco, CA USA
| | - Blair G. Darney
- OHSU, Oregon Health & Science University, Portland, OR USA
- National Institute of Public Health, Cuernavaca, Mexico
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Luccarelli J, Fernandez-Robles C, Fernandez-Robles C, Horvath RJ, Berg S, McCoy TH, Seiner SJ, Henry ME. Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic. Psychother Psychosom 2020; 89:314-319. [PMID: 32554959 PMCID: PMC7483857 DOI: 10.1159/000509113] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. OBJECTIVE To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. METHODS This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. RESULTS A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. CONCLUSIONS A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA,
| | | | | | - Ryan J Horvath
- Department of Anesthesia Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sheri Berg
- Department of Anesthesia Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas H McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen J Seiner
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Michael E Henry
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Morrow A, Tucker KM, Shaw TJ, Parkinson B, Abraham C, Wolfenden L, Taylor N. Understanding implementation success: protocol for an in-depth, mixed-methods process evaluation of a cluster randomised controlled trial testing methods to improve detection of Lynch syndrome in Australian hospitals. BMJ Open 2020; 10:e033552. [PMID: 32540886 PMCID: PMC7299044 DOI: 10.1136/bmjopen-2019-033552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/01/2023] Open
Abstract
INTRODUCTION In multisite intervention trials, implementation success often varies widely across settings. Process evaluations are crucial to interpreting trial outcomes and understanding contextual factors and causal chains necessary for successful implementation. Lynch syndrome is a hereditary cancer predisposition conferring an increased risk of colorectal, endometrial and other cancer types. Despite systematic screening protocols to identify Lynch syndrome, the condition remains largely underdiagnosed. The Hide and Seek Project ('HaSP') is a cluster randomised controlled trial determining the effectiveness of two approaches to improving Lynch syndrome detection at eight Australian hospital networks. To enhance widespread implementation of optimal Lynch syndrome identification, there is a need to understand not only what works, but also why, in what contexts, and at what costs. Here we describe an in-depth investigation of factors influencing successful implementation of procedures evaluated in the HaSP trial. METHODS AND ANALYSIS A mixed-methods, theory-driven process evaluation will be undertaken in parallel to the HaSP trial. Data will include: interviews of Implementation Leads and Lynch syndrome stakeholders, pre-post implementation questionnaires, audio analysis of meetings and focus groups, observation of multidisciplinary team meetings, fidelity checklists and project log analysis. Results will be triangulated and coded, drawing on the Theoretical Domains Framework, Consolidated Framework for Implementation Research and Proctor's implementation outcomes. ETHICS AND DISSEMINATION Use of a theory-based process evaluation will enhance interpretation and generalisability of HaSP trial findings, and contribute to the implementation research field by furthering understanding of the conditions necessary for implementation success. Ethical approval has been granted and results will be disseminated via publications in peer-reviewed journals and conference presentations. At trial completion, key findings will be fed back to sites to enable refinement of intervention strategies, both in the context of Lynch syndrome and for the possible generalisability of intervention components in other genetic and broader clinical specialties. HASP TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (Identifier: ACTRN12618001072202). Registered 27 June 2018. http://www.ANZCTR.org.au/ACTRN12618001072202.aspx.
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Affiliation(s)
- April Morrow
- Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Tim J Shaw
- Research in Implementation Science and eHealth (RISe), Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Bonny Parkinson
- The Macquarie University Centre for the Health Economy, Macquarie University, Macquarie, New South Wales, Australia
| | - Charles Abraham
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie Taylor
- Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Buller DB, Reynolds KD, Buller MK, Massie K, Berteletti J, Ashley J, Meenan R. Parent reports of sun safety communication and behaviour for students in a randomised trial on a school policy implementation intervention. Aust N Z J Public Health 2020; 44:208-214. [PMID: 32459394 DOI: 10.1111/1753-6405.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Schools are an important setting for skin cancer prevention. An intervention for implementation of school sun safety policy, Sun Safety Schools (SSS), was evaluated. METHODS Primary schools (n=118) in California school districts that had already adopted a sun safety policy were enrolled in a study with a randomised controlled design. Half of the schools were randomised to SSS intervention (N=58). Parents completed an online post-test. RESULTS More parents in intervention schools received information about sun safety (mean=26.3%, sd=3.1%, p=0.017) and children more frequently wore sun-protective clothing when not at school (mean=2.93, sd=0.03, p=0.033) than in control schools (mean=18.0%, sd=2.5%; mean=2.83, sd=0.03, respectively). In schools where principals reported implementing sun safety practices, parents reported that children spent less time outdoors at midday (mean=14.78 hours, sd=0.25, p=0.033) and fewer were sunburned (mean=12.7%, sd=1.1%, p=0.009) than in non-implementing schools (M=16.3 hours, sd=0.67; mean=21.2%, sd=3.8%, respectively). Parents who received sun safety information (mean=3.08, sd=0.04, p=0.008) reported more child sun protection than parents not receiving information (mean=2.96, sd=0.02). CONCLUSIONS A school district sun protection policy and support for implementation increased dissemination of sun safety information to parents and student sun safety. Implications for public health: Technical assistance for sun safety policies may increase sun protection of children.
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Affiliation(s)
| | - Kim D Reynolds
- School of Community and Global Health, Claremont Graduate University, California, US
| | | | - Kim Massie
- School of Community and Global Health, Claremont Graduate University, California, US
| | | | | | - Richard Meenan
- Kaiser Permanente Center for Health Research, Oregon, US
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Benítez JL, Abascal A, Garrido M, Escudero V. Building an Expanded Therapeutic Alliance: A Task Analysis with Families Trapped in Parental-Adolescent Conflict. Fam Process 2020; 59:409-427. [PMID: 30865294 DOI: 10.1111/famp.12435] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Parental-adolescent conflict is part of the normal developmental cycle of families, but when it occurs in a dysfunctional way, it is associated with the appearance of various harmful conditions for the family system and for the adolescent in particular. Family therapy is one of the main options for psychotherapeutic intervention in these cases and has ample evidence of its effectiveness. The success of this intervention is conditioned to the construction of an adequate therapeutic alliance with the family, but the process of this task has not been clarified yet. The present study is a task analysis, the purpose of which was to create a heuristic model of how an expanded alliance may be built in these kinds of cases. The model was revised and improved from the intensive analysis of six cases. The resulting model can be a useful guide for family therapists in that it describes the specific client and therapist behaviors involved in balancing the alliance, as well as the potential obstacles and suggested ways to resolve them.
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Affiliation(s)
| | - Alberto Abascal
- Unit of Family Therapy Research, University of A Coruña, A Coruña, Spain
| | | | - Valentín Escudero
- Unit of Family Therapy Research, University of A Coruña, A Coruña, Spain
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Kuhn JL, Vanegas SB, Salgado R, Borjas SK, Magaña S, Smith DaWalt L. The Cultural Adaptation of a Transition Program for Latino Families of Youth with Autism Spectrum Disorder. Fam Process 2020; 59:477-491. [PMID: 30844083 PMCID: PMC7191653 DOI: 10.1111/famp.12439] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
During the transition to adulthood, effective and culturally relevant supports are critical for families of youth with autism spectrum disorder (ASD). There is a dearth of documented program development and research on supports for Spanish-speaking Latino families during this life stage. The present work describes the cultural adaptation process of an evidence-based transition program for Latino families of youth with ASD. A model of the actions necessary to meaningfully conduct a cultural adaptation in this context is described. After implementing the culturally adapted program titled Juntos en la Transición with five Spanish-speaking families, parents reported high social validity of the program through surveys and interviews. The cultural adaptation process followed in this work is important for the further development of programs that address the transition needs of Latino youth with ASD and their families. Our impressions may also be useful to those who aim to develop culturally sensitive and ecologically valid multifamily group intervention programs for families from cultural and linguistic minority groups.
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Abstract
Response to intervention (RTI) has evolved from its first decade of implementation. Because states guide and regulate policy and practice at the state and local education agency levels, it is important to understand their critical role in RTI implementation. A systematic review of all 50 state education agency websites was conducted to provide an updated "snapshot" of states' interpretation of RTI a decade after IDEA regulations were finalized. Findings revealed substantive progress towards developing approaches to systematic supports to students, with a major trend in adoption of multi-tiered system of support (MTSS) models. Findings also documented continued variation in how states are communicating about tiered systems on such matters as the roles of tiered systems in schoolwide prevention frameworks, meeting special education requirements, and aligning multiple systems within schools. Implications for special education services for students with learning disabilities are discussed.
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Steenaart E, Crutzen R, de Vries NK. Implementation of an interactive organ donation education program for Dutch lower-educated students: a process evaluation. BMC Public Health 2020; 20:739. [PMID: 32434504 PMCID: PMC7238559 DOI: 10.1186/s12889-020-08900-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 05/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As organ donation registration rates remain low, especially among lower-educated people, it is important to support this group in making their registration decision. To prepare lower-educated students in the Netherlands for making a well-informed decision, an interactive educational program was developed. We aim to understand both the (quality of) implementation as well as to contextualize the effects of this program in a lower-educated school setting. METHODS The process evaluation was part of a Cluster Randomized Controlled Trial, in which 11 schools for Intermediate Vocational Education throughout the Netherlands participated. Teachers who taught a course on Citizenship delivered three intervention elements (i.e. video fragments and discussion, quizzes with tailored feedback and an exercise filling out a registration form) to their students. Implementation was assessed by interviews with teachers, questionnaires from students, logbooks from teachers and user data from Google Analytics. RESULTS The program was well received and implemented, but on-the-spot adaptations were made by teachers to fit their students better. Within the lower-educated target group, differences between students are high in terms of active participation, reading abilities, knowledge and attention span. The program fit well within their regular teaching activities, but the topic of organ donation is not always prioritized by teachers. CONCLUSIONS We see opportunities to disseminate the program on a larger scale and reach a group that has been neglected in organ donation education before. Within the program, there are possibilities to increase the effectiveness of the program, such as alternative delivery methods for the elements with a lot of text, the addition of booster sessions and guidelines for teachers to adapt the program to students of different levels within Intermediate Vocational Education. Moreover, in order to have an impact on a national level, strategies need to be employed to reach high numbers of students and, therefore, support on a higher level is needed (both within schools and at policy level). TRIAL REGISTRATION Dutch Trial Register, NTR6771. Prospectively registered on 24 October 2017.
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Affiliation(s)
- Esther Steenaart
- Department of Health Promotion, CAPHRI Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Rik Crutzen
- Department of Health Promotion, CAPHRI Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Nanne K de Vries
- Department of Health Promotion, CAPHRI Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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