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Noonan K, Grindrod A, Shrestha S, Lee S, Leonard R, Johansson T. Progressing the Death Literacy Index: the development of a revised version (DLI-R) and a short format (DLI-9). Palliat Care Soc Pract 2024; 18:26323524241274806. [PMID: 39314871 PMCID: PMC11418362 DOI: 10.1177/26323524241274806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/18/2024] [Indexed: 09/25/2024] Open
Abstract
Background Since the development of the Death Literacy Index (DLI) in 2019 in Australia, subsequent internationally validated versions have prompted rewording and refinement of the original survey questions. Use of the DLI in the community has also resulted in requests for a short format. Objectives To examine and report on the psychometric properties of a revised version of the DLI-R and develop a short format DLI-9. Design A cross-sectional national survey was conducted for the validation of the revised DLI. Methods The DLI items were revised by the research team using the international literature. DLI data were collected from a representative online non-probability panel of 1202 Australian adults, based on age, gender, and geographical location. Confirmatory factor analysis (CFA) was conducted to ensure the revised version (DLI-R) was consistent with the original. To develop a short format version of the DLI (DLI-9), items were first removed based on face validity, followed by an exploratory factor analysis (EFA) and CFA. The internal reliability of the DLI-R and the DLI-9 was assessed using Cronbach's alpha. The intraclass correlation coefficient was calculated to examine the inter-rater reliability between the DLI-R and DLI-9. Results Twenty-four questions in the DLI were reworded for clarity. A CFA on the 29 items of this modified version of the DLI indicated a good model fit (Tucker-Lewis Index (TLI): 0.93; Comparative Fit Index (CFI): 0.93; root mean square of approximation (RMSEA): 0.06; standardized root mean residual (SRMR): 0.06), with six latent variables and an underlying latent variable "death literacy." For the DLI-9, an EFA identified a nine-item, two-factor structure model (DLI-9). A subsequent CFA in a separate sample demonstrated a good model fit for the DLI-9 (TLI: 0.92; CFI: 0.94; RMSEA: 0.089; SRMR: 0.07). Excellent inter-rater reliability (0.98) was observed between DLI-9 and DLI-R. Cronbach's alpha coefficients for DLI-R scales and subscales and the DLI-9 all exceeded 0.8, indicating high internal consistency. Conclusion The DLI-R and the DLI-9 were found to have acceptable psychometric properties. The development of a shorter version of the DLI provides a valid measure of overall death literacy.
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Affiliation(s)
- Kerrie Noonan
- Public Health Palliative Care Unit, La Trobe University, Bundoora Campus, Melbourne, VIC 3000, Australia
- Western NSW Local Health District, Dubbo, Australia
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
- Death Literacy Institute, Australia
| | - Andrea Grindrod
- Public Health Palliative Care Unit, La Trobe University, Melbourne, VIC, Australia
| | - Sumina Shrestha
- Public Health Palliative Care Unit, La Trobe University, Melbourne, VIC, Australia
| | - Sora Lee
- Public Health Palliative Care Unit, La Trobe University, Melbourne, VIC, Australia
| | - Rosemary Leonard
- School of Social Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Therese Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
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Vilas-Boas VA, Rondini LA, Czempik TCV, Lorenzetti AHM, Graziano KU, Dini AP. Construction and validation of an instrument for event-related sterility of processed healthcare products. Rev Bras Enferm 2024; 77:e20240021. [PMID: 39258614 PMCID: PMC11382677 DOI: 10.1590/0034-7167-2024-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/20/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVE To construct and validate an instrument to assess events related to maintaining the sterility of processed healthcare products. METHODS This methodological study developed the instrument through analysis by a panel of experts, focusing on the integrity of commonly used packaging: spunbond-meltblown-spunbond and medical-grade paper. The instrument was analyzed using the Content Validity Index and Content Validity Ratio (≥ 0.80) and modified Kappa (≥ 0.74). The instrument underwent pre-testing. RESULTS Six experienced professionals participated in the expert panel. After two rounds, the final version of the instrument contained five dimensions. In the pre-test, 30 nursing professionals participated, of whom 86.67% considered the instrument good, and 90% found it understandable. CONCLUSION The construction and validation followed literature recommendations. The instrument is available, aiding in the safe use of processed healthcare products.
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Affiliation(s)
| | | | | | - Ada Helena Melo Lorenzetti
- Universidade Estadual de Campinas, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti. Campinas, São Paulo, Brazil
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Caulfield L, Arnold S, Biase SD, Buckland C, Heslop P, Hurst C, Sayer AA, Skelton DA, Witham MD. The Benchmarking Exercise Programme for Older People (BEPOP): Design, Results and Recommendations from The First Wave of Data Collection. J Frailty Sarcopenia Falls 2024; 9:169-183. [PMID: 39228669 PMCID: PMC11367081 DOI: 10.22540/jfsf-09-169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 09/05/2024] Open
Abstract
Objectives The Benchmarking Exercise Programme for Older People (BEPOP) service improvement project seeks to determine and promote the exercise training characteristics associated with positive outcomes for resistance exercise for older people living with, or at risk of, sarcopenia or physical frailty. Methods Mixed-methods service improvement project. Ten UK National Health Service physiotherapist-led therapy services delivering exercise interventions for older people submitted anonymized data for up to 20 consecutive patients. A multidisciplinary expert panel generated a report and recommendations with site-specific benchmarking data and feedback. In parallel, participating physiotherapy team members were interviewed to elicit feedback on BEPOP rationale, processes and perceived value. Results Data from 188 patients were included, mean age 80 years (range 60-101). 115 (61%) received objective assessment of strength-based physical performance. Bodyweight exercises (173 [92%]) and resistance bands (49 [26%]) were the commonest exercise modalities. Exercises progressed predominantly through increased repetitions (163 [87%]) rather than increased load. 50 (30%) had no reassessment of outcomes; only 68 (41%) were signposted to follow-on exercise services. Staff interviews identified themes around knowledge, diagnosis, data collection and practice reflection. Conclusion BEPOP was feasible to deliver and generated actionable insights for service improvement via improved diagnosis, measurement and progression of resistance exercise.
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Affiliation(s)
- Lorna Caulfield
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Susanne Arnold
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK & AGILE, Chartered Society of Physiotherapy, London, UK
| | - Sarah De Biase
- West Yorkshire Integrated Care Board Long-term Conditions and Personalisation Function, Wakefield, UK & AGILE, Chartered Society of Physiotherapy, London, UK
| | - Charlotte Buckland
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Philip Heslop
- CoCreate, School of Design, Northumbria University, Newcastle Upon Tyne, UK
| | - Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University
| | - Avan A. Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University
| | - Dawn A. Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Miles D. Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University
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Tseretopoulou X, Ali SR, Bryce J, Amin N, Atapattu N, Bachega TASS, Baronio F, Ortolano R, Birkebaek NH, Bonfig W, Cools M, Davies JH, Thomas T, de Vries L, Elsedfy H, Amr NH, Flueck CE, Globa E, Guran T, Yavas-Abali Z, Guven A, Hannema SE, Iotova V, Konrad D, Lenherr-Taube N, Krone NP, Leka-Emiri S, Vlachopapadopoulou E, Lichiardopol C, Marginean O, Markosyan R, Neumann U, Niedziela M, Banaszak-Ziemska M, Phan-Hug F, Poyrazoglu S, Probst-Scheidegger U, Randell T, Russo G, Salerno M, Seneviratne S, Shnorhavorian M, Thankamony A, Tadokoro-Curraro R, van den Akker E, van Eck J, Vieites A, Wasniewska M, Ahmed SF. Temporal Trends in Acute Adrenal Insufficiency Events in Children With Congenital Adrenal Hyperplasia During 2019-2022. J Endocr Soc 2024; 8:bvae145. [PMID: 39258010 PMCID: PMC11387114 DOI: 10.1210/jendso/bvae145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Indexed: 09/12/2024] Open
Abstract
Background It is unclear whether targeted monitoring of acute adrenal insufficiency (AI) related adverse events (AE) such as sick day episodes (SDEs) and hospitalization rate in congenital adrenal hyperplasia (CAH) is associated with a change in the occurrence of these events. Aim Study temporal trends of AI related AE in the I-CAH Registry. Methods In 2022, data on the occurrence of AI-related AE in children aged <18 years with 21-hydroxylase deficiency CAH were compared to data collected in 2019. Results In 2022, a total of 513 children from 38 centers in 21 countries with a median of 8 children (range 1-58) per center had 2470 visits evaluated over a 3-year period (2019-2022). The median SDE per patient year in 2022 was 0 (0-2.5) compared to 0.3 (0-6) in 2019 (P = .01). Despite adjustment for age, CAH phenotype and duration of study period, a difference in SDE rate was still apparent between the 2 cohorts. Of the 38 centers in the 2022 cohort, 21 had also participated in 2019 and a reduction in SDE rate was noted in 13 (62%), an increase was noted in 3 (14%), and in 5 (24%) the rate remained the same. Of the 474 SDEs reported in the 2022 cohort, 103 (22%) led to hospitalization compared to 299 of 1099 SDEs (27%) in the 2019 cohort (P = .02). Conclusion The I-CAH Registry can be used for targeted monitoring of important clinical benchmarks in CAH. However, changes in reported benchmarks need careful interpretation and longer-term monitoring.
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Affiliation(s)
- Xanthippi Tseretopoulou
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow G51 4TF, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Salma R Ali
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow G51 4TF, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Jillian Bryce
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Nadia Amin
- Department of Paediatric Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Navoda Atapattu
- Department of Paediatric Endocrinology, Lady Ridgeway Hospital, Colombo 00800, Sri Lanka
| | - Tania A S S Bachega
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, 05508-090, Brazil
| | - Federico Baronio
- Department Hospital of Woman and Child, Pediatric Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rita Ortolano
- Department Hospital of Woman and Child, Pediatric Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Niels H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Walter Bonfig
- Department of Paediatrics, Technical University München, D-80804 Munich, Germany
- Department of Paediatrics, Klinikum Wels-Grieskirchen, A-4600 Wels, Austria
| | - Martine Cools
- Department of Paediatric Endocrinology, University Hospital Ghent, Ghent University, 9000 Ghent, Belgium
| | - Justin H Davies
- Department of Paediatric Endocrinology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Tessy Thomas
- Department of Paediatric Endocrinology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Liat de Vries
- The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah 4920235, Israel
- Faculty of Medical&Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, 11566 Cairo, Egypt
| | - Nermine H Amr
- Department of Pediatrics, Ain Shams University, 11566 Cairo, Egypt
| | - Christa E Flueck
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland
- Pediatric Endocrinology, Diabetology and Metabolism, Department of BioMedical Research, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Evgenia Globa
- Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of MOH of Ukraine, Kyiv 01021, Ukraine
| | - Tulay Guran
- Department of Pediatric Endocrinology and Diabetes, Marmara University, 34899 Pendik, Istanbul, Turkey
| | - Zehra Yavas-Abali
- Department of Pediatric Endocrinology and Diabetes, Marmara University, 34899 Pendik, Istanbul, Turkey
| | - Ayla Guven
- Department of Paediatric Endocrinology, Baskent University Medical Faculty, Istanbul Hospital, 06790 Istanbul, Turkey
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands
| | - Violeta Iotova
- Department of Paediatrics, Medical University-Varna, UMHAT "Sv. Marina," 9002 Varna, Bulgaria
| | - Daniel Konrad
- Department of Endocrinology and Diabetology, University Children's Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Nina Lenherr-Taube
- Department of Endocrinology and Diabetology, University Children's Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, UK
| | - Sofia Leka-Emiri
- Department of Endocrinology-Growth and Development, "P&A Kyriakou" Children's Hospital, Athens 115 27, Greece
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, "P&A Kyriakou" Children's Hospital, Athens 115 27, Greece
| | - Corina Lichiardopol
- Department of Endocrinology, University of Medicine and Pharmacy Craiova, University Emergency Hospital, Craiova 200349, Romania
| | - Otilia Marginean
- Department of Paediatrics, University of medicine and Pharmacy "Victor Babes", Clinical children emergency hospital "Louis Turcanu" Timisora, Timisora 300011, Romania
| | | | - Uta Neumann
- Department of Paediatric Endocrinology and Diabetology, Centre for Chronic Sick Children, Institute for Experimental Paediatric Endocrinology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, 61 701 Poznan, Poland
| | - Magdalena Banaszak-Ziemska
- Department of Pediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, 61 701 Poznan, Poland
| | - Franziska Phan-Hug
- Paediatric Endocrinology, EHC-Morges, 1110 Morges, Switzerland
- Paediatric Endocrinology, Hospital Valais-Sion, 1950 Sion, Switzerland
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, 34093 Çapa, Istanbul, Turkey
| | | | - Tabitha Randell
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham NG7 2UH, UK
| | - Gianni Russo
- Department of Paediatrics, Endocrine Unit, RCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Mariacarolina Salerno
- Department of Pediatrics, Unit of Immunology, Federico II University, 80131 Naples, Italy
| | - Sumudu Seneviratne
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 00700, Sri Lanka
| | - Margarett Shnorhavorian
- Department of Urology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Ajay Thankamony
- Department of Paediatrics,University of Cambridge, Cambridge CB2 2QQ, UK
| | | | - Erica van den Akker
- Division of Pediatric Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Judith van Eck
- Division of Pediatric Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, 1425 Buenos Aires, Argentina
| | - Malgorzata Wasniewska
- Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98166 Messina, Italy
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow G51 4TF, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
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van den Eijnde-Damen IMC, Maas J, Burger P, Bodde NMG, Simeunovic-Ostojic M. Towards collaborative care for severe and enduring Anorexia Nervosa - a mixed-method approach. J Eat Disord 2024; 12:124. [PMID: 39187908 PMCID: PMC11346167 DOI: 10.1186/s40337-024-01091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Severe and Enduring Eating Disorders (SEED), in particular SEED-Anorexia Nervosa (SE-AN), may represent the most difficult disorder to treat in psychiatry. Furthermore, the lack of empirical research in this patient group, and, consequently the lack of guidelines, call for an urgent increase in research and discussion within this field. Meanwhile experts concur that effective care should be structured in a collaborative manner. OBJECTIVE To identify the challenges in providing care to patients with SE-AN in the Dutch healthcare context, and propose a collaborative care treatment model to address these issues. METHODS A pragmatic mixed-method approach was used, structured as follows: (1) Identifying perceived barriers and treatment needs from the viewpoint of both patients and eating disorder healthcare professionals through an evaluation questionnaire; (2) Investigating current treatment practices for SEED/SE-AN via benchmarking; (3) Gaining insight into the optimal structure and content of care by interviewing network partners and experts-by-experience. Based on these findings, and drawing from literature on severe and enduring disorders, a treatment model for SE-AN was proposed and implemented. RESULTS The key challenges identified included a lack of knowledge about eating disorders among network partners, treatment ambivalence among patients and poor collaboration between professionals. The proposed model enhances self-management and collaborative relationships with healthcare providers, offers user-friendly and practical guidance, and aims at stabilization, reducing relapses, deterioration, and readmissions, thereby being cost-effective. Importantly, the model operates across levels of care (primary, secondary, tertiary). CONCLUSION This study, describing a collaborative care program for SE-AN, developed and implemented in a highly specialized treatment center for eating disorders, sets the stage for further explanatory/efficacy research to build on the findings in this study, with the following aims: addressing the critical gap in care for SEED/SE-AN, improving better healthcare organization, reducing relapse rates, and lowering costs for this often overlooked patient group.
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Affiliation(s)
- Ilona M C van den Eijnde-Damen
- Center for Eating Disorders Helmond, Mental Health Center Region Oost-Brabant, Wesselmanlaan 25a, Helmond, 5707 HA, The Netherlands
| | - Joyce Maas
- Center for Eating Disorders Helmond, Mental Health Center Region Oost-Brabant, Wesselmanlaan 25a, Helmond, 5707 HA, The Netherlands.
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, Tilburg, 5037 AB, The Netherlands.
| | - Pia Burger
- Center for Eating Disorders Helmond, Mental Health Center Region Oost-Brabant, Wesselmanlaan 25a, Helmond, 5707 HA, The Netherlands
| | - Nynke M G Bodde
- Center for Eating Disorders Helmond, Mental Health Center Region Oost-Brabant, Wesselmanlaan 25a, Helmond, 5707 HA, The Netherlands
| | - Mladena Simeunovic-Ostojic
- Center for Eating Disorders Helmond, Mental Health Center Region Oost-Brabant, Wesselmanlaan 25a, Helmond, 5707 HA, The Netherlands
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Iqbal A, Zhao Z, van Klaveren W, Elbashir M, Moxon A, Houghton J, Kerss J, Jones N, Marino KR, Power J, Roberts H, Cooke R, Astill S, Nykjaer C, Vishnubala D. Creating a postgraduate syllabus for a team care diploma examination: a Delphi study. BMJ Open Sport Exerc Med 2024; 10:e002008. [PMID: 39286317 PMCID: PMC11404180 DOI: 10.1136/bmjsem-2024-002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 09/19/2024] Open
Abstract
Objectives There is no agreed standard assessment of the minimum knowledge and skills that are required to provide healthcare to participants in individual or team sports. This study aims to develop a syllabus for the Faculty of Sport and Exercise Medicine (FSEM) Team Care Diploma examination. This will provide a recognised assessment of the minimum required skills and knowledge for healthcare professionals providing care in an individual and team sport environment. Methods A modified Delphi approach was used. A syllabus was developed by a purposeful selection of members of the FSEM, all of whom have significant team care experience. This was then reviewed by the Delphi expert panel who were team care practitioners with at least 5 years of experience. A two-round Delphi approach was used to develop a consensus. Results The expert panel consisted of 50 individuals, with 46 (92%) completing both rounds. Of the 447 learning objectives (LOs) proposed; 430 (96%) were accepted outright, 17 (4%) were rejected and four new LOs were introduced based on expert panel feedback. The final syllabus contained 434 LOs across 6 modules (clinical governance, safe and effective practice, interdisciplinary teamwork, specific athlete groups, specific health conditions and duties of the medical team). Conclusion This standardised syllabus will be used as the basis for the new FSEM Team Care Diploma examination which will aim to provide world-leading standardised assessment of the minimum skills and knowledge required for healthcare professionals across the multidisciplinary team providing care in individual and team sport.
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Affiliation(s)
- Adil Iqbal
- University of Leeds Faculty of Biological Sciences, Leeds, UK
| | - Zhi Zhao
- University of Leeds Faculty of Biological Sciences, Leeds, UK
| | | | | | - Adam Moxon
- Healthcare Professionals Education Unit, Hull York Medical School, Hull, UK
| | - Jonathan Houghton
- Faculty of Sport And Exercise Medicine, Edinburgh, UK
- Fortius Clinic, London, UK
| | - Jim Kerss
- Faculty of Sport And Exercise Medicine, Edinburgh, UK
- UK Sports Institute, Manchester, UK
| | - Natasha Jones
- Faculty of Sport And Exercise Medicine, Edinburgh, UK
- British Association of Sport and Exercise Medicine, Doncaster, UK
| | - Katherine Rose Marino
- British Association of Sport and Exercise Medicine, Doncaster, UK
- Keele University, Newcastle-under-Lyme, UK
| | - Jonathan Power
- University of Leeds Faculty of Biological Sciences, Leeds, UK
- Yorkshire Sports Medicine Clinic, York, UK
| | | | | | - Sarah Astill
- University of Leeds Faculty of Biological Sciences, Leeds, UK
| | - Camilla Nykjaer
- University of Leeds Faculty of Biological Sciences, Leeds, UK
| | - Dane Vishnubala
- University of Leeds Faculty of Biological Sciences, Leeds, UK
- University of Derby College of Science and Engineering, Derby, UK
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Nova AA, Declercq A, Heckman GA, Hirdes JP, McAiney C, De Lepeleire J. Exploring subjective quality-of-life indicators in long-term care facilities: a mixed-methods research protocol. BMJ Open 2024; 14:e087380. [PMID: 39013649 PMCID: PMC11253758 DOI: 10.1136/bmjopen-2024-087380] [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: 04/09/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Improving quality of life has become a priority in the long-term care (LTC) sector internationally. With development and implementation guidance, standardised quality-of-life monitoring tools based on valid, self-report surveys could be used more effectively to benefit LTC residents, families and organisations. This research will explore the potential for subjective quality-of-life indicators in the interRAI Self-Reported Quality of Life Survey for Long-Term Care Facilities (QoL-LTCF). METHODS AND ANALYSIS Guided by the Medical Research Council Framework, this research will entail a (1) modified Delphi study, (2) feasibility study and (3) realist synthesis. In study 1, we will evaluate the importance of statements and scales in the QoL-LTCF by administering Delphi surveys and focus groups to purposively recruited resident and family advisors, researchers, and LTC clinicians, staff, and leadership from international quality improvement organisations. In study 2, we will critically examine the feasibility and implications of risk-adjusting subjective quality-of-life indicators. Specifically, we will collect expert stakeholder perspectives with interviews and apply a risk-adjustment methodology to QoL-LTCF data. In study 3, we will iteratively review and synthesise literature, and consult with expert stakeholders to explore the implementation of quality-of-life indicators. ETHICS AND DISSEMINATION This study has received approval through a University of Waterloo Research Ethics Board and the Social and Societal Ethics Committee of KU Leuven. We will disseminate our findings in conferences, journal article publications and presentations for a variety of stakeholders.
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Affiliation(s)
- Amanda A Nova
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Doctoral School of Biomedical Sciences, KU Leuven, Leuven, Belgium
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Anja Declercq
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CESO Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Nicolazzi M, Di Martino M, Baroffio P, Donadon M. 6,126 hepatectomies in 2022: current trend of outcome in Italy. Langenbecks Arch Surg 2024; 409:211. [PMID: 38985363 PMCID: PMC11236879 DOI: 10.1007/s00423-024-03398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Whether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume. METHODS This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry "Piano Nazionale Esiti" (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added. RESULTS 6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively). CONCLUSIONS High-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight.
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Affiliation(s)
- Marco Nicolazzi
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Paolo Baroffio
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy.
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy.
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9
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Anik E, Hurlow A, Azizoddin D, West R, Muehlensiepen F, Clarke G, Mitchell S, Allsop M. Characterising trends in the initiation, timing, and completion of recommended summary plan for emergency care and treatment (ReSPECT) plans: Retrospective analysis of routine data from a large UK hospital trust. Resuscitation 2024; 200:110168. [PMID: 38458416 DOI: 10.1016/j.resuscitation.2024.110168] [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: 12/06/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
AIM To assess patient socio-demographic and disease characteristics associated with the initiation, timing, and completion of emergency care and treatment planning in a large UK-based hospital trust. METHODS Secondary retrospective analysis of data across 32 months extracted from digitally stored Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans within the electronic health record system of an acute hospital trust in England, UK. RESULTS Data analysed from ReSPECT plans (n = 23,729), indicate an increase in the proportion of admissions having a plan created from 4.2% in January 2019 to 6.9% in August 2021 (mean = 8.1%). Forms were completed a median of 41 days before death (a median of 58 days for patients with capacity, and 21 days for patients without capacity). Do not attempt cardiopulmonary resuscitation was more likely to be recorded for patients lacking capacity, with increasing age (notably for patients aged over 74 years), being female and the presence of multiple disease groups. 'Do not attempt cardiopulmonary resuscitation' was less likely to be recorded for patients having ethnicity recorded as Asian or Asian British and Black or Black British compared to White. Having a preferred place of death recorded as 'hospital' led to a five-fold increase in the likelihood of dying in hospital. CONCLUSION Variation in the initiation, timing, and completion of ReSPECT plans was identified by applying an evaluation framework. Digital storage of ReSPECT plan data presents opportunities for assessing trends and completion of the ReSPECT planning process and benchmarking across sites. Further research is required to monitor and understand any inequity in the implementation of the ReSPECT process in routine care.
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Affiliation(s)
- Evrim Anik
- Leeds Institute of Health Sciences, University of Leeds, UK; Leeds Dental Institute, University of Leeds, UK.
| | - Adam Hurlow
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Germany.
| | - Gemma Clarke
- Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Sarah Mitchell
- Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Matthew Allsop
- Leeds Institute of Health Sciences, University of Leeds, UK.
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10
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Bernet NS, Everink IHJ, Hahn S, Müller M, Schols JMGA. Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study. BMJ Open 2024; 14:e082417. [PMID: 38754884 PMCID: PMC11097859 DOI: 10.1136/bmjopen-2023-082417] [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: 11/22/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES This study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether the trend persists after risk adjustment for patient-related fall risk factors. DESIGN A secondary data analysis was conducted based on annual multicentre cross-sectional studies carried out between 2011 and 2019. SETTING All Swiss acute care hospitals were obliged to participate in the surveys. Except for emergency departments, outpatient wards and recovery rooms, all wards were included. PARTICIPANTS All inpatients aged 18 or older who had given their informed consent and whose data were complete and available were included. OUTCOME MEASURE Whether a patient had fallen in the hospital was retrospectively determined on the survey day by asking patients the following question: Have you fallen in this institution in the last 30 days? RESULTS Based on data from 110 892 patients from 222 Swiss hospitals, a national inpatient fall rate of 3.7% was determined over the 9 survey years. A significant linear decreasing trend (p=0.004) was observed using the Cochran-Armitage trend test. After adjusting for patient-related fall risk factors in a two-level random intercept logistic regression model, a significant non-linear decreasing trend was found at the national level. CONCLUSIONS A significant decrease in fall rates in Swiss hospitals, indicating an improvement in the quality of care provided, could be confirmed both descriptively and after risk adjustment. However, the non-linear trend, that is, an initial decrease in inpatient falls that flattens out over time, also indicates a possible future increase in fall rates. Monitoring of falls in hospitals should be maintained at the national level. Risk adjustment accounts for the observed increase in patient-related fall risk factors in hospitals, thus promoting a fairer comparison of the quality of care provided over time.
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Affiliation(s)
- Niklaus S Bernet
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Irma H J Everink
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Sabine Hahn
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Marianne Müller
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
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11
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Heesen P, Elyes M, Domanski J, Schelling G, Könneker S, Fuchs B. Exploring Risk Factors for Predicting 30-Day Postoperative Morbidity in Musculoskeletal Tumor Surgery. J Clin Med 2024; 13:2681. [PMID: 38731210 PMCID: PMC11084328 DOI: 10.3390/jcm13092681] [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: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: This study investigates the risk factors associated with postoperative complications in musculoskeletal tumor surgeries and evaluates the impact of benchmarking in enhancing surgical outcomes. Methods: Conducted at a tertiary referral center, this retrospective analysis included 196 patients who underwent surgeries for various musculoskeletal tumors, ranging from soft tissue to bone sarcomas. Patient and tumor characteristics, along with surgical interventions and outcomes, were comprehensively assessed using the Charlson Comorbidity Index and the Clavien-Dindo classification. Results: Key findings indicate that surgical reconstruction, ASA 3 status, bone tumor presence, and the need for multiple erythrocyte transfusions significantly increase postoperative morbidity. Notably, no significant correlation was found between the Charlson Comorbidity Index scores and the occurrence or severity of complications, challenging the utility of this index in predicting short-term surgical outcomes. Conclusions: This study highlights the importance of tailored surgical approaches and emphasizes rigorous preoperative assessments to mitigate risks and enhance patient care. Despite its insights, limitations include its retrospective nature and single-center scope, suggesting a need for broader, multicenter studies to generalize findings. Overall, our results underscore the necessity of integrating clinical assessments with benchmarking data to optimize outcomes in the complex field of musculoskeletal tumor surgery.
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Affiliation(s)
- Philip Heesen
- Department of Plastic & Reconstructive Surgery, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
| | - Maria Elyes
- Department of Orthopedics & Trauma, Sarcoma Service, LUKS University Hospital, University of Lucerne, 6000 Lucerne, Switzerland
| | - Jan Domanski
- Department of Trauma Surgery and Orthopedics, Ortenau Klinikum, 77654 Offenburg, Germany
| | - Georg Schelling
- Department of Orthopedics & Trauma, Sarcoma Service, LUKS University Hospital, University of Lucerne, 6000 Lucerne, Switzerland
| | - Sören Könneker
- Department of Plastic & Reconstructive Surgery, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
| | - Bruno Fuchs
- Department of Orthopedics & Trauma, Sarcoma Service, LUKS University Hospital, University of Lucerne, 6000 Lucerne, Switzerland
- Department of Orthopedics and Trauma, Sarcoma Service, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
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Okeke N, Hennessey KC, Sitapati AM, Weisshaar D, Shah NP, Alicki R, Haft H. Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement. Circ Cardiovasc Qual Outcomes 2024; 17:e010791. [PMID: 38618717 DOI: 10.1161/circoutcomes.123.010791] [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: 04/16/2024]
Abstract
The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.
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Affiliation(s)
- Nkem Okeke
- Medicalincs, Silver Spring, MD (N.O.)
- Harvard Medical School, Center for Primary Care, Boston, MA (N.O.)
| | - Kerrilynn C Hennessey
- Department of Medicine, Section of Cardiovascular Medicine, Dartmouth Hitchcock Health, Lebanon, NH (K.C.H.)
| | - Amy M Sitapati
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health (A.M.S.)
| | - Dana Weisshaar
- Institute of Medical Educators, Kaiser Permanente Santa Clara, CA (D.W.)
| | - Nishant P Shah
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC (N.P.S)
| | - Rebecca Alicki
- American Heart Association, Department of Quality, Outcomes Research and Analytics, Dallas, TX (R.A.)
| | - Howard Haft
- University of Maryland School of Medicine, Division of Health Sciences and Human Services, Baltimore (H.H.)
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13
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Bekkevold M, Solvik-Olsen T, Heyerdahl F, Lang AM, Hagemo J, Rehn M. Reporting interhospital neonatal intensive care transport: international five-step Delphi-based template. BMJ Paediatr Open 2024; 8:e002374. [PMID: 38569741 PMCID: PMC10989109 DOI: 10.1136/bmjpo-2023-002374] [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: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To develop a general and internationally applicable template of data variables for reporting interhospital neonatal intensive care transports. DESIGN A five-step Delphi method. SETTING A group of experts was guided through a formal consensus process using email. SUBJECTS 12 experts in neonatal intensive care transports from Canada, Denmark, Norway, the UK and the USA. Four women and eight men. The experts were neonatologists, anaesthesiologists, intensive care nurse, anaesthetic nurse, medical leaders, researchers and a parent representative. MAIN OUTCOME MEASURES 37 data variables were included in the final template. RESULTS Consensus was achieved on a template of 37 data variables with definitions. 30 variables to be registered for each transport and 7 for annual registration of the system of the transport service. 11 data variables under the category structure, 20 under process and 6 under outcome. CONCLUSIONS We developed a template with a set of data variables to be registered for neonatal intensive care transports. To register the same data will enable larger datasets and comparing services.
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Affiliation(s)
- Marit Bekkevold
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Solvik-Olsen
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fridtjof Heyerdahl
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Air Ambulance, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Astri Maria Lang
- Department of Paediatric, Akershus University Hospital, Lorenskog, Norway
| | - Jostein Hagemo
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Air Ambulance, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Marius Rehn
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Air Ambulance, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
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14
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Hockham C, Ghosh A, Agarwal A, Shah K, Woodward M, Jha V. Centre-level variation in the survival of patients receiving haemodialysis in India: findings from a nationwide private haemodialysis network. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100383. [PMID: 38601176 PMCID: PMC11004392 DOI: 10.1016/j.lansea.2024.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 04/12/2024]
Abstract
Background There are no large studies examining survival in patients receiving haemodialysis in India or considering centre-level effects on survival. We measured survival variation between dialysis centres across India and evaluated the extent to which differences are explained by measured centre characteristics. Methods This is a multilevel analysis of patient survival in centres of the NephroPlus dialysis network consisting of 193 centres across India. Patients receiving haemodialysis at a centre for ≥90 days between April 2014 and June 2019 were included, with analyses restricted to centres with ≥10 such patients. The primary outcome was all-cause mortality, measured from 90 days after joining a centre. Proportional hazards models with shared frailty were used to model centre- and patient-level effects on survival. Findings Amongst 23,601 patients (median age 53 years; 29% female), the unadjusted centre-specific 180-day Kaplan-Meier survival estimates ranged between 55% (95% confidence interval [CI] 38-80%) and 100%, with a median of 88% (interquartile interval 83%-92%). After accounting for multilevel factors, estimated 180-day survival ranged between 83% (73-89%) and 97% (95-98%), with 90% 180-day survival in the average centre. The mortality rate in patients attending rural centres was 32% (Hazard Ratio 1.32; 95% CI 1.06-1.65) higher than those at urban centres in adjusted analyses. Multiple patient characteristics were associated with mortality. Interpretation This is the first national benchmark for survival amongst dialysis patients in India. Centre- and patient-level characteristics are associated with survival but there remains unexplained variation between centres. As India continues to widen dialysis access, ongoing quality improvement programs will be an important part of ensuring that patients experience the best possible outcomes at the point of care. Funding This project received no external funding.
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Affiliation(s)
- Carinna Hockham
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Arpita Ghosh
- The George Institute for Global Health, UNSW International, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Kamal Shah
- NephroPlus Dialysis Network, Hyderabad, India
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, UNSW International, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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15
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Kuipers Y, De Bock V, Van de Craen N, Bosmans V. 'Naming and faming' maternity care providers: A mixed-methods study. Midwifery 2024; 130:103912. [PMID: 38154428 DOI: 10.1016/j.midw.2023.103912] [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: 05/15/2023] [Revised: 10/21/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Positive benchmarking can serve as a catalyst for maternity care improvement. AIM To retrospectively benchmark Flemish maternity care providers' qualities, based on women's positive care experiences, and to explore which attributes of the different care providers contribute to these experiences. METHODS A sequential, two-phased mixed-methods study benchmarking the qualities of the community midwife, the hospital midwife, and the obstetrician. An online questionnaire was used to collect the data among pregnant and postpartum women, who rated their care experiences with the various care providers using the Net Promoter Score. Non-parametric and post hoc tests established the differences between types of clinicians and between antenatal, intrapartum, and postpartum Net Promoter Score mean scores. Content analysis was used to construct a final pool of keywords representing attributes of care professionals, accumulated from the promoters' free text responses. Ranks were assigned to each keyword based on its frequency. FINDINGS A total of 2385 Net Promoter Scale scores and 1856 free-text responses of 1587 responders were included. The community midwife received the overall highest NPS scores (p < .001). The promoters (n = 1015) assigned community midwives the highest NPS scores (9.67), followed by obstetricians (9.57) and hospital-based midwives (9.51). The distinct benchmarking attributes of community midwives were availability (p < .001), supportiveness (p = .04) and personalised care (p < .001). Being honest (p < .001), empathic (p < .001) and inexhaustible (p = .04) benchmarked hospital midwives. Calmness (p < .001), a no-nonsense approach (p < .001), being humane (p = .01) and comforting (p = .02) benchmarked obstetricians. DISCUSSION/CONCLUSION The findings indicate that all care providers are highly valued, but community midwives are ranked the highest. The distinct differences between the care professionals can serve as exemplary performance for professional development and shape the profiles of maternity care professionals.
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Affiliation(s)
- Yvonne Kuipers
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium; School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, EH11 4BN Edinburgh, United Kingdom.
| | - Vanessa De Bock
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium
| | - Natacha Van de Craen
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium
| | - Valerie Bosmans
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium
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16
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Crouse J, Feuling MB, Winter T, Goday PS, Smith A. Electronic health record time-tracking provides real-time data to measure and benchmark dietitian productivity. J Hum Nutr Diet 2024; 37:105-110. [PMID: 37721196 DOI: 10.1111/jhn.13236] [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: 03/21/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Traditional methods for benchmarking dietitian productivity are time-consuming and fail to accurately measure the total time spent providing nutrition care. An electronic health record (EHR)-based tool that allows for daily tracking of both face-to-face and patient care coordination time for dietitians was created. We assessed whether it provided consistent, continuous measurement of time and productivity. METHODS This tool was created in an independent paediatric academic healthcare system in the USA. Time spent by dietitians in face-to-face settings and care coordination were tracked. Changes in time spent between the years 2013-2016 versus 2018-2019 were also analysed. RESULTS The outpatient dietitian spent a mean total of 66.4 min per patient (37.8 ± 6.0 min in face-to-face care and 28.6 ± 5.2 min in care coordination). The total times and fractions spent on face-to-face and care coordination time varied by specialty. Comparison of the two periods of time revealed 75% more productivity on average of dietitians in different outpatient settings after including care coordination tracking. In addition, dietitians were more likely to document time spent in 5-min increments after the institution of this methodology as opposed to 15-min increments. CONCLUSIONS An EHR-based tool that facilitates the documentation of both face-to-face time and patient care coordination time is feasible and enables consistent, continuous measurement of time and productivity. The real-time data from this tool can be used to support adequate dietitian staffing and be used to create a multicentre database to measure the actual time dietitians need to provide care and generate consistent staffing benchmarks.
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Affiliation(s)
- Jennifer Crouse
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary Beth Feuling
- Technology & Research, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Taylor Winter
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Praveen S Goday
- Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amber Smith
- Nutrition Services, University of California San Francisco Health, San Francisco, California, USA
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Mahoney LB, Huang JS, Lightdale JR, Walsh CM. Pediatric endoscopy: how can we improve patient outcomes and ensure best practices? Expert Rev Gastroenterol Hepatol 2024; 18:89-102. [PMID: 38465446 DOI: 10.1080/17474124.2024.2328229] [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: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Strategies to promote high-quality endoscopy in children require consensus around pediatric-specific quality standards and indicators. Using a rigorous guideline development process, the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was developed to support continuous quality improvement efforts within and across pediatric endoscopy services. AREAS COVERED This review presents a framework, informed by the PEnQuIN guidelines, for assessing endoscopist competence, granting procedural privileges, audit and feedback, and for skill remediation, when required. As is critical for promoting quality, PEnQuIN indicators can be benchmarked at the individual endoscopist, endoscopy facility, and endoscopy community levels. Furthermore, efforts to incorporate technologies, including electronic medical records and artificial intelligence, into endoscopic quality improvement processes can aid in creation of large-scale networks to facilitate comparison and standardization of quality indicator reporting across sites. EXPERT OPINION PEnQuIN quality standards and indicators provide a framework for continuous quality improvement in pediatric endoscopy, benefiting individual endoscopists, endoscopy facilities, and the broader endoscopy community. Routine and reliable measurement of data, facilitated by technology, is required to identify and drive improvements in care. Engaging all stakeholders in endoscopy quality improvement processes is crucial to enhancing patient outcomes and establishing best practices for safe, efficient, and effective pediatric endoscopic care.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jeannie S Huang
- Rady Children's Hospital, San Diego, CA and University of California San Diego, La Jolla, CA, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ramos SDS, Coetzer R. The Measure of an Outcome: Comparing Norming and Stacking to Benchmark the Effectiveness of Brain Injury Rehabilitation Services. Behav Sci (Basel) 2023; 13:705. [PMID: 37753983 PMCID: PMC10525701 DOI: 10.3390/bs13090705] [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: 06/19/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/28/2023] Open
Abstract
Practitioners have a clinical, ethical, academic, and economic responsibility to dispassionately consider how effective their services are. Approaches to measure how "good" or "bad" healthcare is include clinical audit, satisfaction surveys, and routine outcome measurement. However, the process of comparing the clinical outcomes of a specific service against the 'best' services in the same specialism, also known as benchmarking, remains challenging, and it is unclear how it affects quality improvement. This paper piloted and compared two different approaches to benchmarking to assess clinical outcomes in neurorehabilitation. Norming involved comparing routine measures of clinical outcome with external validators. Stacking involved pooling and comparing internal data across several years. The analyses of routine clinical outcome data from 167 patients revealed significant differences in the patient characteristics of those admitted to the same service provider over time, but no differences in outcomes achieved when comparing with historical data or with external reference data. These findings illustrate the potential advantages and limitations of using stacking and norming to benchmark clinical outcomes, and how the results from each approach might be used to evaluate service effectiveness and inform quality improvement within the field of brain injury rehabilitation.
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Affiliation(s)
- Sara D. S. Ramos
- Brainkind, Wakefield WF5 9TJ, UK;
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Rudi Coetzer
- Brainkind, Wakefield WF5 9TJ, UK;
- School of Health & Behavioural Sciences, Bangor University, Bangor LL57 2DG, UK
- School of Psychology, Medicine, Health and Life Science Faculty, Swansea University, Swansea SA2 8PP, UK
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Vanin Moreno N, Whitehead M, Siemens DR. Real-life benchmarking bladder cancer care: A population-based study. Can Urol Assoc J 2023; 17:268-273. [PMID: 37581551 PMCID: PMC10426426 DOI: 10.5489/cuaj.8231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Radical cystectomy (RC) is a complex oncological surgical procedure and population studies of routine surgical care have suggested suboptimal results compared to high-volume centers of excellence. A previous Canadian bladder cancer quality-of-care consensus led to adoption of multiple key quality-of-care indicators, with associated benchmarks created using available evidence and expert opinion to inform and measure future performance. Herein, we report real-life benchmark performance for the management of muscle-invasive bladder cancer (MIBC) relative to expert opinion guidance. METHODS This is a population-based, retrospective, cohort study that used the Ontario Cancer Registry (OCR) to identify all incident patients who underwent RC from 2009-2013. Electronic records of treatment from 1573 patients were linked to OCR; pathology records were obtained for all cases and reviewed by a team of trained data abstractors. The primary objective was to describe benchmarks for identified indicators, first as median values obtained across hospitals or providers, as well as a "pared-mean" approach to identify a benchmark population of "top performance," as defined as the best outcome accomplished for at least 10% of the population. RESULTS Overall, performance in Ontario across all indicators fell short of expert opinion-determined benchmarks. Annual surgical volume by each surgeon performing a RC (benchmark >6, percent of institutions meeting benchmark=20%), percent of patients with MIBC referred preoperatively to medical oncology (MO; benchmark>90%, percent of institutions meeting benchmark=2%) and radiation oncology (RO; benchmark>50%, percent of institutions meeting benchmark=0%), time to cystectomy within six weeks of transurethral resection of bladder tumor (TURBT) in patients without neoadjuvant chemotherapy (benchmark <6 weeks, percent of institutions meeting benchmark=0%), percent of patients with adequate lymph node dissection (defined as >14 nodes, benchmark>85%, percent of institutions meeting benchmark=0%), percent of patients with positive margins post-RC (benchmark <10%, percent of institutions meeting benchmark=46%), and 90-day mortality (benchmark<5%, percent of institutions meeting benchmark=37%) fell considerably short. Simply evaluating benchmarks across the province as median performance significantly underestimated benchmarks that were possible by top-performing hospitals. CONCLUSIONS Performance through most bladder cancer quality-of-care indicators fall short of benchmarks proposed by expert opinion. Different methodologies, such as a paredmean approach of top performers, may provide more realistic benchmarking.
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Burke S, Hopkins N, Divine A, Ebenso B, Allsop M. Physical activity service provision in hospice care: A national mixed-methods study. Palliat Support Care 2023:1-9. [PMID: 37365803 DOI: 10.1017/s1478951523000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Physical activity (PA) interventions help people with advanced incurable diseases to manage symptoms and improve their quality of life. However, little is known about the extent to which PA is currently delivered in hospice care in England. OBJECTIVES To determine the extent of and intervention features of PA service provision in hospice care in England alongside barriers and facilitators to their delivery. METHODS An embedded mixed-methods design using (1) a nationwide online survey of 70 adult hospices in England and (2) focus groups and individual interviews with health professionals from 18 hospices. Analysis of the data involved applying descriptive statistics to the numeric items and thematic analysis to the open-ended questions. Quantitative and qualitative data were collected and analyzed separately. RESULTS The majority of responding hospices (n = 47/70, 67%) promoted PA in routine care. Sessions were most often delivered by a physiotherapist (n = 40/47, 85%) using a personalized approach (n = 41/47, 87%) and included resistance/thera bands, Tai Chi/Chi Qong, circuit exercises, and yoga. The following qualitative findings were revealed: (1) variation among hospices in their capacity to deliver PA, (2) a desire to embed a hospice culture of PA, and (3) a need for an organizational commitment to PA service provision. SIGNIFICANCE OF RESULTS While many hospices in England deliver PA, there is considerable variation in its delivery across sites. Funding and policy action may be needed to support hospices to initiate or scale up services and address inequity in access to high-quality interventions.
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Affiliation(s)
- Shaunna Burke
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Natalie Hopkins
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alison Divine
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Bassey Ebenso
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Matthew Allsop
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Scruth E, Betts R. Determining quality metrics for the intensive care unit: Is it time for data sharing and new metrics? Aust Crit Care 2023; 36:293-294. [PMID: 37121628 DOI: 10.1016/j.aucc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- Elizabeth Scruth
- Executive Director Clinical Quality Programs, Data Analytics and Tele Critical Care, NCAL Safety, Quality and Regulatory Services- Kaiser Foundation Hospital and Health Plan, 1950 Franklin Street, 14th Floor, Oakland, CA. 94612, USA
| | - Robin Betts
- Vice President, Safety, Quality & Regulatory Services, Kaiser Foundation Health Plan & Hospitals, Northern California, 1950 Franklin Street, 20th Floor, Oakland, CA 94612 USA
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Wu Y, Li S, Yuan J, Zhang H, Wang M, Zhang Z, Qin R. Benchmarking: a novel measuring tool for outcome comparisons in surgery. Int J Surg 2023; 109:419-428. [PMID: 37093075 PMCID: PMC10389472 DOI: 10.1097/js9.0000000000000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/05/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Benchmarking, a novel measuring tool for outcome comparisons, is a recent concept in surgery. The objectives of this review are to examine the concept, definition, and evolution of benchmarking and its application in surgery. METHODS The literature about benchmarking was reviewed through an ever-narrowing search strategy, commencing from the concept, definition, and evolution of benchmarking to the application of benchmarking and experiences of benchmarking in surgery. PubMed, Web of Science, Embase, and Science Direct databases were searched until 20 September 2022, in the English language according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. RESULTS In the first phase of the literature search, the development of benchmarking was identified. The definitions of benchmarking evolved from a surveying term to a novel quality-improvement tool to assess the best achievable results in surgery. In the second phase, a total of 23 studies were identified about benchmarking in surgery, including esophagectomy, hepatic surgery, pancreatic surgery, rectum resection, and bariatric surgery. All studies were multicenter analyses from national, international, or global expert centers. Most studies (87.0%) adopted the definition that benchmark was the 75th percentile of the median values of centers. Performance metrics to define benchmarks were clinically relevant intraoperative and postoperative outcome indicators. CONCLUSION Benchmarking in surgery is a novel quality-improvement tool to define and measure the best achievable results, establishing a meaningful reference to evaluate surgical performance.
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Affiliation(s)
- Yi Wu
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Rumalla K, Kazim SF, Jain P, McKee RG, Schmidt MH, Bowers CA. Preoperative frailty and 30-day mortality after surgery for type II odontoid fracture: a retrospective observational analysis of a large multicenter surgical registry. Spine J 2023; 23:885-887. [PMID: 36805374 DOI: 10.1016/j.spinee.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
| | - Priyanka Jain
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA
| | - Rohini G McKee
- Department of Surgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA.
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Jhund PS. Implementing the evidence - the true summit of evidence-based care and the false peak of guidelines. Eur J Heart Fail 2022; 24:2090-2092. [PMID: 36194559 DOI: 10.1002/ejhf.2712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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