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Eze C, Vinken M. E-waste: mechanisms of toxicity and safety testing. FEBS Open Bio 2024. [PMID: 38987214 DOI: 10.1002/2211-5463.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
Currently, information on the toxicity profile of the majority of the identified e-waste chemicals, while extensive and growing, is admittedly fragmentary, particularly at the cellular and molecular levels. Furthermore, the toxicity of the chemical mixtures likely to be encountered by humans during and after informal e-waste recycling, as well as their underlying mechanisms of action, is largely unknown. This review paper summarizes state-of-the-art knowledge of the potential underlying toxicity mechanisms associated with e-waste exposures, with a focus on toxic responses connected to specific organs, organ systems, and overall effects on the organism. To overcome the complexities associated with assessing the possible adverse outcomes from exposure to chemicals, a growing number of new approach methodologies have emerged in recent years, with the long-term objective of providing a human-based and animal-free system that is scientifically superior to animal testing, more effective, and acceptable. This encompasses a variety of techniques, typically regarded as alternative approaches for determining chemical-induced toxicities and holds greater promise for a better understanding of key events in the metabolic pathways that mediate known adverse health outcomes in e-waste exposure scenarios. This is crucial to establishing accurate scientific knowledge on mixed e-waste chemical exposures in shorter time frames and with greater efficacy, as well as supporting the need for safe management of hazardous chemicals. The present review paper discusses important gaps in knowledge and shows promising directions for mechanistically anchored effect-based monitoring strategies that will contribute to the advancement of the methods currently used in characterizing and monitoring e-waste-impacted ecosystems.
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Affiliation(s)
- Chukwuebuka Eze
- Entity of In Vitro Toxicology and Dermato-Cosmetology, Department of Pharmaceutical and Pharmacological Sciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mathieu Vinken
- Entity of In Vitro Toxicology and Dermato-Cosmetology, Department of Pharmaceutical and Pharmacological Sciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Ferrier YA, Porter MT, Tellson A. Stressed and Short: Creating a Balanced and Innovative Preceptor Model in a Medical Intensive Care Unit. J Nurses Prof Dev 2024; 40:190-194. [PMID: 38758074 DOI: 10.1097/nnd.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
An innovative preceptor model (IPM) was developed to transition newly graduate nurses (NGNs) to practice. The imbalanced number of experienced nurses to NGNs during COVID-19 demonstrated a need for an "out-of-the-box" solution, one preceptor to two nurse residents, in the medical intensive care unit. The IPM was evaluated through surveys, postclinical immersion debriefs, and feedback sessions with the preceptors and NGNs. The IPM helped preceptors guide NGNs in their journey to independent practice.
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O’Brien-Kelly J, Moore D, O’Leary I, O’Connor T, Moore Z, Patton D, Nugent L. Development and impact of a tailored eHealth resource on fibromyalgia patient's self-management and self-efficacy: A mixed methods approach. Br J Pain 2024; 18:292-307. [PMID: 38751562 PMCID: PMC11092935 DOI: 10.1177/20494637231221647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Aim To develop an eHealth resource to support fibromyalgia patients and explore it for usability and impact on their self-management and self-efficacy. Background Fibromyalgia is a complex, non-progressive chronic condition characterised by a bewildering array of symptoms for patients to self-manage. International guidelines recommend patients receive illness-specific information once diagnosed to promote self-management and improve health-related quality of life. Design A 3-phase mixed methods exploratory sequential design. Methods Qualitative interviews explored the information and self-management needs of fibromyalgia patients attending a large tertiary hospital in Dublin. Identified themes together with an extensive review of the literature of interventions proven to be impactful by patients with fibromyalgia were utilised in the design and development of the eHealth resource. The resource was tested for usability and impact using pre and post-intervention outcomes measures. Results Patient interviews highlighted a lack of easy accessible evidenced information to support self-management implicating the urgent need for a practical solution through development of a tailored eHealth resource. Six themes emerged for inclusion; illness knowledge, primary symptoms, treatment options, self-management strategies, practical support and reliable resources. Forty-five patients who tested the site for usability and impact demonstrated a statistically significant improvement in self-efficacy after 4 weeks access with a medium positive effect size. Patients with the most severe fibromyalgia impact scores pre-intervention demonstrated the most improvement after 4 weeks. Patients gave the resource a System Usability Score A rating, highly recommending it for fellow patients diagnosed with fibromyalgia. Conclusions The study demonstrated how the development of a novel eHealth resource positively impacted fibromyalgia patients' self-efficacy to cope with this debilitating condition. Impact This study suggests that access to eHealth can positively impact patients self-efficacy, has the potential to be a template for eHealth development in other chronic conditions, supporting advanced nurse practitioners working in chronic disease management.
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Affiliation(s)
- Joanne O’Brien-Kelly
- Department of Pain Management, Beaumont Hospital, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - David Moore
- Department of Pain Management, Beaumont Hospital, Dublin, Ireland
| | - Ian O’Leary
- Multimedia Cork Institute of Technology, Cork, Ireland
| | - Tom O’Connor
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
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Berlin KEK, Lagatta J, Dawson S, Malnory M, Scott W, Sprecher A. Inpatient education reduces length of outpatient oxygen therapy in bronchopulmonary dysplasia: A quality improvement project. Pediatr Pulmonol 2024; 59:1677-1685. [PMID: 38501327 DOI: 10.1002/ppul.26971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/02/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Patients discharged on home oxygen therapy (HOT) for bronchopulmonary dysplasia (BPD) often receive months of this therapy. A previous trial comparing two methods of HOT weaning showed that increased parent involvement in HOT weaning decreased HOT duration. Our outpatient team uses a standard protocol for outpatient HOT weaning, starting at the first clinic visit 4-6 weeks after discharge. AIM To shorten HOT duration by teaching parents the outpatient HOT weaning process before neonatal intensive care unit (NICU) discharge. METHODS We launched a quality improvement program in April 2021 for preterm infants with BPD without significant comorbidities who were stable on ≤0.5 L nasal cannula. Eligible infants started the outpatient HOT weaning protocol while inpatient, with education for parents and nurses. The outcome measure was the duration of HOT after discharge. Process measures focused on protocol adherence. Balancing measures included NICU length of stay and appropriateness of parent-directed HOT weaning. RESULTS During the study period, there were a total of 133 eligible patients discharged on home oxygen, with 75 in the baseline group and 58 in the intervention group. Forty-five (78%) participated in the HOT weaning protocol while inpatient. HOT was reduced from an average of 27 to 12 weeks after May 2021. We observed no change in NICU length of stay or inappropriate HOT weaning. CONCLUSION Early introduction of HOT weaning with a focus on caregiver education is associated with a decreased duration of HOT.
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Affiliation(s)
- Kathryn E K Berlin
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joanne Lagatta
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara Dawson
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Margaret Malnory
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William Scott
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alicia Sprecher
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Raff L, Blank AG, Crespo Regalado R, Bulik-Sullivan E, Phillips L, Moore C, Galvan Miranda L, Raff E. A Quality Improvement Project to Reduce Rapid Response System Inequities for Patients with Limited English Proficiency at a Quaternary Academic Medical Center. J Gen Intern Med 2024; 39:1103-1111. [PMID: 38381243 PMCID: PMC11116344 DOI: 10.1007/s11606-024-08678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Recognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts. OBJECTIVE To improve outcomes among hospitalized LEP patients experiencing clinical deteriorations. DESIGN Quasi-experimental pre-post design using quality improvement (QI) statistics. PARTICIPANTS All adult hospitalized non-intensive care patients with LEP who were admitted to a large academic medical center from May 2021 through March 2023 and experienced RR system activation were included in the evaluation. All patients included after May 2022 were exposed to the intervention. INTERVENTIONS Implementation of a modified RR system for LEP patients in May 2022 that included electronic dashboard monitoring of early warning scores (EWSs) based on electronic medical record data; RR nurse initiation of consults or full RR system activation; and systematic engagement of interpreters. MAIN MEASURES Process of care measures included monthly rates of RR system activation, critical response nurse consultations, and disease severity scores prior to activation. Main outcomes included average post-RR system activation length of stay, escalation of care, and in-hospital mortality. Analyses used QI statistics to identify special cause variation in pre-post control charts based on monthly data aggregates. KEY RESULTS In total, 222 patients experienced at least one RR system activation during the study period. We saw no special cause variation for process measures, or for length of hospitalization or escalation of care. There was, however, special cause variation in mortality rates with an overall pre-post decrease in average monthly mortality from 7.42% (n = 8/107) to 6.09% (n = 7/115). CONCLUSIONS In this pilot study, prioritized tracking, utilization of EWS-triggered evaluations, and interpreter integration into the RR system for LEP patients were feasible to implement and showed promise for reducing post-RR system activation mortality.
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Affiliation(s)
- Lauren Raff
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of North Carolina School of Medicine, 4008 Burnett-Womack Building, Campus Box 70, Chapel Hill, NC, 27599, USA
| | - Andrew G Blank
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA
| | - Ricardo Crespo Regalado
- University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC, 27599, USA
| | - Emily Bulik-Sullivan
- University of North Carolina School of Medicine, 321 South Columbia Street, Chapel Hill, NC, 27599, USA
| | - Lindsey Phillips
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA
| | - Carlton Moore
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA
| | - Lilia Galvan Miranda
- Department of Interpreter Services, University of North Carolina Health, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Evan Raff
- Division of Hospital Medicine, Department of Medicine, University of North Carolina School of Medicine, 101 Manning Drive, Campus Box 7085, Chapel Hill, NC, 27599, USA.
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Day C, Meyers J, Kaplan HC. A guide to critical appraisal of quality improvement reports. Semin Perinatol 2024; 48:151900. [PMID: 38653625 DOI: 10.1016/j.semperi.2024.151900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Quality improvement (QI) has become an integral part of healthcare. Despite efforts to improve the reporting of QI through frameworks such as the SQUIRE 2.0 guidelines, there is no standard or well-accepted guide to evaluate published QI for rigor, validity, generalizability, and applicability. User's Guides for evaluation of published clinical research have been employed routinely for over 25 years; however, similar tools for critical appraisal of QI are limited and uncommonly used. In this article we propose an approach to guide the critical review of QI reports focused on evaluating the methodology, improvement results, and applicability and feasibility for implementation in other settings. The resulting Quality Improvement Critical Knowledge (QUICK) Tool can be used by those reviewing manuscripts submitted for publication, as well as healthcare providers seeking to understand how to apply published QI to their local context.
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Affiliation(s)
- Colby Day
- Department of Pediatrics, University of Rochester Medical Center, Rochester NY, USA.
| | - Jeffrey Meyers
- Department of Pediatrics, University of Rochester Medical Center, Rochester NY, USA
| | - Heather C Kaplan
- Perinatal Institute and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, USA
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Grace E, Jayakumar N, Cooper C, Andersen C, Callander E, Gomersall J, Rumbold A, Keir A. Reducing intravenous antibiotics in neonates born ≥35 weeks' gestation: A quality improvement study. J Paediatr Child Health 2024; 60:139-146. [PMID: 38695518 DOI: 10.1111/jpc.16537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 09/21/2023] [Accepted: 03/18/2024] [Indexed: 05/19/2024]
Abstract
AIM To assess the impact of the Early Onset Sepsis (EOS) calculator, implemented as a quality improvement study, to reduce the rate of unnecessary antibiotics in neonates born ≥35 weeks' gestation. METHODS An audit of routinely collected hospital data from January 2008 to March 2014 (retrospective) and from January 2018 to September 2019 (prospective) determined baseline incidence of EOS intravenous antibiotic use in neonates born ≥35 weeks' gestation in a tertiary level perinatal centre. Plan-do-study-act (PDSA) cycles were applied to implement the EOS calculator. Statistical process control methodology and time series analysis assessments were used to assess the potential impact of the PDSA cycles on the rate of intravenous antibiotics, blood culture collection, EOS, length of stay and health care costs (not adjusted for potential confounders). RESULTS In the study population, from January 2008 to March 2014, the baseline incidence of intravenous antibiotic use was 10.49% (2970/28290), whilst only 0.067% (19/28290) neonates had culture proven EOS. From January 2018 to October 2019, prior to implementation of the EOS calculator, 13.3% (1119/8411) neonates were treated with intravenous antibiotic and the use decreased to 8.3% (61/734) post-implementation. The rate of blood culture collection decreased from 14.4% (1211/8411) to 11.9% (87/734). There were no cases of missed EOS. Length of stay decreased from 2.68 to 2.39 days, with an estimated cost saving of $366 per patient per admission. CONCLUSION Implementing the EOS calculator in a tertiary hospital setting reduced invasive investigations for EOS and intravenous antibiotic use among neonates ≥35 weeks' gestation. This can result in reduced length of neonatal hospital stays, and associated health care cost savings and may reduce separation of mother and baby.
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Affiliation(s)
- Erin Grace
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Department of Paediatrics, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Nilarni Jayakumar
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Celia Cooper
- Department of Infectious Diseases, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Chad Andersen
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Judith Gomersall
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Alice Rumbold
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
| | - Amy Keir
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
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van Eck van der Sluijs A, Vonk S, Bonenkamp AA, Prantl K, Riemann AT, van Jaarsveld BC, Abrahams AC. Value of patient decision aids for shared decision-making in kidney failure. J Ren Care 2024; 50:15-23. [PMID: 37211923 DOI: 10.1111/jorc.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 04/02/2023] [Accepted: 04/19/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND It is unknown how often Dutch patient decision aids are used during kidney failure treatment modality education and what their impact is on shared decision-making. OBJECTIVES We determined the use of Three Good Questions, 'Overviews of options', and Dutch Kidney Guide by kidney healthcare professionals. Also, we determined patient-experienced shared decision-making. Finally, we determined whether the experience of shared decision-making among patients changed after a training workshop for healthcare professionals. DESIGN Quality improvement study. PARTICIPANTS Healthcare professionals answered questionnaires regarding education/patient decision aids. Patients with estimated glomerular filtration rate <20 mL/min/1.73 m2 completed shared decision-making questionnaires. Data were analysed with one-way analysis of variance and linear regression. RESULTS Of 117 healthcare professionals, 56% applied shared decision-making by discussing Three Good Questions (28%), 'Overviews of options' (31%-33%) and Kidney Guide (51%). Of 182 patients, 61%-85% was satisfied with their education. Of worst scoring hospitals regarding shared decision-making, only 50% used 'Overviews of options'/Kidney Guide. Of best scoring hospitals 100% used them, needed less conversations (p = 0.05), provided information about all treatment options and more often provided information at home. After the workshop, patients' shared decision-making scores remained unchanged. CONCLUSIONS The use of specifically developed patient decision aids during kidney failure treatment modality education is limited. Hospitals that did use them had higher shared decision-making scores. However, the degree of shared decision-making experienced by patients remained unchanged after healthcare professionals were trained on shared decision-making and the implementation of patient decision aids.
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Affiliation(s)
| | - Sanne Vonk
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anna A Bonenkamp
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research Institute Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association (NVN), Bussum, the Netherlands
| | - Aase T Riemann
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research Institute Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Diapriva Dialysis Centre, Amsterdam, the Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
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Gogovor A, Zomahoun HTV, Ben Charif A, Ekanmian G, Moher D, McLean RKD, Milat A, Wolfenden L, Prévost K, Aubin E, Rochon P, Rheault N, Légaré F. Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review. Medicine (Baltimore) 2024; 103:e37079. [PMID: 38363902 PMCID: PMC10869056 DOI: 10.1097/md.0000000000037079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items. METHODS We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics. RESULTS Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections. CONCLUSION Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.
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Affiliation(s)
- Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
| | | | | | - Giraud Ekanmian
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - Robert K. D. McLean
- International Development Research Centre, Ottawa, ON
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, ON
| | - Andrew Milat
- School of Public Health, University of Sydney, Camperdown, NSW
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW
- The National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW
| | | | | | - Paula Rochon
- Women’s Age Lab, Women’s College Hospital, Toronto, ON
- Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - France Légaré
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
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Frankel RM, Cottingham AH. Making Meaning Matter: an Editor's Perspective on Publishing Qualitative Research. J Gen Intern Med 2024; 39:301-305. [PMID: 37770731 PMCID: PMC10853113 DOI: 10.1007/s11606-023-08361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023]
Abstract
The term qualitative research refers to a family of primarily non-numeric methods for describing, analyzing, and interpreting the lived experiences of people in their day to day lives. Originally developed to study social problems such as poverty, juvenile delinquency, and race relations, qualitative research methods have been used in the health sciences since the 1960s to better understand the socialization of medical professionals and the culture of medical education and practice. More recently, qualitative research has been employed in health services research to address and improve the quality and safety of care. While quantitative researchers generally ask "what" or "how many" questions, qualitative researchers generally ask, "why" or "how"? Publishing qualitative research comes with a number of challenges, among them, manuscript length, unfamiliarity of reviewers with qualitative traditions, and sample sizes that, by design, are difficult to generalize from. In addition, while there is general agreement about the quality of evidence and types of research designs used in quantitative studies, the same is not yet the case for qualitative and mixed methods research although a variety of useful guidelines have recently appeared. From the perspective of journal editors, we raise and offer guidance on three important questions: (1) Is the study under review suitable for this journal? (2) What is the rationale for using qualitative methods to carry out the research? (3) What are editors/reviewers looking for in a qualitative submission? In unpacking the third question, we describe common strategies editors use and challenges that we have encountered in the abstract, background, methods, results, discussion, and conclusions sections of qualitative submissions we and our colleagues have reviewed.
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Affiliation(s)
- Richard M Frankel
- Indiana University School of Medicine, Fairbanks Hall, 340 West 10Th St, Indianapolis, IN, 46202, USA.
- Regenstrief Institute, 1101 West 10Th St, Indianapolis, IN, 46202, USA.
| | - Ann H Cottingham
- Indiana University School of Medicine, Fairbanks Hall, 340 West 10Th St, Indianapolis, IN, 46202, USA
- Regenstrief Institute, 1101 West 10Th St, Indianapolis, IN, 46202, USA
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King L, Belan I, Clark RA, Young T, Grantham H, Thornton K, Kidd MR. Hospital Testing of the Effectiveness of Co-Designed Educational Materials to Improve Patient and Visitor Knowledge and Confidence in Reporting Patient Deterioration. Jt Comm J Qual Patient Saf 2024; 50:116-126. [PMID: 37821325 DOI: 10.1016/j.jcjq.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Co-designed educational materials could significantly improve the likelihood of patients and visitors (consumers) escalating care through hospital systems. The objective was to investigate patients' and visitors' knowledge and confidence in recognizing and reporting patient deterioration in hospitals before and after exposure to educational materials. METHODS A multimethod design involved a convenience sample of patients and visitors at a South Australian hospital. Knowledge and confidence of participants to report patient deterioration was assessed using a validated questionnaire. Baseline group was surveyed, and a second group was surveyed after exposure to a poster and on-hold message relating to consumer-initiated escalation-of-care. Nominal data were examined using chi-square analysis, and ordinal data using the Mann-Whitney U test. Open-ended questions were examined using thematic analysis. RESULTS A total of 407 participants completed the study, 203 undertook the baseline survey, and 204 the postintervention survey. Respondents exposed to the educational materials reported significantly higher recognition of responsibility to report concerns about patient deterioration compared to controls (86.3% vs. 73.1%; p = 0.007). Respondents exposed to the educational materials also had better ability to identify signs that a patient was becoming sicker compared to controls (77.5% vs. 71.3%, p = 0.012). Four overarching themes emerged from the questions: patient/visitor understanding of key messages, patient/visitor recognition of deterioration, patient/visitor response to deterioration and patient/visitor recommendations. CONCLUSION Following educational interventions, patients and visitors report improved awareness of their role in recognizing and responding to clinical deterioration. They advise additional active interventions and caution that the materials should accommodate language, cultural, and disability needs.
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Nourani B, Norton D, Kuchera W, Rabago D. Transrectal osteopathic manipulation treatment for chronic coccydynia: feasibility, acceptability and patient-oriented outcomes in a quality improvement project. J Osteopath Med 2024; 124:77-83. [PMID: 37999720 DOI: 10.1515/jom-2023-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
CONTEXT Pain of the coccyx, coccydynia, is a common condition with a substantial impact on the quality of life. Although most cases resolve with conservative care, 10 % become chronic and are more debilitating. Treatment for chronic coccydynia is limited; surgery is not definitive. Osteopathic manipulative treatment (OMT) is the application of manually guided forces to areas of somatic dysfunction to improve physiologic function and support homeostasis including for coccydynia, but its use as a transrectal procedure for coccydynia in a primary care clinic setting is not well documented. OBJECTIVES We aimed to conduct a quality improvement (QI) study to explore the feasibility, acceptability, and clinical effects of transrectal OMT for chronic coccydynia in a primary care setting. METHODS This QI project prospectively treated and assessed 16 patients with chronic coccydynia in a primary care outpatient clinic. The intervention was transrectal OMT as typically practiced in our clinic, and included myofascial release and balanced ligamentous tension in combination with active patient movement of the head and neck. The outcome measures included: acceptance, as assessed by the response rate (yes/no) to utilize OMT for coccydynia; acceptability, as assessed by satisfaction with treatment; and coccygeal pain, as assessed by self-report on a 0-10 numerical rating scale (NRS) for coccydynia while lying down, seated, standing, and walking. RESULTS Sixteen consecutive patients with coccydynia were offered and accepted OMT; six patients also received other procedural care. Ten patients (two males, eight females) received only OMT intervention for their coccydynia and were included in the per-protocol analysis. Posttreatment scores immediately after one procedure (acute model) and in follow-up were significantly improved compared with pretreatment scores. Follow-up pain scores provided by five of the 10 patients demonstrated significant improvement. The study supports transrectal OMT as a feasible and acceptable treatment option for coccydynia. Patients were satisfied with the procedure and reported improvement. There were no side effects or adverse events. CONCLUSIONS These data suggest that the use of transrectal OMT for chronic coccydynia is feasible and acceptable; self-reported improvement suggests utility in this clinic setting. Further evaluation in controlled studies is warranted.
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Affiliation(s)
- Bobby Nourani
- Associate Professor, Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine (NMM/OMM), College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Derek Norton
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, WI, USA
| | | | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
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Benevides Santos Paiva M, de Gouvêa Viana L, Melo de Andrade MV. Reduction of hospital length of stay through the implementation of SAFER patient flow bundle and Red2Green days tool: a pre-post study. BMJ Open Qual 2024; 13:e002399. [PMID: 38191217 PMCID: PMC10806560 DOI: 10.1136/bmjoq-2023-002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND In 2018, the National Health System released the 'Guide to reducing long hospital stays' to stimulate improvement and decrease length of stay (LOS) in England hospitals. The SAFER patient flow bundle and Red2Green tool were described as strategies to be implemented in inpatient wards to reduce discharge delays. OBJECTIVE To verify if implementing the SAFER patient flow bundle and Red2Green days tool is associated with LOS reduction in the internal medicine unit (IMU) wards of a university hospital in Brazil. METHODS In this pre post study, we compared the LOS of patients discharged from the IMU wards in 2019, during the implementation of the SAFER bundle and Red2Green tool, to the LOS of patients discharged in the same period in 2018. The Diagnosis-Related Group Brazil algorithm compared groups according to complexity and resource requirements. In-hospital mortality, readmission rates, the number of hospital acquired conditions and the number and causes of inappropriate hospital days were also evaluated. RESULTS Two hundred and eight internal medicine patients were discharged in 2018, and 252 were discharged in 2019. The median hospital LOS was significantly lower during the intervention period (14.2 days (IQR, 8-23) vs 19 days (IQR, 12-32); p<0.001). In-hospital mortality, 30-day mortality, readmission in 30 days and the number of hospital acquired conditions were the same between groups. Of the 3350 patient days analysed, 1482 (44.2%) were classified as green and 1868 (55.8%) as red. The lack of senior review was the most frequent cause of a red day (42.4%). CONCLUSION The SAFER patient flow bundle and Red2Green days tool implementation were associated with a significant decrease in hospital LOS in a university hospital IMU ward. There is a considerable improvement opportunity for hospital LOS reduction by changing the multidisciplinary team's attitude during patient hospitalisation using these strategies.
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Affiliation(s)
| | - Luciana de Gouvêa Viana
- Departamento de Propedeutica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcus Vinícius Melo de Andrade
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Hospital Sirio-Libanes, Sao Paulo, Brazil
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de Groot ER, Ryan MA, Sam C, Verschuren O, Alderliesten T, Dudink J, van den Hoogen A. Evaluation of Sleep Practices and Knowledge in Neonatal Healthcare. Adv Neonatal Care 2023; 23:499-508. [PMID: 37595146 PMCID: PMC10686278 DOI: 10.1097/anc.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND Developmental care is designed to optimize early brain maturation by integrating procedures that support a healing environment. Protecting preterm sleep is important in developmental care. However, it is unclear to what extent healthcare professionals are aware of the importance of sleep and how sleep is currently implemented in the day-to-day care in the neonatal intensive care unit (NICU). PURPOSE Identifying the current state of knowledge among healthcare professionals regarding neonatal sleep and how this is transferred to practice. METHODS A survey was distributed among Dutch healthcare professionals. Three categories of data were sought, including (1) demographics of respondents; (2) questions relating to sleep practices; and (3) objective knowledge questions relating to sleep physiology and importance of sleep. Data were analyzed using Spearman's rho test and Cramer's V test. Furthermore, frequency tables and qualitative analyses were employed. RESULTS The survey was completed by 427 participants from 34 hospitals in 25 Dutch cities. While healthcare professionals reported sleep to be especially important for neonates admitted in the NICU, low scores were achieved in the area of knowledge of sleep physiology. Most healthcare professionals (91.8%) adapted the timing of elective care procedures to sleep. However, sleep assessments were not based on scientific knowledge. Therefore, the difference between active sleep and wakefulness may often be wrongly assessed. Finally, sleep is rarely discussed between colleagues (27.4% regularly/always) and during rounds (7.5%-14.3% often/always). IMPLICATIONS Knowledge about sleep physiology should be increased through education among neonatal healthcare professionals. Furthermore, sleep should be considered more often during rounds and handovers.
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Affiliation(s)
- Eline R. de Groot
- Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands
| | - Mary-Anne Ryan
- Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands
| | - Chanel Sam
- Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands
| | - Olaf Verschuren
- Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands
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Pancaro C, Balonov K, Herbert K, Shah N, Segal S, Cassidy R, Engoren MC, Manica V, Habib AS. Role of cosyntropin in the management of postpartum post-dural puncture headache: a two-center retrospective cohort study. Int J Obstet Anesth 2023; 56:103917. [PMID: 37625985 DOI: 10.1016/j.ijoa.2023.103917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/31/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Research suggests that postpartum post-dural puncture headache (PDPH) might be prevented or treated by administering intravenous cosyntropin. METHODS In this retrospective cohort study, we questioned whether prophylactic (1 mg) and therapeutic (7 µg/kg) intravenous cosyntropin following unintentional dural puncture (UDP) was effective in decreasing the incidence of PDPH and therapeutic epidural blood patch (EBP) after birth. Two tertiary-care American university hospitals collected data from November 1999 to May 2017. Two hundred and fifty-three postpartum patients who experienced an UDP were analyzed. In one institution 32 patients were exposed to and 32 patients were not given prophylactic cosyntropin; in the other institution, once PDPH developed, 36 patients were given and 153 patients were not given therapeutic cosyntropin. The primary outcome for the prophylactic cosyntropin analysis was the incidence of PDPH and for the therapeutic cosyntropin analysis in exposed vs. unexposed patients, the receipt of an EBP. The secondary outcome for the prophylactic cosyntropin groups was the receipt of an EBP. RESULTS In the prophylactic cosyntropin analysis no significant difference was found in the risk of PDPH between those exposed to cosyntropin (19/32, 59%) and unexposed patients (17/32, 53%; odds ratio (OR) 1.37, 95% CI 0.48 to 3.98, P = 0.56), or in the incidence of EBP between exposed (12/32, 38%) and unexposed patients (6/32, 19%; OR 2.6, 95% CI 0.83 to 8.13, P = 0.095). In the therapeutic cosyntropin analysis, in patients exposed to cosyntropin the incidence of EBP was significantly higher (20/36, 56% vs. 43/153, 28%; OR 3.20, 95% CI 1.52 to 6.74, P = 0.002). CONCLUSIONS Our data show no benefits from the use of cosyntropin for preventing or treating postpartum PDPH.
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Affiliation(s)
- C Pancaro
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA.
| | - K Balonov
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
| | - K Herbert
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
| | - N Shah
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
| | - S Segal
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
| | - R Cassidy
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
| | - M C Engoren
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
| | - V Manica
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
| | - A S Habib
- Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA
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Shade K, Hidalgo P, Arteaga M, Rowland J, Huang W. Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project. Prof Case Manag 2023; 28:271-279. [PMID: 37787704 DOI: 10.1097/ncm.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE OF STUDY Hospital readmissions burden the U.S. health care system, and they have negative effects on patients and their families. The primary aim of this study was to pilot an intensive case management (ICM) intervention to reduce 30-day hospital readmissions. A secondary aim was to obtain patient- and caregiver-reported reasons for readmission. PRIMARY PRACTICE SETTING The setting was a vertically integrated health care system located in Northern California. METHODOLOGY AND SAMPLE This pilot quality improvement project occurred over a 4-month period. The intervention was delivered by master's degree students in nurse case management through an academic-clinical partnership. Patients hospitalized with a 30-day readmission were offered the ICM intervention. A total of 36 patients were identified and 20 accepted. Patient and/or caregiver was interviewed to identify reasons for their readmission. Data were collected about pre-/post-health care utilization including subsequent 30-day readmission. Mixed methods were used to analyze the findings. RESULTS Thirteen of 20 enrolled patients received the weekly ICM intervention for at least 30 days. Seven declined further contact before 30 days. Patient-reported reasons for readmission included being discharged too soon, poor communication among providers and with patients/families, lack of understanding about disease management and/or treatment options, and inadequate support. Several patients believed that their readmission was unavoidable due to the complexity of their illnesses. We compared 30-day readmissions for those who participated in and those who declined the ICM intervention, finding that those who received the ICM intervention had a lower readmission rate than those who did not receive the intervention (35% vs. 37.5%).
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Affiliation(s)
- Kate Shade
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Paulina Hidalgo
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Manuel Arteaga
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Janet Rowland
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Winnie Huang
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
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Ulvin OE, Skjærseth EÅ, Krüger AJ, Thorsen K, Nordseth T, Haugland H. Can video communication in the emergency medical communication centre improve dispatch precision? A before-after study in Norwegian helicopter emergency medical services. BMJ Open 2023; 13:e077395. [PMID: 37899141 PMCID: PMC10618992 DOI: 10.1136/bmjopen-2023-077395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Dispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres (EMCC) could provide additional information for EMCC operators and HEMS physicians when assessing the need for HEMS dispatch. The aim of this study was to evaluate the impact from VC in the EMCC on HEMS dispatch precision. DESIGN An observational before-after study. SETTING The regional EMCC and one HEMS base in Mid-Norway. PARTICIPANTS EMCC operators and HEMS physicians at the EMCC and HEMS base in Trondheim, Norway. INTERVENTION In January 2022, VC became available in emergency calls in Trondheim EMCC. Data were collected from 2020 2021 (pre-intervention) and 2022 (post-intervention). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of seriously ill or injured HEMS patients, defined as a National Advisory Committee for Aeronautics (NACA) score between 4 and 7. The secondary outcome was the proportion of inappropriate dispatches, defined as missions with neither provision of additional competence nor any logistical contribution based on quality indicators for physician-staffed emergency medical services. RESULTS 811 and 402 HEMS missions with patient contact were included in the pre- and post-intervention group, respectively. The proportion of missions with NACA 4-7 was not significantly changed after the intervention (OR 1.21, 95% CI 0.92 to 1.61, p=0.17). There was no significant change in HEMS alarm times between the pre- and post-intervention groups (7.6 min vs 6.4 min, p=0.15). The proportion of missions with neither medical nor logistical benefit was significantly lower in the post-intervention group (28.4% vs 40.3%, p=0.007). CONCLUSION The results from this study indicate that VC is a promising, feasible and safe tool for EMCC operators in the complex HEMS dispatch process.
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Affiliation(s)
- Ole Erik Ulvin
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
| | - Andreas J Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
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Pace D, Mack SJ, Chan S, Mumford SJ, Fuchs L, Shapiro C, Berman L. Antimicrobial Stewardship in Neonates with Necrotizing Enterocolitis: A Quality Improvement Initiative. J Pediatr Surg 2023; 58:1982-1989. [PMID: 37479571 DOI: 10.1016/j.jpedsurg.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Antibiotic overutilization in the neonatal intensive care unit (NICU) has many adverse effects, and necrotizing enterocolitis (NEC) is one of the most common indications for antibiotics in premature infants. Evidence for a preferred antibiotic regimen for NEC is lacking. This project aims to reduce piperacillin-tazobactam use and overall antibiotic duration in neonates with NEC through the implementation of an antibiotic stewardship pathway based on the modified Bell stage classification system. METHODS A multidisciplinary team consisting of neonatology, pharmacy, infectious disease, and surgery developed an antibiotic protocol for the management of NEC based on Bell stage. Recommendations included 48 h of ampicillin/gentamicin (AG) for stage I, 5-10 days of AG for stage II, the addition of metronidazole for stage IIIA, and 7-14 days of piperacillin-tazobactam (PT) for stage IIIB. We evaluated overall antibiotic and PT exposure, progression to surgical NEC, NEC recurrence, antibiotic resistance, bacteremia/fungemia, and mortality 1 year pre- and post-protocol implementation. RESULTS 27 patients pre-intervention and 44 post-intervention were analyzed. Antibiotic exposure was reduced from a median 119.19 to 80.65 days of therapy (DOT) per 1000 patient days (p = 0.11). PT exposure decreased after protocol implementation (median 68.78 vs. 7.97 DOT per 1000 patient days, p = 0.002). There were no significant differences in morbidity or mortality outcomes. CONCLUSIONS Antibiotic stewardship strategies can be implemented in the NICU without compromising outcomes in patients with NEC. Bell stage stratification appears to be an effective method for antibiotic selection. Further studies are needed in a larger population to optimize regimens and ensure safety. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devon Pace
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Shale J Mack
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Shannon Chan
- Department of Pharmacy, Nemours Children's Health, Wilmington, DE, USA
| | | | - Lynn Fuchs
- Division of Neonatology, Nemours Children's Health, Wilmington, DE, USA
| | - Craig Shapiro
- Division of Infectious Disease, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
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Codner JA, Falconer EA, Mlaver E, Zeidan RH, Sharma J, Lynde GC. A Self-Sustaining Antibiotic Prophylaxis Program to Reduce Surgical Site Infections. Surg Infect (Larchmt) 2023; 24:716-724. [PMID: 37831935 DOI: 10.1089/sur.2023.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
Background: Our multi-institutional healthcare system had a higher-than-expected surgical site infection (SSI) rate. We aimed to improve our peri-operative antibiotic administration process. Gap analysis identified three opportunities for process improvement: standardized antibiotic selection, standardized second-line antibiotic agents for patients with allergies, and feedback regarding antibiotic administration compliance. Hypothesis: Implementation of a multifaceted quality improvement initiative including a near-real-time pre-operative antibiotic compliance feedback tool will improve compliance with antibiotic administration protocols, subsequently lowering SSI rate. Methods: A compliance feedback tool designed to provide monthly reports to all anesthesia and surgical personnel was implemented at two facilities, in September 2017 and December 2018. Internal case data were tracked for antibiotic compliance through June 2021, and these data were merged with American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data at the case level to provide process and outcome measures for SSIs. Implementation success was evaluated by comparing protocol compliance and risk-adjusted rates of superficial and deep SSI before and after the quality improvement implementation. Results: A total of 20,385 patients were included in this study; 11,548 patients in the pre-implementation and 8,837 in the post-implementation groups. Baseline patient and operative characteristics were similar between groups, except the post-implementation group had a higher median expected SSI rate (2.2% vs. 1.6%). Post-implementation, antibiotic protocol compliance increased from 86.3% to 97.6%, and superficial and deep SSIs decreased from 2.8% to 1.9% (p < 0.001). The odds of superficial and deep SSI in patients in the post-implementation group was 0.69 (0.57, 0.83) times the odds of superficial and deep SSI in pre-implementation patients while adjusting for age, gender, diabetes mellitus, American Society of Anesthesiologists Physical Status (ASA) classification, wound class, smoking, and chronic obstructive pulmonary disease (COPD). Observed-to-expected ratios of superficial and deep SSI decreased from 0.82 to 0.48 after the intervention. Conclusions: Surgical antibiotic prophylaxis standardization and providing near-real-time individualized feedback resulted in sustained improvement in peri-operative antibiotic compliance rates and reduced superficial and deep SSIs.
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Affiliation(s)
- Jesse A Codner
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elissa A Falconer
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eli Mlaver
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ronnie H Zeidan
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jyotirmay Sharma
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Grant C Lynde
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Chun BC, Chmil M, Ruess L. Decreasing Radiation Exposure to the Abdomen in Children with Chronic Constipation. Pediatr Qual Saf 2023; 8:e681. [PMID: 37780600 PMCID: PMC10538869 DOI: 10.1097/pq9.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/14/2023] [Indexed: 10/03/2023] Open
Abstract
Background Bowel management for children with chronic constipation may include repeated single-view abdomen radiographs (AXR) to monitor treatment success. Only one image of the abdomen is needed to include most of the colon, but technologists often make a second (or even third) exposure to be sure they have imaged the entire abdomen. Our quality improvement project aimed to reduce radiation exposure by decreasing the frequency of >1 exposure performed for AXR orders in children with chronic constipation from 27% to <10% by December 2022 and sustain. Methods We counted baseline (01/2020-11/2020) and intervention (12/2020-5/2023) examinations with >1 exposure. Initial interventions were a structured communication to technologists and an article in the monthly department newsletter and later, a technologist education module. Additional interventions included communication to radiologists, project updates and encouragement to all technologists, and individual technologist feedback. A statistical process control chart tracked data to study process changes over time. Results During the baseline and intervention periods, 525/1944 and 1329/8334 examinations, respectively, had >1 exposure performed for AXR orders. Interventions created 2 centerline shifts. Overall, examinations with >1 exposure decreased from 27% to 13.5%. Conclusions Frequency of >1 exposure performed for AXR orders in children with chronic constipation decreased from 27% to 13.5% through education and communication. This was sustained. We plan to assign training modules for all new technologists, policy reminders (annual training in odd years) for all technologists, and continue individualized learning opportunities.
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Affiliation(s)
- Bennet C. Chun
- From the Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Margarita Chmil
- From the Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio
- Center for Clinical Excellence, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lynne Ruess
- From the Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio
- Center for Clinical Excellence, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio
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21
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Nelson P, Kuriakose L, Brennan M, Alemar D, Villamayor JM, Sebastian B, Cortes O, Goode-Marshall B. Procedural Unit Nurses' Perception of Confidence in Performing Critical Care Skills During COVID-19 Crisis. J Nurses Prof Dev 2023; 39:272-277. [PMID: 37683205 DOI: 10.1097/nnd.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nursing professional development practitioners at an academic medical center conducted a quality improvement project to address the educational needs of procedural unit nurses during the COVID-19 pandemic. Procedural nurses completed a 1-day critical care nursing skills education and pre- and postsurveys. Survey results indicated an improved nurses' skills confidence in caring for COVID-19 patients, which was statistically significant, t (34.9) = 4.8, p < .001.
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22
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Cosgrove TC, Gajarski RJ, Dolan KF, Hart SA, L’Italien KE, Kuehn S, Ishmael S, Bowman JL, Fitch JA, Hills BK, Bode RS. Improving Situational Awareness to Decrease Emergency ICU Transfers for Hospitalized Pediatric Cardiology Patients. Pediatr Qual Saf 2023; 8:e630. [PMID: 37780603 PMCID: PMC10538891 DOI: 10.1097/pq9.0000000000000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/22/2022] [Indexed: 10/03/2023] Open
Abstract
Introduction Failure to recognize and mitigate critical patient deterioration remains a source of serious preventable harm to hospitalized pediatric cardiac patients. Emergency transfers (ETs) occur 10-20 times more often than code events outside the intensive care unit (ICU) and are associated with morbidity and mortality. This quality improvement project aimed to increase days between ETs and code events on an acute care cardiology unit (ACCU) from a baseline median of 17 and 32 days to ≥70 and 90 days within 12 months. Methods Institutional leaders, cardiology-trained physicians and nurses, and trainees convened, utilizing the Institution for Healthcare Improvement model to achieve the project aims. Interventions implemented focused on improving situational awareness (SA), including a "Must Call List," evening rounds, a visual management board, and daily huddles. Outcome measures included calendar days between ETs and code events in the ACCU. Process measures tracked the utilization of interventions, and cardiac ICU length of stay was a balancing measure. Statistical process control chart methodology was utilized to analyze the impact of interventions. Results Within the study period, we observed a centerline shift in primary outcome measures with an increase from 17 to 56 days between ETs and 32 to 62 days between code events in the ACCU, with sustained improvement. Intervention utilization ranged from 87% to 100%, and there was no observed special cause variation in our balancing measure. Conclusions Interventions focused on improving SA in a particularly vulnerable patient population led to sustained improvement with reduced ETs and code events outside the ICU.
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Affiliation(s)
- Tara C. Cosgrove
- From the The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio
| | - Robert J. Gajarski
- From the The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio
| | - Kevin F. Dolan
- Clinical Excellence at Nationwide Children’s Hospital, Columbus, Ohio
| | - Stephen A. Hart
- From the The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Stacy Kuehn
- Clinical Excellence at Nationwide Children’s Hospital, Columbus, Ohio
| | - Stephanie Ishmael
- From the The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio
| | - Jessica L. Bowman
- From the The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio
| | - Jill A. Fitch
- From the The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio
| | - Brittney K. Hills
- From the The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio
| | - Ryan S. Bode
- Clinical Excellence at Nationwide Children’s Hospital, Columbus, Ohio
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Rubenstein LV, Curtis I, Wheat CL, Grembowski DE, Stockdale SE, Kaboli PJ, Yoon J, Felker BL, Reddy AS, Nelson KM. Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation. BMC Health Serv Res 2023; 23:790. [PMID: 37488518 PMCID: PMC10367243 DOI: 10.1186/s12913-023-09799-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The Veterans Affairs (VA) Clinical Resource Hub (CRH) program aims to improve patient access to care by implementing time-limited, regionally based primary or mental health staffing support to cover local staffing vacancies. VA's Office of Primary Care (OPC) designed CRH to support more than 1000 geographically disparate VA outpatient sites, many of which are in rural areas, by providing virtual contingency clinical staffing for sites experiencing primary care and mental health staffing deficits. The subsequently funded CRH evaluation, carried out by the VA Primary Care Analytics Team (PCAT), partnered with CRH program leaders and evaluation stakeholders to develop a protocol for a six-year CRH evaluation. The objectives for developing the CRH evaluation protocol were to prospectively: 1) identify the outcomes CRH aimed to achieve, and the key program elements designed to achieve them; 2) specify evaluation designs and data collection approaches for assessing CRH progress and success; and 3) guide the activities of five geographically dispersed evaluation teams. METHODS The protocol documents a multi-method CRH program evaluation design with qualitative and quantitative elements. The evaluation's overall goal is to assess CRH's return on investment to the VA and Veterans at six years through synthesis of findings on program effectiveness. The evaluation includes both observational and quasi-experimental elements reflecting impacts at the national, regional, outpatient site, and patient levels. The protocol is based on program evaluation theory, implementation science frameworks, literature on contingency staffing, and iterative review and revision by both research and clinical operations partners. DISCUSSION Health systems increasingly seek to use data to guide management and decision-making for newly implemented clinical programs and policies. Approaches for planning evaluations to accomplish this goal, however, are not well-established. By publishing the protocol, we aim to increase the validity and usefulness of subsequent evaluation findings. We also aim to provide an example of a program evaluation protocol developed within a learning health systems partnership.
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Affiliation(s)
- Lisa V Rubenstein
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA.
- Geffen School of Medicine and Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
| | - Idamay Curtis
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Chelle L Wheat
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - David E Grembowski
- The Department of Health Systems and Population Health in the School of Public Health, University of Washington, Seattle, USA
| | - Susan E Stockdale
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Peter J Kaboli
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Bradford L Felker
- Mental Health Service Line, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ashok S Reddy
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Karin M Nelson
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Orford R, Slater P, Spencer B, Giarola T, Nicholls W, Walker R, Foresto S, Bradford N. One Hundred Times Better, at Home in Our Own Beds: Implementation of Home Intravenous Hydration After Chemotherapy in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:265-276. [PMID: 37017002 DOI: 10.1177/27527530221147880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background: Home-based cancer care offers new ways of delivering supportive therapies, including post-chemotherapy hydration, traditionally delivered in hospital settings. Understanding how programs are developed and how parents perceive managing care at home offers opportunities to improve services and experiences. Aim: To describe the implementation process and evaluation of a home intravenous hydration program for children with cancer and thus to provide practical information for future initiatives. Methods: Data were prospectively collected on clinical impact, safety indicators, and estimated costs; these were tabulated and analysed. Semi-structured interviews were undertaken with a subset of parents regarding their experience and analysed using content analysis. Results: Over 34 months, 21 children were eligible, and 16 parents were educated and assessed competent with providing home care. All 16 children received home hydration with a median of 5.5 days per child (IQR 6.65 days). This avoided 116 hospital bed-days and associated costs, at an estimated total value of USD $ 105,521, on average saving USD $ 910 per day and USD $ 6,596 per child. There were no adverse events reported, and no child required re-admission to hospital while receiving home hydration. Parents were overwhelmingly positive in their feedback about the program. Verbatim quotes were synthesized under one overarching theme-supporting normality promotes recovery. Conclusion: When adequately trained and well supported, parents highly value providing home-based care to their children. This offers opportunities to improve experiences and outcomes for children and families as well as reduce costs to health services, achieving clinical impact without reducing safety.
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Affiliation(s)
- Rebekah Orford
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Penelope Slater
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Brooke Spencer
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Teghan Giarola
- Oncology Pharmacy, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Wayne Nicholls
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Rick Walker
- Queensland Youth Cancer Service, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Steven Foresto
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research and School of Nursing, Queensland University of Technology, South Brisbane, Australia
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Ostenfeld A, Futtrup TB, Løkkegaard ECL, Westergaard HB. Reorganising and improving quality of care for hyperemesis gravidarum in a Danish hospital: a quality improvement project. BMJ Open Qual 2023; 12:e002035. [PMID: 37463782 PMCID: PMC10357691 DOI: 10.1136/bmjoq-2022-002035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG) is a pregnancy complication comprising severe nausea and vomiting in pregnancy. It is associated with adverse outcomes for both mother and child. Treatment consists primarily of antiemetics and intravenous fluids; however, support from healthcare professionals is also important. LOCAL PROBLEM At the department of obstetrics at Nordsjællands Hospital, an increasing workload caused challenges regarding patient care and organisation for patients with HG, and exploring possibilities of reorganising HG care to release midwife resources was warranted. METHODS Through input from staff and patients, possible improvements were identified. Plan-do-study-act cycles were conducted with staff and patients, resulting in adjustments in care and organisation and thus use of resources. The specific, measurable, attainable, realistic and timely aims included patient satisfaction and number of follow-ups conducted via phone. INTERVENTIONS HG care was relocated to the department of gynaecology, where it was managed primarily by nurses. Staff and patients were actively involved in the process. RESULTS HG care was successfully relocated without compromising patient satisfaction. Additionally, an option of patient-administered home treatment for selected patients was established. CONCLUSION This quality improvement project describes the relocation and set-up of hospital care provided to patients with HG, resulting in high patient satisfaction. This project might serve as an inspiration to other departments of obstetrics and gynaecology.
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Affiliation(s)
- Anne Ostenfeld
- Department of Obstetrics and Gynaecology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Ellen Christine Leth Løkkegaard
- Department of Obstetrics and Gynaecology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Brix Westergaard
- Department of Obstetrics and Gynaecology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Meador M, Bay RC, Anderson E, Roy D, Allgood JA, Lewis JH. Using the Practical Robust Implementation and Sustainability Model (PRISM) to Identify and Address Provider-Perceived Barriers to Optimal Statin Prescribing and Use in Community Health Centers. Health Promot Pract 2023; 24:776-787. [PMID: 35603709 PMCID: PMC10336706 DOI: 10.1177/15248399221088592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Statins are an important but underutilized therapy to prevent cardiovascular events, particularly in high-risk patients. To increase use of statin therapy in high-risk patients, the Centers for Disease Control and Prevention funded a project led by the National Association of Community Health Centers to discover reasons for statin underuse in health centers and identify possible leverage points, particularly among vulnerable and underserved patients. The project further sought to develop training and educational materials to improve statin prescribing for and acceptance in eligible high-risk patients. As a first step, investigators implemented a questionnaire to clinical providers (n = 45) at health centers participating in the project to obtain their perspective on barriers to optimal statin use. We used the practical robust implementation and sustainability model (PRISM) domains to frame the overall project and guide the development of our questionnaire. This paper summarizes top perceived barriers to patient and health system/provider statin initiation and sustainment, as well as facilitators to prescribing, using PRISM as an organizing framework. Our questionnaire yielded important suggestions related to public awareness, education materials, health information technology (HIT)/data solutions, and clinical guidelines as key factors in optimizing statin use. It also informed the design of patient education resources and provider training tools. Future directions include using the full application of the PRISM implementation science model to assess how well our educational and training resources help overcome barriers to statin use in high-risk patients, including evaluating how key contextual factors influence successful implementation.
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Affiliation(s)
- Margaret Meador
- National Association of Community Health Centers, Bethesda, MD, USA
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27
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Udom GJ, Frazzoli C, Ekhator OC, Onyena AP, Bocca B, Orisakwe OE. Pervasiveness, bioaccumulation and subduing environmental health challenges posed by polycyclic aromatic hydrocarbons (PAHs): A systematic review to settle a one health strategy in Niger Delta, Nigeria. ENVIRONMENTAL RESEARCH 2023; 226:115620. [PMID: 36931380 DOI: 10.1016/j.envres.2023.115620] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
The crude oil-rich Niger Delta region of Nigeria is under threat due to anthropogenic activities that include mainly PAH contamination. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), multiple online searches were conducted using several databases (e.g. Cochrane Library, Scopus, Embase, National Library of Medicine, PubMed etc.) between October and November 2022 to collect evidence on pervasiveness, bioaccumulation and health challenges posed by PAH in Nigeria Niger Delta. Included studies were appraised for quality using the Standard for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework and the Joanna Briggs (JB) checklist and retrieved data were analysed using the narrative synthesis method. With the indiscriminate exposure of the local inhabitants to PAH and a lack of public health policies that efficiently prevent exposure-associated adverse health events, there is a need for a collaborative and multi-disciplinary approach, cutting across boundaries of animal, human, and environmental health to undertake risk assessments, develop plans for response and control in an attempt to protect public health. The complex and wide distribution of PAHs within the Niger Delta region would benefit of the One Health strategy. Such systemic approach would help managing the harmful effects of PAHs on ecosystems, from environmental remedial approaches to measures to mitigate exposure-associated risks. One health, including environmental health and food safety, would help risk assessors and risk managers in prioritising actions for the prevention and mitigation of PAHs pollution and its spread and accumulation.
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Affiliation(s)
- Godswill J Udom
- Department of Pharmacology and Toxicology, Federal University Oye-Ekiti, Nigeria
| | - Chiara Frazzoli
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Amarachi Paschaline Onyena
- Department of Marine Environment and Pollution Control, Nigeria Maritime University Okerenkoko, Warri, Delta State, Nigeria
| | - Beatrice Bocca
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Orish Ebere Orisakwe
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323, Port Harcourt, Choba, Nigeria; Provictorie Research Institute Port Harcourt, Rivers State, Nigeria.
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Jones IGR, Friedman S, Vu M, Awladthani S, Watts C, Simpson A, Al-Farsi AA, Gupta R, Cupido C, Choong K. Improving Daily Patient Goal-Setting and Team Communication: The Liber8 Glass Door Project. Pediatr Crit Care Med 2023; 24:382-390. [PMID: 36877021 DOI: 10.1097/pcc.0000000000003192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To develop and implement a tool to improve daily patient goal setting, team collaboration and communication. DESIGN Quality improvement implementation project. SETTING Tertiary-level PICU. PATIENTS Inpatient children less than 18 years old requiring ICU level care. INTERVENTION A "Glass Door" daily goals communication tool located in the door front of each patient room. MEASUREMENTS AND MAIN RESULTS We used Pronovost's 4 E's model to implement the Glass Door. Primary outcomes were uptake of goal setting, healthcare team discussion rate around goals, rounding efficiency, acceptability and sustainability of the Glass Door. The total implementation duration from engagement to evaluation of sustainability was 24 months. Goal setting increased significantly from 22.9% to 90.7% ( p < 0.01) patient-days using the Glass Door compared to a paper-based daily goals checklist (DGC). One-year post implementation, the uptake was sustained at 93.1% ( p = 0.04). Rounding time decreased from a median of 11.7 minutes (95% CI, 10.9-12.4 min) to 7.5 minutes (95% CI, 6.9-7.9 min) per patient post-implementation ( p < 0.01). Goal discussions on ward rounds increased overall from 40.1% to 58.5% ( p < 0.01). Ninety-one percent of team members perceive that the Glass Door improves communication for patient care, and 80% preferred the Glass Door to the DGC for communicating patient goals with other team members. Sixty-six percent of family members found the Glass Door helpful in understanding the daily plan and 83% found it helpful in ensuring thorough discussion among the PICU team. CONCLUSIONS The Glass Door is a highly visible tool that can improve patient goal setting and collaborative team discussion with good uptake and acceptability among healthcare team members and patient families.
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Affiliation(s)
- Ian G R Jones
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Shayne Friedman
- Department of Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Vu
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Saif Awladthani
- Section of Pediatric Intensive Care, Child Health Department, The Royal Hospital, Muscat, Oman
- Departments of Pediatrics and Critical Care Medicine, McMaster University, Hamilton, ON, Canada
| | - Cathy Watts
- McMaster Children's Hospital, Hamilton, ON, Canada
| | | | - Ahmed A Al-Farsi
- Departments of Pediatrics and Critical Care Medicine, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, Rustaq Hospital, Rustaq, Oman
| | - Ronish Gupta
- Departments of Pediatrics and Critical Care Medicine, McMaster University, Hamilton, ON, Canada
| | - Cynthia Cupido
- Departments of Pediatrics and Critical Care Medicine, McMaster University, Hamilton, ON, Canada
| | - Karen Choong
- Departments of Pediatrics and Critical Care Medicine, McMaster University, Hamilton, ON, Canada
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Oyekan AA, Lee JY, Hodges JC, Chen SR, Wilson AE, Fourman MS, Clayton EO, Njoku-Austin C, Crasto JA, Wisniewski MK, Bilderback A, Gunn SR, Levin WI, Arnold RM, Hinrichsen KL, Mensah C, Hogan MV, Hall DE. Increasing Quality and Frequency of Goals-of-Care Documentation in the Highest-Risk Surgical Candidates: One-Year Results of the Surgical Pause Program. JB JS Open Access 2023; 8:JBJSOA-D-22-00107. [PMID: 37101601 PMCID: PMC10125643 DOI: 10.2106/jbjs.oa.22.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Patient values may be obscured when decisions are made under the circumstances of constrained time and limited counseling. The objective of this study was to determine if a multidisciplinary review aimed at ensuring goal-concordant treatment and perioperative risk assessment in high-risk orthopaedic trauma patients would increase the quality and frequency of goals-of-care documentation without increasing the rate of adverse events. Methods We prospectively analyzed a longitudinal cohort of adult patients treated for traumatic orthopaedic injuries that were neither life- nor limb-threatening between January 1, 2020, and July 1, 2021. A rapid multidisciplinary review termed a "surgical pause" (SP) was available to those who were ≥80 years old, were nonambulatory or had minimal ambulation at baseline, and/or resided in a skilled nursing facility, as well as upon clinician request. Metrics analyzed include the proportion and quality of goals-of-care documentation, rate of return to the hospital, complications, length of stay, and mortality. Statistical analysis utilized the Kruskal-Wallis rank and Wilcoxon rank-sum tests for continuous variables and the likelihood-ratio chi-square test for categorical variables. Results A total of 133 patients were either eligible for the SP or referred by a clinician. Compared with SP-eligible patients who did not undergo an SP, patients who underwent an SP more frequently had goals-of-care notes identified (92.4% versus 75.0%, p = 0.014) and recorded in the appropriate location (71.2% versus 27.5%, p < 0.001), and the notes were more often of high quality (77.3% versus 45.0%, p < 0.001). Mortality rates were nominally higher among SP patients, but these differences were not significant (10.6% versus 5.0%, 5.1% versus 0.0%, and 14.3% versus 7.9% for in-hospital, 30-day, and 90-day mortality, respectively; p > 0.08 for all). Conclusions The pilot program indicated that an SP is a feasible and effective means of increasing the quality and frequency of goals-of-care documentation in high-risk operative candidates whose traumatic orthopaedic injuries are neither life- nor limb-threatening. This multidisciplinary program aims for goal-concordant treatment plans that minimize modifiable perioperative risks. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anthony A. Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, Pennsylvania
- Email for corresponding author:
| | - Joon Y. Lee
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacob C. Hodges
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen R. Chen
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alan E. Wilson
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mitchell S. Fourman
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Elizabeth O. Clayton
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Jared A. Crasto
- Department of Orthopaedic Surgery, The Spine Institute of Arizona, Scottsdale, Arizona
| | - Mary Kay Wisniewski
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Bilderback
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Scott R. Gunn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - William I. Levin
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert M. Arnold
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Katie L. Hinrichsen
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Mensah
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - MaCalus V. Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel E. Hall
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Daniel Pereira D, Market MR, Bell SA, Malic CC. Assessing the quality of reporting on quality improvement initiatives in plastic surgery: A systematic review. J Plast Reconstr Aesthet Surg 2023; 79:101-110. [PMID: 36907019 DOI: 10.1016/j.bjps.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/07/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND There has been a recent increase in the number and complexity of quality improvement studies in plastic surgery. To assist with the development of thorough quality improvement reporting practices, with the goal of improving the transferability of these initiatives, we conducted a systematic review of studies describing the implementation of quality improvement initiatives in plastic surgery. We used the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guideline to appraise the quality of reporting of these initiatives. METHODS English-language articles published in Embase, MEDLINE, CINAHL, and the Cochrane databases were searched. Quantitative studies evaluating the implementation of quality improvement initiatives in plastic surgery were included. The primary endpoint of interest in this review was the distribution of studies per SQUIRE 2.0 criteria scores in proportions. Abstract screening, full-text screening, and data extraction were completed independently and in duplicate by the review team. RESULTS We screened 7046 studies, of which 103 full texts were assessed, and 50 met inclusion criteria. In our assessment, only 7 studies (14%) met all 18 SQUIRE 2.0 criteria. SQUIRE 2.0 criteria that were met most frequently were abstract, problem description, rationale, and specific aims. The lowest SQUIRE 2.0 scores appeared in funding, conclusion, and interpretation criteria. CONCLUSIONS Improvements in QI reporting in plastic surgery, especially in the realm of funding, costs, strategic trade-offs, project sustainability, and potential for spread to other contexts, will further advance the transferability of QI initiatives, which could lead to significant strides in improving patient care.
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Affiliation(s)
- D Daniel Pereira
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Marisa R Market
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie A Bell
- Department of Plastic Surgery, Children's Hospital of Eastern Ontario, Canada
| | - Claudia C Malic
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Plastic Surgery, Children's Hospital of Eastern Ontario, Canada
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von Meyenfeldt EM, van Nassau F. Implementing an enhanced recovery after thoracic surgery programme: just having a protocol is not enough. J Thorac Dis 2023; 15:1-4. [PMID: 36794130 PMCID: PMC9922613 DOI: 10.21037/jtd-2022-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Erik M. von Meyenfeldt
- Department of Thoracic Surgery, Lung Cancer Centre, Albert Schweitzer Hospital, Dordrecht, The Netherlands;,Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Carmack A, Valleru J, Randall K, Baka D, Angarano J, Fogel R. A Multicenter Collaborative Effort to Reduce Preventable Patient Harm Due to Retained Surgical Items. Jt Comm J Qual Patient Saf 2023; 49:3-13. [PMID: 36334991 DOI: 10.1016/j.jcjq.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Unintentional retention of surgical items is severe but preventable patient harm in surgical procedures. One multicenter health care organization experienced a harm event due to retained surgical items (RSIs) every eight days in 2019-2020. The research team sought to reduce the incidence of harm due to RSIs, improve near-miss reporting, and increase process reliability in operating rooms across the organization. METHODS A total of 114 health care facilities in the organization were invited to participate in a multistate, multicenter patient safety initiative to reduce patient harm caused by RSIs. A national-level workgroup comprising various disciplines proposed an evidence-based best practice bundle with five elements: surgical stop, surgical debrief, visual counter, imaging, and reporting of deviations. The workgroup ensured that extensive education and support were accessible to all the participating sites. The researchers monitored the process reliability of bundle elements and improvement milestones of all the sites, along with rates of harm related to RSIs. RESULTS Implementing the evidence-based RSI reduction bundle across 114 health care facilities resulted in a 14.3% reduction in the rate of harm caused by RSIs and a 59.1% increase in RSI near-miss reporting. The compliance to the RSI bundle reached an average of 70.5%, and 63.2% of the facilities are actively performing Plan-Do-Check-Act (PDCA) cycles to improve bundle compliance continually. CONCLUSION Implementation of an RSI bundle can be done reliably, can improve near-miss reporting, and can reduce patient harm. Variation in process reliability between centers suggests the significance of overcoming cultural and organizational barriers.
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Manzar S, Cole SR, Bhat R. Improving maternal update rates within the first hour of NICU admission. J Neonatal Perinatal Med 2023; 16:605-610. [PMID: 38007675 DOI: 10.3233/npm-230050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND Timely communication is essential in attaining maternal satisfaction, developing an excellent physician-patient rapport, and increasing trust. This study reports a significant improvement in maternal communication rates through the quality improvement method. METHODS An educational module was developed, and NICU staff was presented with the slides, followed by a performance questionnaire to demonstrate understanding. The first phase was completed by obtaining feedback from mothers through a questionnaire. The first plan-do-study-act (PDSA) cycle, carried out for eight weeks looking at the rates of the maternal update provided within an hour of admission of their neonates to the NICU, was followed by the second PDSA cycle, carried out for ten weeks. The improvement was calculated using conventional statistics and a statistical process control chart. RESULTS During the first phase of the study, thirty-six percent of the mothers were updated within an hour of admission of their neonates to the NICU. During the first PDSA cycle, we did not notice a special cause variation or process change. A significant shift, eight consecutive points above the mean, was noted on the control chart during PDSA cycle 2. The mean±SD of the weekly update rate increased significantly during PDSA cycle 2 (76.8±11) compared to PDSA cycle 1 (47.5±14), p-value = 0.0002. CONCLUSION We improved the maternal update rates through the educational module following the QI improvement model using the PDSA cycles.
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Affiliation(s)
- S Manzar
- Neonatal Intensive Care Unit, Ochsner LSU Health, Shreveport, LA, USA
- Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - S R Cole
- Neonatal Intensive Care Unit, Ochsner LSU Health, Shreveport, LA, USA
| | - R Bhat
- Neonatal Intensive Care Unit, Ochsner LSU Health, Shreveport, LA, USA
- Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Williams FB, Pierce H, McBride CA, DeAngelis J, McLean K. Quality Initiative to Reduce Failed Trial of Labor after Cesarean Using Calculated VBAC Success Likelihood. Am J Perinatol 2022; 40:575-581. [PMID: 36228652 DOI: 10.1055/a-1960-2797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Vaginal birth after cesarean can reduce morbidity associated with multiple cesarean deliveries. Failed vaginal birth after cesarean is associated with increased maternal and neonatal morbidity. The Maternal-Fetal Medicine Units Vaginal Birth After Cesarean calculator is a validated tool to predict the likelihood of successful trial of labor after cesarean. Predicted likelihood < 60% has been associated with increased maternal and neonatal morbidity. We sought to determine if formal incorporation of calculated vaginal birth after cesarean likelihood into patient-centered counseling would reduce failed vaginal birth after cesarean. STUDY DESIGN This is a quality improvement intervention at a single tertiary-care academic medical center, in which standardized patient counseling was implemented, facilitated by an electronic medical record template featuring patient-specific likelihood of vaginal birth after cesarean success. Term singleton pregnancies with history of one to two cesareans were included; those with contraindication to labor were excluded. Historical controls (January 2016-December 2018, n = 693) were compared with a postimplementation cohort (January 2019-April 2020, n = 328). Primary outcome was failed vaginal birth after cesarean. RESULTS Fewer patients in the postintervention cohort had a history of an arrest disorder (PRE: 48%, 330/693 vs. POST: 40%, 130/326, p = 0.03); demographics were otherwise similar, including the proportion of patients with <60% likelihood of success (PRE: 39%, 267/693, vs. POST: 38%, 125/326). Following implementation, induction of labor in patients with a <60% likelihood of successful vaginal birth after cesarean decreased from 17% (45/267) to 5% (6/125, p < 0.01). The proportion of failed vaginal birth after cesarean decreased from 33% (107/329) to 22% (32/143, p = 0.04). Overall vaginal birth after cesarean rate did not change (PRE: 32%, 222/693, vs. POST: 34%, 111/326, p = 0.52). CONCLUSION An intervention targeting provider counseling that included a validated vaginal birth after cesarean success likelihood was associated with decreased risk of failed trial of labor after cesarean without affecting overall vaginal birth after cesarean rate. KEY POINTS · Labored cesarean increases maternal morbidity.. · Application of the Maternal-Fetal Medicine Units (MFMU) calculator to antenatal counseling decreased labored cesarean.. · Application of the MFMU calculator to antenatal counseling did not decrease overall vaginal birth after cesarean rate..
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Affiliation(s)
- Frank B Williams
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Hayley Pierce
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Carole A McBride
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Justin DeAngelis
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
| | - Kelley McLean
- Department of Obstetrics, Gynecology and Reproductive Services, University of Vermont, Burlington, Vermont
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Abstract
Can we speed the testing, implementation and spread of management innovations in a systematic way to also contribute to scientific knowledge? Researchers and implementers have developed an approach to test and revise a local version of an innovation during its implementation. The chapter starts with a case example of an application of this combination of implementation and quality improvement sciences and practices (improve-mentation). It then summarizes four examples of this approach so as to help understand what improve-mentation is and how it is different from traditional quality improvement and traditional implementation of evidence-based practices. It considers gaps in knowledge that are hindering both more use of improve-mentation to generate scientific knowledge about spread and implementation, as well as more use of improve-mentation by health care service organizations and researchers. It closes by proposing fruitful research and development that can address these knowledge gaps to speed the implementation, sustainment and spread of care and management innovations.
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Li J, Sun X, Wu X. Effects of implementation strategies aimed at improving high-value verification methods of nasogastric tube placement: A systematic review. Front Nutr 2022; 9:1009666. [DOI: 10.3389/fnut.2022.1009666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
BackgroundX-ray and pH testing, which clinical practice guidelines have proven to be effective in determining nasogastric tube (NGT) placement, were named the high-value methods. Implementation strategies can help to integrate high-value methods into particular contexts. The aim of this systematic review was to summarize the evidence of implementation strategies aimed at improving high-value verification methods of NGT placement.MethodsPubMed, ProQuest, and CINAHL were searched until June 2022. The Cochrane Effective Practice and Organization of Care (EPOC) taxonomy was used to categorize implementation strategies.ResultsThe initial search identified 1,623 records. Of these, 64 full-text studies were reviewed. Finally, 12 studies were included and used for qualitative synthesis. Eleven studies used an education component as an implementation strategy. Only one study based their implementation strategy on a barriers and facilitators assessment. None of the studies reported enough detail of the implementation strategy used in their studies. Seven studies were eligible for inclusion in the meta-analysis. Three of these seven studies revealed a significant improvement of the high-value method after strategy implementation. As heterogeneity was present in the high level, the pooled effect estimated was not calculated.ConclusionMost studies used an implementation strategy with an educational component. Unfortunately, no conclusion can be drawn about which strategy is most effective for improving high-value verification methods of NGT placement due to a high level of heterogeneity and a lack of studies. We recommend that future studies fully connect their implementation strategies to influencing factors and better report the details of implementation strategies.Systematic review registration[www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022349997].
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Lin AG, Shaheen N, Ganda K, Cullen J, Waite LM, Seibel MJ. Improving osteoporosis treatment rates in inpatients admitted with hip fracture: A healthcare improvement initiative in a tertiary referral hospital. Aging Med (Milton) 2022; 5:264-271. [PMID: 36606266 PMCID: PMC9805288 DOI: 10.1002/agm2.12229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/23/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This healthcare improvement initiative was designed to increase inpatient osteoporosis treatment after hip fracture. Methods A new protocol was developed by Geriatric Medicine and Endocrinology departments at a tertiary care hospital in Sydney. Its aim was to standardize assessment and treatment of osteoporosis in patients admitted with hip fracture. Eligible inpatients would receive intravenous zoledronic acid during their admission. A 6-month sample of hip fracture patients admitted after the protocol's implementation was compared to a group admitted before. Data collected included demographics, biochemistry, treatment rates, adverse effects, and admission survival. Results There was a considerable increase in osteoporosis treatment after introducing the protocol. Before the protocol's introduction, none of 36 eligible patients received treatment. After the intervention 79% (23 out of 29) of eligible patients were treated.All treated patients had renal function and serum calcium levels checked post-infusion with no adverse outcomes. Eight patients developed flu-like symptoms within 24 h of the infusion. There were no instances of arrhythmias, ocular inflammation, or death. The cost per patient treated was AUD $87. Conclusion Adopting a standardized protocol for osteoporosis treatment in patients admitted for hip fracture was effective in improving treatment rates whilst being relatively safe and inexpensive.
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Affiliation(s)
- Andrew Gan Lin
- Department of EndocrinologyConcord HospitalConcordNew South WalesAustralia
| | - Nargis Shaheen
- Centre for Education and Research on Ageing (CERA), Department of Geriatric MedicineConcord HospitalConcordNew South WalesAustralia
| | - Kirtan Ganda
- Department of EndocrinologyConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - John Cullen
- Centre for Education and Research on Ageing (CERA), Department of Geriatric MedicineConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Louise M. Waite
- Centre for Education and Research on Ageing (CERA), Department of Geriatric MedicineConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Markus J. Seibel
- Department of EndocrinologyConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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Ng GY, Ong BC. Contact tracing using real-time location system (RTLS): a simulation exercise in a tertiary hospital in Singapore. BMJ Open 2022; 12:e057522. [PMID: 36192104 PMCID: PMC9535253 DOI: 10.1136/bmjopen-2021-057522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We aim to assess the effectiveness of contact tracing using real-time location system (RTLS) compared with the conventional (electronic medical records (EMRs)) method via an emerging infectious disease (EID) outbreak simulation exercise. The aims of the study are: (1) to compare the time taken to perform contact tracing and list of contacts identified for RTLS versus EMR; (2) to compare manpower and manpower-hours required to perform contact tracing for RTLS versus EMR; and (3) to extrapolate the cost incurred by RTLS versus EMR. DESIGN Prospective case study. SETTING Sengkang General Hospital, a 1000-bedded public tertiary hospital in Singapore. PARTICIPANTS 1000 out of 4000 staff wore staff tags in this study. INTERVENTIONS A simulation exercise to determine and compare the list of contacts, time taken, manpower and manpower-hours required between RTLS and conventional methods of contact tracing. Cost of both methods were compared. PRIMARY AND SECONDARY OUTCOME MEASURES List of contacts, time taken, manpower required, manpower-hours required and cost incurred. RESULTS RTLS identified almost three times the number of contacts compared with conventional methods, while achieving that with a 96.2% reduction in time taken, 97.6% reduction in manpower required and 97.5% reduction in manpower-hours required. However, RTLS incurred significant equipment cost and might take many contact tracing episodes before providing economic benefit. CONCLUSION Although costly, RTLS is effective in contact tracing. RLTS might not be ready at present time to replace conventional methods, but with further refinement, RTLS has the potential to be the gold standard in contact tracing methods of the future, particularly in the current pandemic.
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Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis. Pediatr Crit Care Med 2022; 23:774-783. [PMID: 35699766 DOI: 10.1097/pcc.0000000000003010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The effectiveness of pharmacologic prophylaxis against catheter-associated thrombosis in children is unclear. We evaluated the compliance and outcomes associated with a prophylactic enoxaparin protocol in postoperative cardiac children. DESIGN The protocol was implemented as a quality improvement initiative and then analyzed using interrupted time series method. Data collected from November 2014 to December 2018 were divided into preprotocol (period 1), protocol implementation (period 2), and protocol revision (period 3). SETTING A 12-bed academic pediatric cardiac ICU. PATIENTS Children less than or equal to 18 years old with congenital heart disease admitted postoperatively with central venous catheter in situ for greater than or equal to 1 day. INTERVENTIONS Before 2016, prophylactic enoxaparin was administered according to physician preference. In January 2016, an enoxaparin protocol was implemented with a goal anti-Xa range of 0.25-0.49 international units/mL. Protocol was revised in February 2017 to increase the starting dose by 25% for infants less than 1 year old. MEASUREMENTS AND MAIN RESULTS We analyzed 780 hospitalizations from 636 children. Median percentage of catheter-days on prophylactic enoxaparin was 33% (interquartile range [IQR], 23-47%), 42% (IQR, 30-51%), and 38% (IQR, 35-52%) in periods 1-3, respectively. Percentage of catheter-days on enoxaparin showed immediate increase of 90% (95% CI, 17-210%) between periods 1 and 2 and sustained increase of 2% (95% CI, 0.3-4%) between periods 2 and 3. Median rates of thrombosis per 1,000 catheter-days were 5.8 (IQR, 0-9.3), 3.8 (IQR, 0-12), and 0 (IQR, 0-5.3) in periods 1-3, respectively. Rate of thrombosis showed immediate decrease of 67% (95% CI, 12-87%) between periods 1 and 2 and sustained decrease of 11% (95% CI, 2-18%) between periods 1 and 3. CONCLUSIONS The temporal association between increase in percentage of catheter-days on enoxaparin and decrease in rate of thrombosis suggests the effectiveness of prophylactic enoxaparin.
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Sousa ARD, Santos GLA, Salbego C, Santana TDS, Félix NDDC, Santana RF, Silva RSD. Management technology for implementing the Systematization of Nursing Care. Rev Esc Enferm USP 2022; 56:e20220028. [PMID: 36082983 PMCID: PMC10116890 DOI: 10.1590/1980-220x-reeusp-2022-0028en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the construction of a management technology aimed at implementing the Systematization of Nursing Care in nursing services. METHOD This is a methodological, qualitative and explanatory study, based on the normative and legal framework of COFEN Resolution 358/2009. It comprised the theoretical construction of instruments for practice anchored in the literature and expertise of a group of 40 nurses, between April 2020 and June 2021. RESULTS The technology is outlined from the dimensions of method, personnel and nursing instruments that support the Systematization of Nursing Care tripod. It consists of an explanatory model of an operational management matrix and a checklist-type instrument for follow-up/monitoring of Systematization of Nursing Care management in services. CONCLUSION Management technology is inserted as a solution to improve organizational performance, health care, clinical decision support, planning, administration, organization of services and professional practice, and create favorable conditions for applying the Process of Nursing at its fullest.
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Affiliation(s)
- Anderson Reis de Sousa
- Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brazil
| | | | - Cléton Salbego
- Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Wu C, O'Keeffe C, Sanford J, Hagel J, Childs S, Evers G, Melbourne J, West C, Koch M, Cornia PB. Simple signature/countersignature shared-accountability quality improvement initiative to improve reliability of blood sample collection: an essential clinical task. BMJ Open Qual 2022; 11:bmjoq-2021-001765. [PMID: 36130832 PMCID: PMC9494581 DOI: 10.1136/bmjoq-2021-001765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background Timely lab results are important to clinical decision-making and hospital flow. However, at our institution, unreliable blood sample collection for patients with central venous access jeopardised this outcome and created staff dissatisfaction. Methods A multidisciplinary team of nurses including a specialist clinical nurse leader (CNL), the hospital intravenous team and quality improvement (QI) consultants aimed to achieve >80% blood sample collection reliability among patients with central venous access by employing a simple signature/countersignature form coupled with audit-feedback and behavioural economics strategies. The form was piloted on one 25-bed unit. Data were collected for 60 weeks and interpreted per standard run chart rules. Results Blood sample collection reliability exceeded the 80% goal by week 22. The practice was sustained on the pilot unit and spread successfully to other wards despite significant operational threats including the COVID-19 pandemic. Conclusions At our institution, a simple signature/countersignature form supplemented by audit-feedback and behavioural economics strategies led to sustained practice change among staff. The pairing of CNL to QI consultant enhanced change potency and durability.
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Affiliation(s)
- Chenwei Wu
- Hospital and Specialty Medicine, VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chatty O'Keeffe
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Jesse Sanford
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Jean Hagel
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Shelia Childs
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Gary Evers
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Julie Melbourne
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Collyn West
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Michael Koch
- VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
| | - Paul B Cornia
- Hospital and Specialty Medicine, VA Puget Sound HCS Seattle Division, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Ulvin OE, Skjærseth EÅ, Haugland H, Thorsen K, Nordseth T, Orre MF, Vesterhus L, Krüger AJ. The introduction of a regional Norwegian HEMS coordinator: an assessment of the effects on response times, geographical service areas and severity scores. BMC Health Serv Res 2022; 22:1020. [PMID: 35948977 PMCID: PMC9365225 DOI: 10.1186/s12913-022-08337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Due to unwanted delays and suboptimal resource control of helicopter emergency medical services (HEMS), regional HEMS coordinators have recently been introduced in Norway. This may represent an unnecessary link in the alarm chain, which could cause delays in HEMS dispatch. Systematic evaluations of this intervention are lacking. We wanted to conduct this study to assess possible changes in HEMS response times, mission distribution patterns and patient characteristics within our region following this intervention. Methods We retrospectively collected timeline parameters, patient characteristics and GPS positions from HEMS missions executed by three regional HEMS bases in Mid-Norway during 2017–2018 (preintervention) and 2019 (postintervention). The mean regional response time in HEMS missions was assessed by an interrupted time series analysis (ITS). The geographical mission distribution between regional HEMS resources was assessed by a before-after study with a convex hull-based method. Results There was no significant change in the level (-0.13 min/month, p = 0.88) or slope (-0.13 min/month, p = 0.30) of the mean regional response time trend line pre- and postintervention. For one HEMS base, the service area was increased, and the median mission distance was significantly longer. For the two other bases, the service areas were reduced. Both the mean NACA score (4.13 ± SD 0.027 vs 3.98 ± SD 0.04, p < 0.01) and the proportion of patients with severe illness or injury (NACA 4–7, 68.2% vs 61.5%, p < 0.001) were higher in the postintervention group. Conclusion The introduction of a regional HEMS coordinator in Mid-Norway did not cause prolonged response times in acute HEMS missions during the first year after implementation. Higher NACA scores in the patients treated postintervention suggest better selection of HEMS use.
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Affiliation(s)
- Ole Erik Ulvin
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. .,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway. .,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Marie Falch Orre
- Department of Civil and Environmental Engineering, Master's Degree Programme of Engineering and ICT, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Vesterhus
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Andreas Jørstad Krüger
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
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Cassie H, Treweek S, McKee L, Ramsay C, Young L, Clarkson J. 'Well, in dentistry the dentist is always the boss': a multi-method exploration of which organisational characteristics of dental practices most influence the implementation of evidence-based guidance. BMJ Open 2022; 12:e059564. [PMID: 35922111 PMCID: PMC9352983 DOI: 10.1136/bmjopen-2021-059564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate which organisational characteristics of primary care dental practices influence the implementation of evidence-based guidance. DESIGN A multimethod study set within primary care dentistry in Scotland comprising: (1) Semistructured interviews with dental teams to inform development of a self-report questionnaire exploring the translation of guidance in primary care dentistry and (2) A questionnaire-based survey and case studies exploring which organisational characteristics influence knowledge translation. RESULTS Interview data identified three themes: leadership, communication and context. Survey data revealed compliance with recommendations from three topics of dental guidance to be variable, with only 41% (emergency dental care), 19% (oral health assessment and review) and 4% (drug prescribing) of respondents reporting full compliance. Analysis revealed no significant relationship between practice characteristics and compliance with emergency dental care or drug prescribing recommendations. Positive associations were observed between compliance with oral health assessment and review recommendations and having a practice manager, as well as with the type of treatment offered, with fully private practices more likely, and fully National Health Service practices less likely to comply, when compared with those offering a mixture of treatment. Synthesis of the data identified leadership and context as key drivers of guidance uptake. CONCLUSIONS Evidence-based dental recommendations are not routinely translated into practice, with variable leadership and differing practice contexts being central to poor uptake. Guidelines should aim to tailor recommendations and implementation strategies to reflect the complexities and varying contexts that exist in primary care dentistry, thus facilitating the implementation of evidence-based guidance.
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Affiliation(s)
- Heather Cassie
- School of Dentistry, University of Dundee, Dundee, Scotland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Young
- Dental Clinical Effectiveness Workstream, Dundee Dental Education Centre, NHS Education for Scotlland, University of Dundee, Dundee, UK
| | - Jan Clarkson
- School of Dentistry, University of Dundee, Dundee, Scotland
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Wasp GT, Cullinan AM, Anton CP, Williams A, Perry JJ, Holthoff MM, Buus-Frank ME. Interdisciplinary Approach and Patient/Family Partners to Improve Serious Illness Conversations in Outpatient Oncology. JCO Oncol Pract 2022; 18:e1567-e1573. [DOI: 10.1200/op.22.00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: We aimed to increase Serious Illness Conversations (SIC) from a baseline of, at or near, zero to 25% of eligible patients by December 31, 2020. METHODS: We assembled an interdisciplinary team inclusive of a family partner and used the Model for Improvement as our quality improvement framework. The team developed a SMART Aim, key driver diagram, and SIC workflow. Standardized screening for SIC eligibility was implemented using the 2-year surprise question. Team members were trained in SIC communication skills by a trained facilitator and received ongoing coaching in quality improvement. We performed Plan-Do-Study-Act cycles and used audit-feedback data in weekly team meetings to inform iterative Plan-Do-Study-Act cycles. The primary outcome was the percent of eligible patients with documented SIC. RESULTS: Over 18 months, three clinics identified 63 eligible patients; of these, 32 (51%) were diagnosed with head and neck cancer and 31 (49%) with sarcoma. The SIC increased from a baseline near zero to 43 of 63 (70%) patients demonstrating three shifts in the median (95% CI). Conversations were interdisciplinary with 25 (57%) by oncology MD, six (14%) by advanced practice registered nurse, and 13 (30%) by specialty palliative care. We targeted four key drivers: (1) standardized work, (2) engaged interdisciplinary team, (3) engaged patients and families, and (4) system-level support. CONCLUSION: Our approach was successful in its documentation of end points and required resource investment (training and time) to embed into team workflows. Future work will evaluate scaling the approach across multiple clinics, the patient experience, and outcomes of care associated with oncology clinician–led SIC.
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Affiliation(s)
- Garrett T. Wasp
- Section of Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, NH
- Norris Cotton Cancer Center, DHMC, Lebanon, NH
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Amelia M. Cullinan
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Section of Palliative Care, Department of Medicine, DHMC, Lebanon, NH
| | - Catherine P. Anton
- Section of Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, NH
- Norris Cotton Cancer Center, DHMC, Lebanon, NH
| | - Andy Williams
- Volunteer and Guest Services, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - Megan M. Holthoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Madge E. Buus-Frank
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- The Children's Hospital at Dartmouth, Section of Neonatology, Department of Pediatrics, Lebanon, NH
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Fabozzi F, Trovato CM, Diamanti A, Mastronuzzi A, Zecca M, Tripodi SI, Masetti R, Leardini D, Muratore E, Barat V, Lezo A, De Lorenzo F, Caccialanza R, Pedrazzoli P. Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers (Basel) 2022; 14:cancers14143378. [PMID: 35884438 PMCID: PMC9319266 DOI: 10.3390/cancers14143378] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Nutritional management is an underestimated issue in treating pediatric cancer, since a systematic approach is currently lacking. In this consensus statement, a cohort of 12 experts selected from four different tertiary pediatric oncology centers formulated 21 clinical questions regarding the identification and treatment of nutritional issues in children with cancer. These questions were discussed, and practical recommendations were provided. With this paper, we aimed to give consensus-based guidance for addressing the nutritional needs of children with cancer, filling a gap in the field. Abstract Malnutrition, intended as both overnutrition and undernutrition, is a common problem in children with cancer, impacting quality of life as well as survival. In addition, nutritional imbalances during childhood can significantly affect proper growth. Nevertheless, there is currently a lack of a systematic approach to this issue in the pediatric oncology population. To fill this gap, we aimed to provide practice recommendations for the uniform management of nutritional needs in children with cancer. Twenty-one clinical questions addressing evaluation and treatment of nutritional problems in children with cancer were formulated by selected members from four Italian Association of Pediatric Hematology and Oncology (AIEOP) centers and from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. A literature search in PubMed was performed; during two consensus meetings, all recommendations were discussed and finalized using the nominal group technique. Members representing every institution voted on each recommendation. Finally, recommendations were approved by all authors.
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Affiliation(s)
- Francesco Fabozzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.F.); (A.M.)
- Department of Pediatrics, University of Rome Tor Vergata, 00165 Rome, Italy
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
- Correspondence:
| | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.F.); (A.M.)
| | - Marco Zecca
- Pediatric Hematology-Oncology, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (M.Z.); (S.I.T.)
| | - Serena Ilaria Tripodi
- Pediatric Hematology-Oncology, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (M.Z.); (S.I.T.)
| | - Riccardo Masetti
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Davide Leardini
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Edoardo Muratore
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Veronica Barat
- SC Onco-Ematologia Pediatrica, AOU Città della Salute e della Scienza, 10126 Torino, Italy;
| | - Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Children’s Hospital Regina Margherita, AOU Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy;
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Removal of Circulating Tumor Cells from Blood Samples of Cancer Patients Using Highly Magnetic Nanoparticles: A Translational Research Project. Pharmaceutics 2022; 14:pharmaceutics14071397. [PMID: 35890293 PMCID: PMC9315588 DOI: 10.3390/pharmaceutics14071397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022] Open
Abstract
The count of circulating tumor cells (CTCs) has been associated with a worse prognosis in different types of cancer. Perioperatively, CTCs detach due to mechanical forces. Diagnostic tools exist to detect and isolate CTCs, but no therapeutic technique is currently available to remove CTCs in vivo from unprocessed blood. The aim of this study was to design and test new magnetic nanoparticles to purify whole blood from CTCs. Novel magnetic carbon-coated cobalt (C/Co) nanoparticles conjugated with anti-epithelial cell adhesion molecule (EpCAM) antibodies were synthesized, and their antifouling and separation properties were determined. The newly developed C/Co nanoparticles showed excellent separation and antifouling properties. They efficiently removed tumor cells that were added to healthy subjects’ blood samples, through an anti-EpCAM antibody interaction. The nanoparticles did not interact with other blood components, such as lymphocytes or the coagulation system. In blood samples of carcinoma patients suffering from metastatic disease, on average, ≥68% of CTCs were removed. These nanoparticles could prompt the development of a blood purification technology, such as a dialysis-like device, to perioperatively remove CTCs from the blood of cancer patients in vivo and potentially improve their prognosis.
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Madan E, Carrié S, Donado C, Lobo K, Souris M, Laine R, Beers E, Cornelissen L, Darras BT, Koka A, Riley B, Dinakar P, Stone S, Snyder B, Graham RJ, Padua H, Sethna N, Berde C. Nusinersen for Patients With Spinal Muscular Atrophy: 1415 Doses via an Interdisciplinary Institutional Approach. Pediatr Neurol 2022; 132:33-40. [PMID: 35636280 DOI: 10.1016/j.pediatrneurol.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Spinal deformity and prior spinal fusion pose technical challenges to lumbar puncture (LP) for nusinersen administration for patients with spinal muscular atrophy (SMA). In this retrospective study over two study phases, we evaluated (1) factors associated with difficult LP or unscheduled requirement for image guidance and (2) effectiveness of a triage pathway for selective use of image guidance and nonstandard techniques, particularly for patients with spinal instrumentation/fusion to the sacrum. METHODS With institutional review board approval, electronic health records, imaging, and administrative databases were analyzed for patients receiving nusinersen from January 2012 through September 2021. Descriptive statistics and univariate analyses were used. RESULTS From January 2012 to March 2018 (phase 1), among 82 patients with SMA, 461 of 464 (99.4%) LP attempts were successful. Univariate analyses associated difficulty with prior spinal instrumentation, higher body mass index, and severity of the spinal deformity. Based on this experience, starting in April 2018 (phase 2), 125 patients were triaged selectively for ultrasound, fluoroscopy, or Dyna computed tomography. Patients with spinal instrumentation/fusion to the sacrum were treated primarily via intrathecal ports (137 doses) or transforaminal LP (55 doses). From April 2018 through September 2021, 704 of 709 (99.3%) LPs were successful. In total from January 2012 to September 2021, 1415 doses were administered. Over 50% of LPs were performed by neurology nurse practitioners without image guidance. Safety outcomes were excellent. CONCLUSIONS A stratified approach resulted in successful intrathecal nusinersen delivery and efficient resource allocation for patients with SMA, with or without complex spinal anatomy.
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Affiliation(s)
- Elena Madan
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sabrina Carrié
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carolina Donado
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kimberly Lobo
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle Souris
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Regina Laine
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Beers
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura Cornelissen
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anjali Koka
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bobbie Riley
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Pradeep Dinakar
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scellig Stone
- Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert J Graham
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Horacio Padua
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Navil Sethna
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles Berde
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates. Pediatr Qual Saf 2022; 7:e580. [PMID: 35928022 PMCID: PMC9345641 DOI: 10.1097/pq9.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
Despite recommendations promoting noninvasive delivery room (DR) ventilation, local historical preterm DR noninvasive ventilation rates were low (50%−64%). Project aims were to improve DR noninvasive ventilation rate in very low birth weight (VLBW) neonates (<1500 g) with a focus on decreasing DR intubations for ineffective positive pressure ventilation (PPV).
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Weening-Verbree LF, Schuller AA, Zuidema SU, Hobbelen JSM. Evaluation of an Oral Care Program to Improve the Oral Health of Home-Dwelling Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127251. [PMID: 35742500 PMCID: PMC9223830 DOI: 10.3390/ijerph19127251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the impact of the implementation of an Oral Care Program on home care nurses’ attitudes and knowledge about oral health (care) and the impact on older people’s oral health. A pre–post study, without a control group, was conducted. A preventive Oral Care Program (OCP) was designed, focusing on home care nurses and older people, in collaboration with dental hygienists. Implementation was measured with questionnaires at baseline and after 6 months for home care nurses; for older people, implementation was measured at baseline and after 3 months with the Oral Health Assessment Tool and a questionnaire about oral (self) care between January 2018 and September 2019. Although the study design has limitations, the oral health of older people improved significantly after 3 months and the OCP was most beneficial for people with full dentures. The OCP improved knowledge and attitude of home care nurses. The program fitted well with the daily work routines of home care nurses. Individual-centered care plans for older people, education of home care nurses and the expertise of the dental hygienists have added value in home care nursing. Future implementations should focus on older people with natural teeth.
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Affiliation(s)
- Lina F. Weening-Verbree
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands;
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, A. Deusinglaan 1, FB 21, 9713 AV Groningen, The Netherlands;
- Correspondence:
| | - Annemarie A. Schuller
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, A. Deusinglaan 1, FB 21, 9713 AV Groningen, The Netherlands;
- TNO the Netherlands Organisation for Applied Scientific Research, Schipholweg 77-89, 2316 ZL Leiden, The Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, FA21, P.O. Box 196, 9700 AD Groningen, The Netherlands;
| | - Johannes S. M. Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands;
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, FA21, P.O. Box 196, 9700 AD Groningen, The Netherlands;
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Hosseini S, Yilmaz Y, Shah K, Gottlieb M, Stehman CR, Hall AK, Chan TM. Program evaluation: An educator's portal into academic scholarship. AEM EDUCATION AND TRAINING 2022; 6:S43-S51. [PMID: 35783081 PMCID: PMC9222891 DOI: 10.1002/aet2.10745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 06/15/2023]
Abstract
Program evaluation is an "essential responsibility" but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.
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Affiliation(s)
- Shera Hosseini
- Faculty of Health SciencesMcMaster Institute for Research on AgingMcMaster Education Research, Innovation, and TheoryMcMaster UniversityHamiltonOntarioCanada
| | - Yusuf Yilmaz
- McMaster Education Research, Innovation and Theory (MERIT) Program & Office of Continuing Professional DevelopmentFaculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Department of Medical EducationFaculty of MedicineEge UniversityIzmirTurkey
| | - Kaushal Shah
- Department of Emergency MedicineWeill Cornell Medical SchoolNew YorkNew YorkUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Christine R. Stehman
- Department of Emergency MedicineUniversity of Illinois College of Medicine ‐ Peoria/OSF HealthcarePeoriaIllinoisUSA
| | - Andrew K. Hall
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Teresa M. Chan
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Division of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
- McMaster Program for Education Research, Innovation, and Theory (MERIT)McMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methodology, Impact, and EvidenceMcMaster UniversityHamiltonOntarioCanada
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