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Cobianchi L, Dal Mas F, Abu Hilal M, Adham M, Alfieri S, Balzano G, Barauskas G, Bassi C, Besselink MG, Bockhorn M, Boggi U, Conlon KC, Coppola R, Dervenis C, Dokmak S, Falconi M, Fusai GK, Gumbs AA, Ivanecz A, Memeo R, Radenković D, Ramia JM, Rangelova E, Salvia R, Sauvanet A, Serrablo A, Siriwardena AK, Stättner S, Strobel O, Zerbi A, Malleo G, Butturini G, Frigerio I. Toward a new paradigm of care: a surgical leaders' Delphi consensus on the organizational factors of the new pancreas units (E-AHPBA PUECOF study). Updates Surg 2024:10.1007/s13304-024-01839-x. [PMID: 38662309 DOI: 10.1007/s13304-024-01839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
Pancreas units represent new organizational models of care that are now at the center of the European debate. The PUECOF study, endorsed by the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), aims to reach an expert consensus by enquiring surgical leaders about the Pancreas Units' most relevant organizational factors, with 30 surgical leaders from 14 countries participating in the Delphi survey. Results underline that surgeons believe in the need to organize multidisciplinary meetings, nurture team leadership, and create metrics. Clinical professionals and patients are considered the most relevant stakeholders, while the debate is open when considering different subjects like industry leaders and patient associations. Non-technical skills such as ethics, teamwork, professionalism, and leadership are highly considered, with mentoring, clinical cases, and training as the most appreciated facilitating factors. Surgeons show trust in functional leaders, key performance indicators, and the facilitating role played by nurse navigators and case managers. Pancreas units have a high potential to improve patients' outcomes. While the pancreas unit model of care will not change the technical content of pancreatic surgery, it may bring surgeons several benefits, including more cases, professional development, easier coordination, less stress, and opportunities to create fruitful connections with research institutions and industry leaders.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, Italy.
- Pancreas Unit Directorship, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
- Collegium Medicum, University of Social Sciences, Łodz, Poland.
| | - Francesca Dal Mas
- Collegium Medicum, University of Social Sciences, Łodz, Poland
- Department of Management - Venice School of Management, Ca' Foscari University, Venice, Italy
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Mustapha Adham
- Department of Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Hospices Civils De Lyon, Lyon, France
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Gianpaolo Balzano
- Pancreatic and Transplant Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS Ospedale San Raffaele, ENETS Center of Excellence, Milan, Italy
| | - Giedrius Barauskas
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Maximilian Bockhorn
- Department of General and Visceral Surgery, University Medical Centre Oldenburg, Oldenburg, Germany
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Kevin C Conlon
- Department of Surgery, School of Medicine, Trinity College, Dublin, Ireland
- Centre for Pancreatico-Biliary Diseases, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Roberto Coppola
- General Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Christos Dervenis
- Department of Hepatobiliary and Pancreatic Surgery, Metropolitan Hospital, Piraeus, Greece
| | - Safi Dokmak
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Massimo Falconi
- Pancreatic and Transplant Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS Ospedale San Raffaele, ENETS Center of Excellence, Milan, Italy
| | - Giuseppe Kito Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Andrew A Gumbs
- Advanced & Minimally Invasive Surgery Excellence Center, Department of Surgery, American Hospital Tbilisi, Tbilisi, Georgia
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | - Dejan Radenković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Clinic of Digestive Surgery, Belgrade, Serbia
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Elena Rangelova
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Section for Upper Abdominal Surgery at Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roberto Salvia
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
- General and Pancreatic Surgery Department, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alain Sauvanet
- Université Paris Cité, Centre de Recherche Sur l'InflammationInserm, Paris, France
- Department of Hepatobiliary Surgery, APHP Nord Beaujon Hospital, Clichy, France
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
| | | | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Pancreatic Surgery Unit, Humanitas Research Hospital -IRCCS, Rozzano, Italy
| | - Giuseppe Malleo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
- General and Pancreatic Surgery Department, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Butturini
- Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Isabella Frigerio
- Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
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Cox A, Ip A, Watkin S, Matuska G, Bunford S, Gallagher A, Taylor C. Implementing and evaluating resources to support good maternity care for parents with learning disabilities: A qualitative feasibility study in England. Midwifery 2024; 133:104001. [PMID: 38643599 DOI: 10.1016/j.midw.2024.104001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/23/2024]
Abstract
PROBLEM Parents with learning disabilities are often disadvantaged and their needs not well understood in maternity services. BACKGROUND Despite a global vision to improve maternity care, current evidence confirms poor pre- and post-natal care for parents with learning disabilities and their families. Midwives have expressed a need for support in the delivery of good care to this population of parents. AIM To test the feasibility of implementing and evaluating two evidence-based and values-based resources - the Together Toolkit and Maternity Passport - to support good maternity care for people with learning disabilities. METHODS A qualitative feasibility study employing semi-structured interviews with 17 midwives and 6 parents who had used the resources in practice in four NHS Trusts in the south of England. FINDINGS Midwives and parents described how the resources positively impacted maternity care by enabling midwives, connecting networks and empowering parents. Factors affecting effective implementation of the resources were reported at an individual and setting level. DISCUSSION Staff training to raise awareness and confidence in supporting parents with learning disabilities, and improved systems for recording parent's individual needs are required to enable the delivery of personalised care. CONCLUSION Reasonable adjustments need to be prioritised to facilitate implementation of resources to support personalised maternity care and to address inequity for parents with learning disabilities. Aspirations for equity suggested commitment from midwives to challenge and overcome barriers to implementation. Recommendations were made to improve the resources and their implementation. These resources are free and accessible for use [www.surrey.ac.uk/togetherproject].
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Affiliation(s)
- Anna Cox
- School of Health Sciences, University of Surrey, Surrey GU2 7XH, United Kingdom.
| | - Athena Ip
- Research Fellow, School of Health Sciences, University of Surrey, United Kingdom
| | | | - George Matuska
- Learning Disability and Autism Lead, Kent and Medway NHS and Social Care Partnership Trust, United Kingdom
| | - Sharon Bunford
- Named Midwife for Safeguarding Vulnerable Women and Babies, Royal Surrey NHS Foundation Trust, United Kingdom
| | - Ann Gallagher
- Professor/Head of Department of Health Sciences, Brunel University, United Kingdom
| | - Cath Taylor
- Professor of Healthcare Workforce Organisation and Wellbeing, School of Health Sciences, University of Surrey, United Kingdom
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Krontoft ASB, Skov L, Ammitzboell E, Lomborg K. Self-management Support for Patients with Atopic Dermatitis: A Qualitative Interview Study. J Patient Exp 2024; 11:23743735241231696. [PMID: 38464888 PMCID: PMC10921857 DOI: 10.1177/23743735241231696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Patients with a chronic skin disease, eg, atopic dermatitis, need self-management skills to increase their quality of life. We explored patients' needs for self-management support from healthcare professionals and how these needs can be met in a dermatology setting. Interpretive description methodology was chosen for iterative data collection and analysis of qualitative interviews with patients with atopic dermatitis. Two mutually dependent themes were found to be supportive of patients' self-management. Personal and disease-related recognition was fundamental to successful support. However, guidance for agenda-setting from healthcare professionals was also needed on the wide range of topics that could be covered in the consultation based on individual needs. Patients need self-management support in addition to what can be found with family, friends, or peers. It is crucial that the support is delivered with an appreciative approach by healthcare professionals with profound knowledge of atopic dermatitis. Equally important is guidance towards agenda-setting, a way to co-construct the consultation with a clear focus on the specific patient's needs.
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Affiliation(s)
- Anna Sophie Belling Krontoft
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | | | - Kirsten Lomborg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Popa V, Geissler J, Vermeulen R, Priest E, Capperella K, Susuzlu G, Terry SF, Brooke N. Delivering Digital Health Solutions that Patients Need: A Call to Action. Ther Innov Regul Sci 2024; 58:236-241. [PMID: 38082118 PMCID: PMC10850017 DOI: 10.1007/s43441-023-00592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/27/2023] [Indexed: 02/09/2024]
Abstract
Digital health solutions have the potential to complement traditional healthcare approaches and deliver improved health outcomes, but there are system-wide challenges that need to be addressed. These include fragmentation of the digital health landscape, regulatory processes that lack the agility to accommodate the fast pace of digital health advances, and inadequate transparency around data sharing and data governance. All of these challenges have led to mistrust, limited understanding and sharing of best practices, a lack of digital education and awareness, and insufficient patient and public engagement and involvement. In this paper, we argue that for digital health solutions to fulfil their potential, there needs to be a significant increase in early, meaningful, and sustained engagement with the people they intend to benefit. The uptake as well as the impact of digital solutions created in partnership with patients for patients are greater and more relevant to the communities they address.
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Jahan E, Almansour R, Ijaz K, Baptista S, Giordan LB, Ronto R, Zaman S, O'Hagan E, Laranjo L. Smartphone Applications to Prevent Type 2 Diabetes: A Systematic Review and Meta-Analysis. Am J Prev Med 2024:S0749-3797(24)00021-7. [PMID: 38272243 DOI: 10.1016/j.amepre.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Evidence supporting the use of apps for lifestyle behavior change and diabetes prevention in people at high risk of diabetes is lacking. The aim of this systematic review was to determine the acceptability and effectiveness of smartphone applications (apps) for the prevention of type 2 diabetes. METHODS PubMed, Embase, CINAHL and PsychInfo were searched from 2008 to 2023. Included studies involved adults at high risk of developing diabetes evaluating an app intervention with the aim of preventing type 2 diabetes. Random-effects meta-analyses were conducted for weight loss, body mass index (BMI), glycated hemoglobin, and waist circumference. Narrative synthesis was conducted for all studies, including qualitative studies exploring user perspectives. RESULTS Twenty-four studies (n=2,378) were included in this systematic review, including 9 randomized controlled trials (RCTs) with an average duration of 6 months, 10 quasi-experimental and 7 qualitative studies. Socially disadvantaged groups were poorly represented. Six RCTs were combined in meta-analyses. Apps were effective at promoting weight loss [mean difference (MD) -1.85; 95% CI -2.90 to -0.80] and decreasing BMI [MD -0.90, 95% CI -1.53 to -0.27], with no effect on glycated hemoglobin and waist circumference. No studies reported on diabetes incidence. Qualitative studies highlighted the need for app personalization. DISCUSSION Smartphone apps have a promising effect on preventing type 2 diabetes by supporting weight loss. Future robust trials should include diverse populations in co-design and evaluation of apps and explore the role of artificial intelligence in further personalizing interventions for higher engagement and effectiveness.
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Affiliation(s)
- Esrat Jahan
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia; Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rawan Almansour
- College of Applied Medical Sciences, King Faisal University, Al Ahsa, Saudi Arabia
| | - Kiran Ijaz
- Affective Interactions lab, School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Shaira Baptista
- The Australian Centre for Behavioural Research in Diabetes, Deakin University and the University of Melbourne, Melbourne, Victoria, Australia
| | - Leticia Bezerra Giordan
- Northern Beaches Hospital, 105 French's Forest Rd W, French's Forest, Sydney, NSW, Australia
| | - Rimante Ronto
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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Alhawsawi A, Greenfield D. Implementing co-production to enhance patient safety: the introduction of the patient safety consent tool, an example of a simple local solution to a common challenge. Int J Qual Health Care 2024; 36:mzad115. [PMID: 38156455 DOI: 10.1093/intqhc/mzad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/25/2023] [Accepted: 12/27/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Abdulelah Alhawsawi
- University of New South Wales-UNSW Medicine, Sydney, New South Wales, Australia
| | - David Greenfield
- University of New South Wales-UNSW Medicine, Sydney, New South Wales, Australia
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Coelho J, Moreno Poyato A, Roldán Merino J, Sequeira C, Sampaio F. Perspectives of adult patients with mental health disorders on the relationship with nurses: a focus group study. BMC Nurs 2024; 23:9. [PMID: 38163914 PMCID: PMC10759621 DOI: 10.1186/s12912-023-01663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The relationship between the nurse and the patient with mental health disorder is crucial to the recovery process. Thus, patients with mental health disorders should be active subjects in this relationship by having autonomy and self-determination. METHODS This study aimed to explore the perspectives of adult patients with mental health disorders on the relationship with nurses. A qualitative, descriptive, and exploratory study was conducted in March 2023, using focus group meetings in an association to support patients with severe mental health disorders in the Northern region of Portugal. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). A total of 8 patients participated in the study. Two focus group meetings were conducted. The inductive method was used, and content analysis of the transcripts was performed. The QDA Miner Lite 4.0 and Microsoft Excel were used for content analysis. RESULTS Participants considered the relationship with nurses important for their recovery and expected nurses to provide support and help, being able to identify their needs, thus personalising their care. Attitudinal and communication aspects were also considered crucial for establishing a solid, trusting, and meaningful relationship. CONCLUSION According to the findings nursing care is expected to focus on the patient, his/her preferences, expectations, and the uniqueness of each individual. The results of this study may be useful for the reflection and improvement of nurses in their relational and communication skills and the driving force for nursing students' awareness of the perspective of the relationship with patients with mental health disorder and its relevance.
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Affiliation(s)
- Joana Coelho
- Research and Development Unit, Northern Health Higher School of the Portuguese Red Cross, Oliveira de Azeméis, 3720-126, Portugal.
- Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal.
- CINTESIS@RISE, Nursing School of Porto (ESEP), Porto, 4200-450, Portugal.
| | - Antonio Moreno Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, Barcelona, 08007, Spain
- NURSEARCH - 2021 SGR 01083, Mental Health, Psychosocial and Complex Nursing Care Research Group, Universitat de Barcelona, Barcelona, 08007, Spain
| | - Juan Roldán Merino
- NURSEARCH - 2021 SGR 01083, Mental Health, Psychosocial and Complex Nursing Care Research Group, Universitat de Barcelona, Barcelona, 08007, Spain
- Campus Docent Sant Joan de Déu, University of Barcelona, Barcelona, 08830, Spain
| | - Carlos Sequeira
- CINTESIS@RISE, Nursing School of Porto (ESEP), Porto, 4200-450, Portugal
- Nursing School of Porto, Porto, 4200-072, Portugal
| | - Francisco Sampaio
- CINTESIS@RISE, Nursing School of Porto (ESEP), Porto, 4200-450, Portugal
- Nursing School of Porto, Porto, 4200-072, Portugal
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Heenan M, Chung A, Howse E, Signy H, Rychetnik L. Combining public health evidence, policy experience and communications expertise to inform preventive health: reflections on a novel method of knowledge synthesis. Health Res Policy Syst 2023; 21:112. [PMID: 37907940 PMCID: PMC10617064 DOI: 10.1186/s12961-023-01062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023] Open
Abstract
Knowledge synthesis methods help summarize evidence and utilize content expertise to draw out key messages to aid knowledge mobilization and translation. Systems thinking and coproduction can support this by facilitating a multiperspective view and ensuring that knowledge is mobilized and translated in a useful and meaningful way for policy-makers and practitioners. In this paper, we describe the development of a knowledge synthesis approach that utilizes coproduction with policy-makers to combine the findings of a programme of research with policy knowledge to support decision-makers working in chronic disease prevention. The process developed by The Australian Prevention Partnership Centre combined the expertise of research, policy and science communications experts. We reflect on how we used coproduction processes to embed policy-makers as partners in the evidence synthesis process via research-policy dialogues, and embedded science communication into the development and presentation of the findings. This differs from a more common approach of researchers generating evidence for policy with limited input from policy-makers themselves. By collaborating with policy-makers and using coproduction, we can better inform policy-relevant research and generate policy-relevant knowledge. We describe the development of our knowledge synthesis approach using two case studies: the first drawing on a body of work in public health law, and the second on a body of work focused on the first 2000 days of life. We consider how these case studies demonstrate the value of working with policy partners as part of a knowledge synthesis process, and discuss how this process could be adapted and used in future.
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Affiliation(s)
- Maddie Heenan
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elly Howse
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia
| | - Helen Signy
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
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Holmboe ES, Osman NY, Murphy CM, Kogan JR. The Urgency of Now: Rethinking and Improving Assessment Practices in Medical Education Programs. Acad Med 2023; 98:S37-S49. [PMID: 37071705 DOI: 10.1097/acm.0000000000005251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Assessment is essential to professional development. Assessment provides the information needed to give feedback, support coaching and the creation of individualized learning plans, inform progress decisions, determine appropriate supervision levels, and, most importantly, help ensure patients and families receive high-quality, safe care in the training environment. While the introduction of competency-based medical education has catalyzed advances in assessment, much work remains to be done. First, becoming a physician (or other health professional) is primarily a developmental process, and assessment programs must be designed using a developmental and growth mindset. Second, medical education programs must have integrated programs of assessment that address the interconnected domains of implicit, explicit and structural bias. Third, improving programs of assessment will require a systems-thinking approach. In this paper, the authors first address these overarching issues as key principles that must be embraced so that training programs may optimize assessment to ensure all learners achieve desired medical education outcomes. The authors then explore specific needs in assessment and provide suggestions to improve assessment practices. This paper is by no means inclusive of all medical education assessment challenges or possible solutions. However, there is a wealth of current assessment research and practice that medical education programs can use to improve educational outcomes and help reduce the harmful effects of bias. The authors' goal is to help improve and guide innovation in assessment by catalyzing further conversations.
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Affiliation(s)
- Eric S Holmboe
- E.S. Holmboe is chief, Research, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0108-6021
| | - Nora Y Osman
- N.Y. Osman is associate professor of medicine, Harvard Medical School, and director of undergraduate medical education, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-3542-1262
| | - Christina M Murphy
- C.M. Murphy is a fourth-year medical student and president, Medical Student Government at Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3966-5264
| | - Jennifer R Kogan
- J.R. Kogan is associate dean, Student Success and Professional Development, and professor of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-8426-9506
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Glasdam S, Hybholt L, Stjernswärd S. Experiences of Everyday Life among Individuals with Co-Existence of Serious Mental Illness and Cancer-A Qualitative Systematic Literature Review. Healthcare (Basel) 2023; 11:1897. [PMID: 37444731 DOI: 10.3390/healthcare11131897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Daily life with severe mental health (SMI) and cancer comorbidity entails multiple challenges. The study aims to explore everyday life experiences among individuals with SMI and cancer comorbidity from the perspectives of patients, significant others, and involved healthcare professionals. The study is registered in PROSPERO (CRD42021259604). A qualitative systematic review was conducted through searches in the databases MEDLINE, CINAHL, PsychInfo, and Web of Sciences (last search 14 February 2023). Inclusion criteria were empirical qualitative research studies investigating experiences of healthcare and everyday life among persons living with SMI and who were subsequently diagnosed with cancer from the perspective of the individuals themselves, their significant others, and healthcare professionals involved in their care. Exclusion criteria: Literature reviews, quantitative studies, intervention studies, quantitative parts of mix-methods studies, non-English languages, persons <18 years, dementia/learning disabilities, diagnosed with anxiety/depression as a consequence of cancer. Seven articles, published between January 2011 and February 2023, were included and analysed through a thematic analysis. The PRISMA 2020 checklist guided the study. The results were presented in four themes: 'Navigating between different worlds and logics', 'Decision-making capacity depending on the assessor', 'Cancer must give way to severe mental illness or vice versa', and 'Significant others as a safety net'. Research about the everyday lives of persons with SMI and cancer comorbidities from patients' and relatives' perspectives is lacking and thus called for.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, 222 41 Lund, Sweden
| | - Lisbeth Hybholt
- Research Unit, Mental Health Services East, Psychiatry Region Zealand, Smedegade 16, 4000 Roskilde, Denmark
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark
| | - Sigrid Stjernswärd
- Department of Health Sciences, Faculty of Medicine, Lund University, 222 41 Lund, Sweden
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Fernandes B, Neelakantan L, Shah H, Sumant S, Collins PY, Velloza J, Bampton E, Ranganathan S, Sibisi R, Bashir T, Bowes J, David EL, Kaur H, Malik U, Shannon I, Gurumayum S, Burn AM, Sieberts SK, Fazel M. Evidencing the Impact of Web-Based Coproduction With Youth on Mental Health Research: Qualitative Findings From the MindKind Study. JMIR Public Health Surveill 2023; 9:e42963. [PMID: 37335609 PMCID: PMC10365598 DOI: 10.2196/42963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Public involvement in research is a growing phenomenon as well as a condition of research funding, and it is often referred to as coproduction. Coproduction involves stakeholder contributions at every stage of research, but different processes exist. However, the impact of coproduction on research is not well understood. Web-based young people's advisory groups (YPAGs) were established as part of the MindKind study at 3 sites (India, South Africa, and the United Kingdom) to coproduce the wider research study. Each group site, led by a professional youth advisor, conducted all youth coproduction activities collaboratively with other research staff. OBJECTIVE This study aimed to evaluate the impact of youth coproduction in the MindKind study. METHODS To measure the impact of web-based youth coproduction on all stakeholders, the following methods were used: analysis of project documents, capturing the views of stakeholders using the Most Significant Change technique, and impact frameworks to assess the impact of youth coproduction on specific stakeholder outcomes. Data were analyzed in collaboration with researchers, advisors, and YPAG members to explore the impact of youth coproduction on research. RESULTS The impact was recorded on 5 levels. First, at the paradigmatic level, a novel method of conducting research allowed for a widely diverse group of YPAG representations, influencing study priorities, conceptualization, and design. Second, at the infrastructural level, the YPAG and youth advisors meaningfully contributed to the dissemination of materials; infrastructural constraints of undertaking coproduction were also identified. Third, at the organizational level, coproduction necessitated implementing new communication practices, such as a web-based shared platform. This meant that materials were easily accessible to the whole team and communication streams remained consistent. Fourth, at the group level, authentic relationships developed between the YPAG members, advisors, and the rest of the team, facilitated by regular web-based contact. Finally, at the individual level, participants reported enhanced insights into mental well-being and appreciation for the opportunity to engage in research. CONCLUSIONS This study revealed several factors that shape the creation of web-based coproduction, with clear positive outcomes for advisors, YPAG members, researchers, and other project staff. However, several challenges of coproduced research were also encountered in multiple contexts and amid pressing timelines. For systematic reporting of the impact of youth coproduction, we propose that monitoring, evaluation, and learning systems be designed and implemented early.
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Affiliation(s)
- Blossom Fernandes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Lakshmi Neelakantan
- Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Himani Shah
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Sushmita Sumant
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Pamela Y Collins
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Emily Bampton
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Refiloe Sibisi
- Higher Health, Higher Education and Training: Health, Wellness, and Development Centre, Pretoria, South Africa
| | - Toiba Bashir
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Joshua Bowes
- Mindkind Young People's Advisory Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Esther Larisa David
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Harsimar Kaur
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Umairah Malik
- Mindkind Young People's Advisory Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Issy Shannon
- Mindkind Young People's Advisory Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Suvlaxmi Gurumayum
- Mindkind Young People's Advisory Group, Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Pila S, Stern BZ, Rothrock NE, Franklin PD. Evaluating a web-based personalized decision report for total knee or hip replacement: Lessons learned from patients. J Eval Clin Pract 2023. [PMID: 37316454 DOI: 10.1111/jep.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
RATIONALE Patient-reported outcomes (PROs) are increasingly used in the context of clinical care, but evaluation of patients' perspectives of PRO-based applications in routine care remains limited. AIMS AND OBJECTIVES This paper investigates patients' acceptability of a personalized web-based decision report for total knee or hip replacement and identifies opportunities to refine the report. METHOD This qualitative evaluation was embedded in a pragmatic cluster randomized trial of the report. We interviewed 25 patients with knee and hip osteoarthritis about their experiences using the personalized decision report in the context of a surgical consultation. The web-based report contained current descriptive PRO scores of pain, function and general physical health; tailored predicted postoperative PRO scores (i.e., personalized likely outcomes based on actual knee or hip replacement outcomes of similar patients in a national registry); and information about alternative nonoperative treatments. Two trained researchers analysed the interview data qualitatively using a combination of inductive and deductive coding. RESULTS We identified three major categories for evaluation: content of report, presentation of data in report and engagement with report. Patients generally liked the report overall but specifically valued different pages of the report based on where they were in the surgical decision-making process. Patients identified areas of confusion in data presentation related to graph orientation, terminology and interpretation of T-scores. Patients also highlighted support needs to meaningfully engage with the information in the report. CONCLUSION Our findings highlight areas of opportunity to further refine this personalized web-based decision report and similar patient-facing PRO applications for routine clinical care. Specific examples include additional tailoring of reports via filterable web-based dashboards and scalable educational supports to facilitate more independent patient understanding and use.
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Affiliation(s)
- Sarah Pila
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brocha Z Stern
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nan E Rothrock
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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13
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Elg M, Gremyr I. Patient involvement in quality improvement: a survey comparing naturalistic and reflective approaches. BMJ Open Qual 2023; 12:bmjoq-2022-001981. [PMID: 37192776 DOI: 10.1136/bmjoq-2022-001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND This study investigates reflective and naturalistic approaches to patient involvement in quality improvement. The reflective approach, using, for example, interviews, provides insights into patient needs and demands to support an established improvement agenda. The naturalistic approach, for example, observations, is used to discover practical problems and opportunities that professionals are currently unaware of. METHODS We assessed the use of naturalistic and reflective approaches in quality improvement to see whether they differed in their impact on patient needs, financial improvements and improved patient flows. Four possible combinations were used as a starting point: restrictive (low reflective-low naturalistic), in situ (low reflective-high naturalistic), retrospective (high reflective-low naturalistic) and blended (high reflective-high naturalistic). Data were collected through an online cross-sectional survey using a web-based survey tool. The original sample was based on a list of 472 participants enrolled in courses on improvement science in three Swedish regions. The response rate was 34%. Descriptives and ANOVA (Analysis of Variance) in SPSS V.23 were used for the statistical analysis. RESULTS The sample consisted of 16 projects characterised as restrictive, 61 as retrospective and 63 as blended. No projects were characterised as in situ. There was a significant effect of patient involvement approaches on patient flows and patient needs at the p<0.05 level (patient flows, (F(2, 128)=5.198, p=0.007) and patient needs (F(2, 127)=13.228, p=0.000)). No significant effect was found for financial results. CONCLUSIONS Moving beyond restrictive patient involvement is important to meet new patient needs and improve patient flows. This can be done either by increasing the use of a reflective approach or by increasing the use of both reflective and naturalistic approaches. A blended approach with high levels of both is likely to produce better results in addressing new patient needs and improving patient flows.
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Affiliation(s)
- Mattias Elg
- Department of Management and Engineering, Linköping University, Linkoping, Östergötland, Sweden
| | - Ida Gremyr
- Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
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14
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Balbale SN, Cho M, Raval MV, Close SM. Role of patient and family engagement in quality improvement for pediatric surgery. Semin Pediatr Surg 2023; 32:151281. [PMID: 37094531 DOI: 10.1016/j.sempedsurg.2023.151281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
In recent decades, the role of quality improvement (QI) in pediatric surgery has grown substantially. Patient and family engagement can help to maximize the impact of QI by enhancing safety and patient outcomes. Yet, broader, systematic efforts to actively involve patients and families in QI initiatives remain a persistent gap in pediatric surgery. To address this gap, we propose an agenda centered on three key goals for future quality improvement efforts: (1) building partnerships with patients and their families; (2) expanding the use of patient-reported outcomes (PROs) and novel, cross-disciplinary research methods; and (3) engaging patients and families consistently across all stages of pediatric surgical care. Fulfilling this agenda will be essential in shifting our mindset to view QI as a collective that involves patients, families, clinicians, and payers in continuous, system-wide opportunities to evaluate and improve care. Actively listening to and collaborating with patients and families may also help renew our focus on narrowing the gap between current practice and the best possible practice for children undergoing surgery.
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Affiliation(s)
- Salva N Balbale
- Division of Gastroenterology and Hepatology, Department of Medicine; Department of Medical Social Sciences; Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery; & Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (IPHAM), Northwestern University Feinberg School of Medicine, Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Edward Hines, Jr. VA Hospital, Hines, IL.
| | | | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sharron M Close
- Department of Pediatric Advanced Practice Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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15
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Suutari AM, Thor J, Nordin A, Josefsson KA. Improving heart failure care with an Experience-Based Co-Design approach: what matters to persons with heart failure and their family members? BMC Health Serv Res 2023; 23:294. [PMID: 36978125 PMCID: PMC10044106 DOI: 10.1186/s12913-023-09306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Heart failure is a chronic heart condition. Persons with heart failure often have limited physical capability, cognitive impairments, and low health literacy. These challenges can be barriers to healthcare service co-design with family members and professionals. Experience-Based Co-Design is a participatory healthcare quality improvement approach drawing on patients', family members' and professionals' experiences to improve healthcare. The overall aim of this study was to use Experience-Based Co-Design to identify experiences of heart failure and its care in a Swedish cardiac care setting, and to understand how these experiences can translate into heart failure care improvements for persons with heart failure and their families. METHODS A convenience sample of 17 persons with heart failure and four family members participated in this single case study as a part of an improvement initiative within cardiac care. In line with Experienced-Based Co-Design methodology, field notes from observations of healthcare consultations, individual interviews and meeting minutes from stakeholders' feedback events, were used to gather participants' experiences of heart failure and its care. Reflexive thematic analysis was used to develop themes from data. RESULTS Twelve service touchpoints, organized within five overarching themes emerged. The themes told a story about persons with heart failure and family members struggling in everyday life due to a poor quality of life, lack of support networks, and difficulties understanding and applying information about heart failure and its care. To be recognized by professionals was reported to be a key to good quality care. Opportunities to be involved in healthcare varied, Further, participants' experiences translated into proposed changes to heart failure care such as improved information about heart failure, continuity of care, improved relations, and communication, and being invited to be involved in healthcare. CONCLUSIONS Our study findings offer knowledge about experiences of life with heart failure and its care, translated into heart failure service touchpoints. Further research is warranted to explore how these touchpoints can be addressed to improve life and care for persons with heart failure and other chronic conditions.
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Affiliation(s)
- Anne-Marie Suutari
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
- Department of Internal Medicine and Geriatrics, the Highland Hospital (Höglandssjukhuset), Region Jönköping County, Eksjö, Sweden.
| | - Johan Thor
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annika Nordin
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristina Areskoug Josefsson
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- The Department of Health Sciences, University West, Trollhättan, Sweden
- Department of Behavioral Science, Oslo Metropolitan University, Oslo, Norway
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Marsall M, Bäuerle A, Hasenberg T, Schräpler L, Robitzsch A, Niedergethmann M, Teufel M, Weigl M. Quality of Care Transition During Hospital Discharge, Patient Safety, and Weight Regain After Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2023; 33:1143-1153. [PMID: 36773181 PMCID: PMC10079752 DOI: 10.1007/s11695-023-06486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Bariatric surgery is established as the gold standard in the treatment of severe obesity. However, a significant proportion of patients experience a substantial weight regain afterwards. Previous research focused predominantly on patients' personal factors. Yet, critical discharge process factors that contribute to patient's adherence after surgical interventions are rarely examined. This study investigated whether high quality of care transitions in discharge management influences weight regain and the likelihood of experiencing adverse patient safety incidents. MATERIALS AND METHODS A cross-sectional study with 578 patients after bariatric surgery was conducted. Participants answered a standardized assessment on the quality of care transition from hospital to home-, surgery-, and nutrition-related characteristics as well as patient safety incidents. RESULTS Significant weight regain was observed 24 months after surgery. The association between time since surgery and weight regain was weaker in patients with high quality of care transitions (B = 2.27, p < .001). Higher quality of care transition was also significantly related to a lower likelihood of unplanned hospital readmissions (OR = 0.67) and fewer medication complications (OR = 0.48) after surgery. CONCLUSION This study sheds first light on the key influence of high quality of care transitions after bariatric surgery. Improvement efforts into effective discharge processes may establish smoother care transitions and help patients to assume responsibility and compliance with behavioral recommendations after surgery. Moreover, adverse patient safety incidents are less frequent after high quality care transitions indicating both high quality of health services for patients and reducing costs for the health care system.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany.
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Till Hasenberg
- Helios Obesity Center West, Helios St. Elisabeth Hospital Oberhausen, Witten/Herdecke University, Helios University Hospital Wuppertal, 42283, Wuppertal, Germany
| | - Laura Schräpler
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Anita Robitzsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Marco Niedergethmann
- Department of Surgery, Obesity and Metabolic Surgery Center, Alfried Krupp Hospital Essen, 45131, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany
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Downs J, Ayton A, Collins L, Baker S, Missen H, Ibrahim A. Untreatable or unable to treat? Creating more effective and accessible treatment for long-standing and severe eating disorders. Lancet Psychiatry 2023; 10:146-154. [PMID: 36697122 DOI: 10.1016/s2215-0366(22)00400-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 01/25/2023]
Abstract
The evidence base for the treatment of severe eating disorders is limited. In addition to improving access to early intervention, there is a need to develop more effective treatments for complex presentations of eating disorders. For patients with long-standing and severe illnesses, particular difficulties might exist with their engagement with treatment and achieving treatment outcomes. Alarmingly, there is an emerging international discourse about a concept labelled as terminal anorexia and about the withdrawal of treatment for people with severe eating disorders, resulting in the death of patients, as a legitimate option. This concept has arisen in the context of vastly overstretched specialist services and insufficient research and funding for new treatments. This Personal View combines multiple perspectives from carers, patients, and mental health professionals based in the UK, highlighting how the risks of current service provision are best alleviated by increasing resources, capacity, and training, and not by a narrowing of the criteria according to which patients with eating disorders are offered the care and support they need.
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Affiliation(s)
- James Downs
- Royal College of Psychiatrists, London, UK; Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK.
| | - Agnes Ayton
- Department of Psychiatry, Oxford University, Oxford, UK
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Mavragani A, Svedberg P, Lexén A, Tjörnstrand C, Strid C, Bejerholm U. Co-design Process of a Digital Return-to-Work Solution for People With Common Mental Disorders: Stakeholder Perception Study. JMIR Form Res 2023; 7:e39422. [PMID: 36652285 PMCID: PMC9892984 DOI: 10.2196/39422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Service users and other stakeholders have had few opportunities to influence the design of their mental health and return-to-work services. Likewise, digital solutions often fail to align with stakeholders' needs and preferences, negatively impacting their utility. mWorks is a co-design initiative to create a digital return-to-work solution for persons with common mental disorders that is acceptable and engaging for those receiving and delivering the intervention. OBJECTIVE This study aimed to describe stakeholder perceptions and the involvement of a design process during the prototype development of mWorks. METHODS A co-design approach was used during the iterative development of mWorks. Overall, 86 stakeholders were recruited using a combination of purposeful and convenience sampling. Five stakeholder groups represented service users with experience of sick leave and common mental disorders (n=25), return-to-work professionals (n=19), employers (n=1), digital design and system developers (n=4), and members of the public (n=37). Multiple data sources were gathered using 7 iterations, from March 2018 to November 2020. The rich material was organized and analyzed using content analysis to generate themes and categories that represented this study's findings. RESULTS The themes revealed the importance of mWorks in empowering service users with a personal digital support solution that engages them back in work. The categories highlighted that mWorks needs to be a self-management tool that enables service users to self-manage as a supplement to traditional return-to-work services. It was also important that content features helped to reshape a positive self-narrative, with a focus on service users' strengths and resources to break the downward spiral of ill health during sick leave. Additional crucial features included helping service users mobilize their own strategies to cope with thoughts and feelings and formulate goals and a plan for their work return. Once testing of the alpha and beta prototypes began, user engagement became the main focus for greater usability. It is critical to facilitate the comprehension and purpose of mWorks, offer clear guidance, and enhance motivational and goal-setting strategies. CONCLUSIONS Stakeholders' experience-based knowledge asserted that mWorks needs to empower service users by providing them with a personal support tool. To enhance return-to-work prospects, users must be engaged in a meaningful manner while focusing on their strengths and resources.
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Affiliation(s)
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Annika Lexén
- Department of Health Science, Lund University, Lund, Sweden
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Tanay MAL, Armes J, Moss-Morris R, Rafferty AM, Robert G. A systematic review of behavioural and exercise interventions for the prevention and management of chemotherapy-induced peripheral neuropathy symptoms. J Cancer Surviv 2023; 17:254-77. [PMID: 33710510 DOI: 10.1007/s11764-021-00997-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) can result in functional difficulties. Pharmacological interventions used to prevent CIPN either show low efficacy or lack evidence to support their use and to date, duloxetine remains the only recommended treatment for painful CIPN. Non-pharmacological interventions such as exercise and behavioural interventions for CIPN exist. PURPOSE The aims were to (1) identify and appraise evidence on existing behavioural and exercise interventions focussed on preventing or managing CIPN symptoms, (2) describe psychological mechanisms of action by which interventions influenced CIPN symptoms, (3) determine the underpinning conceptual models that describe how an intervention may create behaviour change, (4) identify treatment components of each intervention and contextual factors, (5) determine the nature and extent of patient and clinician involvement in developing existing interventions and (6) summarise the relative efficacy or effectiveness of interventions to lessen CIPN symptoms and to improve quality of life, balance and muscle strength. METHODS A systematic search of Ovid Medline, Cochrane Library, EMBASE, PsycINFO, Health Management Information Consortium, Global Health and CINAHL was performed to identify articles published between January 2000 to May 2020, followed by OpenGrey search and hand-searching of relevant journals. Studies that explored behavioural and/or exercise interventions designed to prevent or improve symptoms of CIPN in adults who had received or were receiving neurotoxic chemotherapy for any type of cancer, irrespective of when delivered within the cancer pathway were included. RESULTS Nineteen randomised controlled trials and quasi-experimental studies which explored behavioural (n=6) and exercise (n=13) interventions were included. Four studies were rated as methodologically strong, ten were moderate and five were weak. Ten exercise and two behavioural interventions, including those that improved CIPN knowledge and self-management resources and facilitated symptom self-reporting, led to reduced CIPN symptoms during and/or after chemotherapy treatment. CONCLUSIONS The extent of potential benefits from the interventions was difficult to judge, due to study limitations. Future interventions should incorporate a clear theoretical framework and involve patients and clinicians in the development process. IMPLICATIONS FOR CANCER SURVIVORS Our findings show exercise interventions have beneficial effects on CIPN symptoms although higher quality research is warranted. Behavioural interventions that increase patient's CIPN knowledge, improve self-management capacity and enable timely access to symptom management led to reduced CIPN symptoms.
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Gremyr A, Holmberg C, Thor J, Malm U, Gäre BA, Andersson AC. How a point-of-care dashboard facilitates co-production of health care and health for and with individuals with psychotic disorders: a mixed-methods case study. BMC Health Serv Res 2022; 22:1599. [PMID: 36585696 PMCID: PMC9803257 DOI: 10.1186/s12913-022-08992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden's largest department specializing in psychotic disorders sought to improve patients' health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics. METHODS This study evaluates the dashboard by addressing two questions: 1) Can differences in health-related outcome measures be attributed to the use of the dashboard? 2) How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients. RESULTS Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients' health. The dashboard helped users identify critical changes and enabled joint planning and evaluation. CONCLUSION Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients' health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.
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Affiliation(s)
- Andreas Gremyr
- grid.1649.a000000009445082XDepartment of Psychotic Disorders, Sahlgrenska University, Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, 431 80, Mölndal, Sweden ,grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden
| | - Christopher Holmberg
- grid.1649.a000000009445082XDepartment of Psychotic Disorders, Sahlgrenska University, Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, 431 80, Mölndal, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Göteborg, Sweden
| | - Johan Thor
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden
| | - Ulf Malm
- grid.8761.80000 0000 9919 9582Sahlgrenska Academy at Gothenburg University, Institute of Neuroscience and Physiology, Box 400, 40530 Göteborg, Sweden
| | - Boel Andersson Gäre
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden ,Futurum Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Ann-Christine Andersson
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden ,grid.32995.340000 0000 9961 9487Department of Care Science, Malmö University, Nordenskiöldsgatan 1, 21119 Malmö, Sweden
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Walshe J, Akbari A, Hawthorne AB, Laing H. Data linkage can reduce the burden and increase the opportunities in the implementation of Value-Based Health Care policy: a study in patients with ulcerative colitis (PROUD-UC Study). Int J Popul Data Sci 2022; 6:1705. [PMID: 37649471 PMCID: PMC10464864 DOI: 10.23889/ijpds.v6i3.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Healthcare systems face rising demand and unsustainable cost pressures. In response, health policymakers are adopting Value-Based Health Care (VBHC), targeting available resources to achieve the best possible patient outcomes at the lowest possible cost and actively disinvesting in care of low-value. This requires the evaluation of longitudinal clinical and patient reported outcome measures (PROMs) at an individual-level and population-scale, which can create significant data challenges. Achieving this through routinely collected electronic health record (EHR) data-linkage could facilitate the implementation of VBHC without an unacceptable data burden on patients or health systems and release time for higher-value activities. Objectives Our study tested the ability to report an international, patient-centred outcome dataset (ICHOM-IBD) using only anonymised individual-level population-scale linked electronic health record (EHR) data sources, including clinical and patient-reported outcomes, in a cohort of patients with moderate-to-severe ulcerative colitis (UC), receiving biopharmaceutical therapies ("biologics") in a single, publicly funded, healthcare system. Results We identified a cohort of 17,632 patients with UC in Wales and a cohort from two Health Boards of 447 patients with UC receiving biologics. 112 of these patients had completed 866 condition-specific PROMs during their biologics treatment. 44 out of 59 (74.6%) items in the ICHOM-IBD could be derived from routinely collected data of which a primary care source was essential for eight items and desirable for 21. Conclusions We demonstrated that it is possible to report most but not all the ICHOM-IBD outcomes using routinely collected data from multiple sources without additional system burden, potentially supporting Value-Based Health Care implementation with population data science. As digital collection of PROMs and use of condition-specific registries grow, greater utility of this approach can be anticipated. We have identified that the availability of longitudinal primary and secondary care data linked with PROMs is essential for this to be possible.
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Affiliation(s)
- John Walshe
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Wales, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Wales, UK
| | | | - Hamish Laing
- Value-Based Health and Care Academy, Faculty of Humanities and Social Sciences, Swansea University, Wales, UK
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22
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Kinnear B, Schumacher DJ, Driessen EW, Varpio L. How argumentation theory can inform assessment validity: A critical review. Med Educ 2022; 56:1064-1075. [PMID: 35851965 PMCID: PMC9796688 DOI: 10.1111/medu.14882] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Many health professions education (HPE) scholars frame assessment validity as a form of argumentation in which interpretations and uses of assessment scores must be supported by evidence. However, what are purported to be validity arguments are often merely clusters of evidence without a guiding framework to evaluate, prioritise, or debate their merits. Argumentation theory is a field of study dedicated to understanding the production, analysis, and evaluation of arguments (spoken or written). The aim of this study is to describe argumentation theory, articulating the unique insights it can offer to HPE assessment, and presenting how different argumentation orientations can help reconceptualize the nature of validity in generative ways. METHODS The authors followed a five-step critical review process consisting of iterative cycles of focusing, searching, appraising, sampling, and analysing the argumentation theory literature. The authors generated and synthesised a corpus of manuscripts on argumentation orientations deemed to be most applicable to HPE. RESULTS We selected two argumentation orientations that we considered particularly constructive for informing HPE assessment validity: New rhetoric and informal logic. In new rhetoric, the goal of argumentation is to persuade, with a focus on an audience's values and standards. Informal logic centres on identifying, structuring, and evaluating arguments in real-world settings, with a variety of normative standards used to evaluate argument validity. DISCUSSION Both new rhetoric and informal logic provide philosophical, theoretical, or practical groundings that can advance HPE validity argumentation. New rhetoric's foregrounding of audience aligns with HPE's social imperative to be accountable to specific stakeholders such as the public and learners. Informal logic provides tools for identifying and structuring validity arguments for analysis and evaluation.
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Affiliation(s)
- Benjamin Kinnear
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- School of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
| | - Daniel J. Schumacher
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Erik W. Driessen
- School of Health Professions Education Faculty of HealthMedicine and Life Sciences of Maastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
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23
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Claessens F, Castro EM, Jans A, Jacobs L, Seys D, Van Wilder A, Brouwers J, Van der Auwera C, De Ridder D, Vanhaecht K. Patients' and kin's perspective on healthcare quality compared to Lachman's multidimensional quality model: Focus group interviews. Patient Educ Couns 2022; 105:3151-3159. [PMID: 35843847 DOI: 10.1016/j.pec.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To identify key attributes of healthcare quality relevant to patients and kin and to compare them to Lachman's multidimensional quality model. METHODS Four focus groups with patients and kin were conducted using a semi-structured interview guide and a purposive sampling method. Classical content analysis and constant comparison method were used to focus data analysis on individual and group level. RESULTS Communication with patients, kin and professionals emerged as a new dimension from interview transcripts. Other identified key attributes largely corresponded with Lachman's multidimensional quality model. They were mainly classified in dimensions: 'Partnership and Co-Production', 'Dignity and Respect' and 'Effectiveness'. Technical quality dimensions were linked to organisational aspects of care in terms of staffing levels and time. The dimension 'Eco-friendly' was not addressed by patients or kin. CONCLUSIONS The results enhance the comprehension of healthcare quality and contribute to its academic understanding by validating Lachman's multidimensional quality model from patients' and kin's perspective. The model robustness is increased by including communication as a quality dimension surrounding technical domains and core values. PRACTICE IMPLICATIONS The key attributes can serve as a holistic framework for healthcare organisations to design their quality management system. An instrument can be developed to measure key attributes.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Laura Jacobs
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium.
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24
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Perry LM, Morken V, Peipert JD, Yanez B, Garcia SF, Barnard C, Hirschhorn LR, Linder JA, Jordan N, Ackermann RT, Harris A, Kircher S, Mohindra N, Aggarwal V, Frazier R, Coughlin A, Bedjeti K, Weitzel M, Nelson EC, Elwyn G, Van Citters AD, O'Connor M, Cella D. Patient-Reported Outcome Dashboards Within the Electronic Health Record to Support Shared Decision-making: Protocol for Co-design and Clinical Evaluation With Patients With Advanced Cancer and Chronic Kidney Disease. JMIR Res Protoc 2022; 11:e38461. [PMID: 36129747 PMCID: PMC9536520 DOI: 10.2196/38461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported outcomes-symptoms, treatment side effects, and health-related quality of life-are important to consider in chronic illness care. The increasing availability of health IT to collect patient-reported outcomes and integrate results within the electronic health record provides an unprecedented opportunity to support patients' symptom monitoring, shared decision-making, and effective use of the health care system. OBJECTIVE The objectives of this study are to co-design a dashboard that displays patient-reported outcomes along with other clinical data (eg, laboratory tests, medications, and appointments) within an electronic health record and conduct a longitudinal demonstration trial to evaluate whether the dashboard is associated with improved shared decision-making and disease management outcomes. METHODS Co-design teams comprising study investigators, patients with advanced cancer or chronic kidney disease, their care partners, and their clinicians will collaborate to develop the dashboard. Investigators will work with clinic staff to implement the co-designed dashboard for clinical testing during a demonstration trial. The primary outcome of the demonstration trial is whether the quality of shared decision-making increases from baseline to the 3-month follow-up. Secondary outcomes include longitudinal changes in satisfaction with care, self-efficacy in managing treatments and symptoms, health-related quality of life, and use of costly and potentially avoidable health care services. Implementation outcomes (ie, fidelity, appropriateness, acceptability, feasibility, reach, adoption, and sustainability) during the co-design process and demonstration trial will also be collected and summarized. RESULTS The dashboard co-design process was completed in May 2020, and data collection for the demonstration trial is anticipated to be completed by the end of July 2022. The results will be disseminated in at least one manuscript per study objective. CONCLUSIONS This protocol combines stakeholder engagement, health care coproduction frameworks, and health IT to develop a clinically feasible model of person-centered care delivery. The results will inform our current understanding of how best to integrate patient-reported outcome measures into clinical workflows to improve outcomes and reduce the burden of chronic disease on patients and health care systems. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38461.
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Affiliation(s)
- Laura M Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Victoria Morken
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - John D Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cynthia Barnard
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert J Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, United States
| | - Ronald T Ackermann
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alexandra Harris
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nisha Mohindra
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Vikram Aggarwal
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca Frazier
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ava Coughlin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Melissa Weitzel
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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25
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Rodríguez-Mercedes SL, Patel KF, Rencken CA, Grant GG, Surette K, Kinney EM, Brady KJ, Slavin MD, Schneider JC, Stoddard FJ, Kazis LE, Ryan CM. Item Pool Development for the School-Aged Life Impact Burn Recovery Evaluation Profile Computerized Adaptive Test: An Observer-Reported Outcome Assessment Measuring the Impact of Burn Injuries in School-Aged Children. J Burn Care Res 2022; 43:1114-1128. [PMID: 34965302 PMCID: PMC9255664 DOI: 10.1093/jbcr/irab247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The transition from early childhood to teen years (5-12) is a critical time of development, which can be made particularly challenging by a burn injury. Assessing postburn recovery during these years is important for improving pediatric survivors' development and health outcomes. Few validated burn-specific measures exist for this age group. The purpose of this study was to generate item pools that will be used to create a future computerized adaptive test (CAT) assessing postburn recovery in school-aged children. Item pool development was guided by the previously developed School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) conceptual framework. The item pool development process involved a systematic literature review, extraction of candidate items from existing legacy measures, iterative item review during expert consensus meetings, and parent cognitive interviews. The iterative item review with experts consisted of six rounds. A total of 10 parent cognitive interviews were conducted. The three broad themes of concern were items that needed 1) clarification, needed context, or were vague, 2) age dependence and relevance, and 3) word choice. The cognitive interviews indicated that survey instructions, recall period, item stem, and response choices were interpretable by respondents. Final item pool based on parental feedback consists of 57, 81, and 60 items in physical, psychological, and family and social functioning, respectively. Developed item pools (n = 198) in three domains are consistent with the existing conceptual framework. The next step involves field testing the item pool and calibration using item response theory to develop and validate the SA-LIBRE5-12 CAT Profile.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Camerin A. Rencken
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Gabrielle G. Grant
- University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC
| | - Kate Surette
- Shriners Hospitals for Children – Boston, Boston, MA
| | | | - Keri J.S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Mary D. Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Frederick J. Stoddard
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
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26
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Coyne E, Winter N, Carlini J, Robertson J, Dieperink K. Developing video resources to reduce the burden of caring for persons with brain cancer. Eur J Oncol Nurs 2022; 60:102187. [DOI: 10.1016/j.ejon.2022.102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
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Cobianchi L, Verde JM, Loftus TJ, Piccolo D, Dal Mas F, Mascagni P, Garcia Vazquez A, Ansaloni L, Marseglia GR, Massaro M, Gallix B, Padoy N, Peter A, Kaafarani HM. Artificial Intelligence and Surgery: Ethical Dilemmas and Open Issues. J Am Coll Surg 2022; 235:268-75. [PMID: 35839401 DOI: 10.1097/XCS.0000000000000242] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Artificial intelligence (AI) applications aiming to support surgical decision-making processes are generating novel threats to ethical surgical care. To understand and address these threats, we summarize the main ethical issues that may arise from applying AI to surgery, starting from the Ethics Guidelines for Trustworthy Artificial Intelligence framework recently promoted by the European Commission. STUDY DESIGN A modified Delphi process has been employed to achieve expert consensus. RESULTS The main ethical issues that arise from applying AI to surgery, described in detail here, relate to human agency, accountability for errors, technical robustness, privacy and data governance, transparency, diversity, non-discrimination, and fairness. It may be possible to address many of these ethical issues by expanding the breadth of surgical AI research to focus on implementation science. The potential for AI to disrupt surgical practice suggests that formal digital health education is becoming increasingly important for surgeons and surgical trainees. CONCLUSIONS A multidisciplinary focus on implementation science and digital health education is desirable to balance opportunities offered by emerging AI technologies and respect for the ethical principles of a patient-centric philosophy.
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Bergerød IJ, Clay-Williams R, Wiig S. Developing Methods to Support Collaborative Learning and Co-creation of Resilient Healthcare-Tips for Success and Lessons Learned From a Norwegian Hospital Cancer Care Study. J Patient Saf 2022; 18:396-403. [PMID: 35067616 PMCID: PMC9329041 DOI: 10.1097/pts.0000000000000958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing attention on the role of patients and stakeholders in resilience, but there is lack of knowledge and methods on how to support collaborative learning between stakeholders and co-creation of resilient healthcare. The aim of this article was to demonstrate how the methodological process of a consensus process for exploring aspects of next of kin involvement in hospital cancer care can be replicated as an effort to promote resilient healthcare through co-creation with multiple stakeholders in hospitals. METHODS The study applied a modified nominal group technique process developed by synthesizing research findings across 4 phases of a research project with a mixed-methods approach. The process culminated in a 1-day meeting with 20 stakeholder participants (5 next of kin representatives, 10 oncology nurses, and 5 physicians) from 2 Norwegian university hospitals. RESULTS The consensus method established reflexive spaces with collective sharing of experiences between the 2 hospitals and between the next of kin and healthcare professionals. The method promoted collaborative learning processes including identification and reflection upon new ideas for involvement, and reduction of the gap between healthcare professionals' and next of kin experiences and expectations for involvement. Next of kin were considered as important resources for resilient performance, if involved with a proactive approach. The consensus process identified both successful and unsuccessful collaborative practices and resulted in a co-designed guide for healthcare professionals to support next of kin involvement in hospital cancer care. CONCLUSIONS This study expands the body of knowledge on methods development that is relevant for collaborative learning and co-creation of resilient healthcare. This study demonstrated that the consensus methods process can be used for creating reflexive spaces to support collaborative learning and co-creation of resilience in cancer care. Future research within the field of collaborative learning should explore interventions that include a larger number of stakeholders.
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Affiliation(s)
- Inger Johanne Bergerød
- From the Stavanger University Hospital
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siri Wiig
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Miceli L, Dal Mas F, Biancuzzi H, Bednarova R, Rizzardo A, Cobianchi L, Holmboe ES. Doctor@Home: Through a Telemedicine Co-production and Co-learning Journey. J Cancer Educ 2022; 37:1236-1238. [PMID: 33442862 PMCID: PMC7806439 DOI: 10.1007/s13187-020-01945-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 05/05/2023]
Abstract
Telemedicine and remote visits are becoming more and more popular in several medical disciplines, including oncology. The Covid-19 pandemic has enhanced the need to continue to meet patients' ambulatory care necessities ensuring social distancing and limiting the access to clinical facilities. The National Cancer Institute of Aviano, Italy, has recently launched a program called "Doctor @ Home" (D@H). The pillars of the program are the co-production of the oncological care and the co-learning approach, which sees the clinical staff "hand in hand" with patients to maximize the outcome of the care, trying to take advantage of the new tools offered by modern technologies.
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Affiliation(s)
- Luca Miceli
- Department of Pain Medicine, IRCCS C.R.O. National Cancer Institute of Aviano, Aviano, Italy
| | - Francesca Dal Mas
- Lincoln International Business School, University of Lincoln, Lincoln, UK
- Ipazia, International Observatory on Gender Research, Rome, Italy
| | - Helena Biancuzzi
- Ipazia, International Observatory on Gender Research, Rome, Italy
| | - Rym Bednarova
- Pain medicine, Hospital of Latisana (ASUFC), Latisana, Italy
| | | | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, PV, Italy.
- General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- Yale School of Medicine, New Haven, CT, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
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30
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LeGrow K, Cohen E, Espin S. Mother-nurse decision making practices for children with complex health care needs receiving homecare services: A qualitative descriptive study. Child Care Health Dev 2022; 48:605-612. [PMID: 35043429 DOI: 10.1111/cch.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 11/08/2021] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many children with complex health care needs face chronic health and developmental issues that may include functional impairments, neurodevelopmental disabilities, and lifelong dependence on medical technology. Providing the necessary care and services for this unique group of children and youth places substantial demands on the health care system. Much of the focus on improvements has been in acute care settings even though homecare accounts for the largest proportion of health care utilization among children with complex health care needs. While parents assume great responsibility for their child's care at home, they indicate that the balance of power between themselves and their health care providers does not change when care shifts from the hospital to home. Given the expanding role of paediatric homecare and parents' concerns of their role in decisions related to their child's care, it is imperative to explore these practices in this unique setting. PURPOSE The purpose of this work is to explore mother-nurse decision making practices for children with complex health care needs receiving health care services in their home. METHODS A qualitative descriptive study design was used. Five mothers and five nurses participated. Twenty-six home observations with accompanying analytical memos and 10 semistructured interviews were conducted with five mothers and five homecare nurses. Thematic analysis of study data, using an iterative process, identified major themes. FINDINGS Data revealed the complex and relational nature of mother-nurse decision making practices within the home setting. Three major themes were identified: (1) core areas of decision making, (2) a dynamic and collaborative process, and (3) centrality of relationships. CONCLUSIONS Study findings enhanced our understanding of how decision making and relational care practices take place in the home for children with complex health care needs receiving homecare services, which has implications for child and family health.
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Affiliation(s)
- Karen LeGrow
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - Eyal Cohen
- Complex Care Program, Hospital for Sick Children, Professor, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Edward S. H. Leong Centre for Health Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
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Hedberg B, Wijk H, Andersson Gäre B, Petersson C. Shared decision-making and person-centred care in Sweden: Exploring coproduction of health and social care services. Z Evid Fortbild Qual Gesundhwes 2022; 171:129-134. [PMID: 35610136 DOI: 10.1016/j.zefq.2022.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
In Sweden the health system is nationally regulated and locally provided by 21 regions and 290 municipalities. To meet the shifting paradigm, where the person is viewed as a co-producer of health and care, Sweden has laws, regulations and policies which support the patient as an active partner in the communication with professionals in the system. Coproduction, person-centred care and shared decision making contribute jointly to the paradigm shift. Principles of human dignity and equity must be supported nationally and enacted in the decentralized, regional provision of care. Infrastructures exist or are under development which can support and strengthen care that is co-produced and based in a person-centred philosophy and approach, where shared decision making becomes a reality in practice. A Knowledge management system together with National Quality registries have the potential to form a co-produced, person-centred learning health system, where patients, and next of kin and professionals are included as partners. The joint integration of Shared decision making, Person-centre care and Coproduction into the Swedish healthcare system now looks like a possible way to realize the emerging paradigm.
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Affiliation(s)
- Berith Hedberg
- Jönköping Academy, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Helle Wijk
- Institute of Health and Care Science, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Boel Andersson Gäre
- Jönköping Academy, School of Health and Welfare, Jönköping University, Jönköping, Sweden; Futurum-the Academy for Health and Care, Region Jönköping, County, Sweden
| | - Christina Petersson
- Jönköping Academy, School of Health and Welfare, Jönköping University, Jönköping, Sweden; Futurum-the Academy for Health and Care, Region Jönköping, County, Sweden
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Bravo P, Härter M, McCaffery K, Giguère A, Hahlweg P, Elwyn G. Editorial: 20 years after the start of international Shared Decision-Making activities: Is it time to celebrate? Probably… . Z Evid Fortbild Qual Gesundhwes 2022; 171:1-4. [PMID: 35662496 DOI: 10.1016/j.zefq.2022.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Stjernswärd S, Glasdam S. The European Standard EN 17398:2020 on Patient Involvement in Health Care - a Fairclough-Inspired Critical Discourse Analysis. Policy Polit Nurs Pract 2022; 23:130-141. [PMID: 35306903 PMCID: PMC9014666 DOI: 10.1177/15271544221088250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of ‘patient involvement’ is highlighted in healthcare. However, hindrances
can prevent its implementation. This article explored how ‘patient involvement’ is
understood and on what ideas this understanding is based through a critical textual
analysis of the European document on patient involvement in health systems using a
Fairclough-inspired critical discourse analysis. The findings showed that the document
arose from a social discourse based on a mix of a neoliberal ideology, with a
marketisation of care focusing on a cost-effective and evidence-based logic of care,
and a humanistic ideology of patient involvement. It had the form of a
normative, consensus-based standard, supported by European organisations. The document
incorporated a visionary, well-intentioned abstract guide to promote patient involvement
across European care contexts, however without addressing hindrances nor differences
across the contexts in which it ought to be implemented. It raises questions about its
usability, inviting further research into empirical applications.
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Affiliation(s)
- Sigrid Stjernswärd
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
| | - Stinne Glasdam
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
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Price A, Clarke M, Staniszewska S, Chu L, Tembo D, Kirkpatrick M, Nelken Y. Patient and Public Involvement in research: A journey to co-production. Patient Educ Couns 2022; 105:1041-1047. [PMID: 34334264 DOI: 10.1016/j.pec.2021.07.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
The public and patients can be powerful sensors for shaping and powering healthcare research. They are joining research teams as investigators and collaborators to co-produce evidence for the practical use of interventions in clinical practice. While clinicians and researchers are encouraged by funders and policymakers to involve the public and patients as partners in research, knowledge on what involvement consists of is limited, and the continuum between consultation, collaboration and co-production are not clearly defined. In this article, we explore Patient and Public Involvement (PPI) and introduce greater involvement through research co-production. Co-production describes ways that research partnership can work through public and patient involvement and we outline the similarities of co-production to "The Commons", a strategy utilized by economists to increase effective use of resources. We share examples of how public and patient involvement have used co-production, to demonstrate financial and health benefits. We then outline practical challenges at system, social and cultural levels and consider how others have worked to resolve them.
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Affiliation(s)
- Amy Price
- AIM Lab, Stanford School of Medicine, Department of Continuing Education, University of Oxford, UK.
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK; Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | | | - Larry Chu
- Stanford Medicine X, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Doreen Tembo
- University of Southampton, National Institute for Health Research Evaluation Trials and Studies Coordinating Centre, UK.
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Mcgill B, Corbett L, Grunseit AC, Irving M, O’hara BJ. Co-Produce, Co-Design, Co-Create, or Co-Construct—Who Does It and How Is It Done in Chronic Disease Prevention? A Scoping Review. Healthcare (Basel) 2022; 10:647. [PMID: 35455826 PMCID: PMC9029027 DOI: 10.3390/healthcare10040647] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/17/2022] [Accepted: 03/28/2022] [Indexed: 01/18/2023] Open
Abstract
Co-production in health literature has increased in recent years. Despite mounting interest, numerous terms are used to describe co-production. There is confusion regarding its use in health promotion and little evidence and guidance for using co-produced chronic disease prevention interventions in the general population. We conducted a scoping review to examine the research literature using co-production to develop and evaluate chronic disease prevention programs. We searched four electronic databases for articles using co-production for health behaviour change in smoking, physical activity, diet, and/or weight management. In 71 articles that reported using co-production, co-design, co-create, co-develop, and co-construct, these terms were used interchangeably to refer to a participatory process involving researchers, stakeholders, and end users of interventions. Overall, studies used co-production as a formative research process, including focus groups and interviews. Co-produced health promotion interventions were generally not well described or robustly evaluated, and the literature did not show whether co-produced interventions achieved better outcomes than those that were not. Uniform agreement on the meanings of these words would avoid confusion about their use, facilitating the development of a co-production framework for health promotion interventions. Doing so would allow practitioners and researchers to develop a shared understanding of the co-production process and how best to evaluate co-produced interventions.
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Haugom EW, Stensrud B, Beston G, Ruud T, Landheim AS. Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study. BMC Psychiatry 2022; 22:192. [PMID: 35300633 PMCID: PMC8932170 DOI: 10.1186/s12888-022-03849-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) is a process where the patient and the health professional collaborate to make decisions based on both the patient's preferences and the best available evidence. Patients with psychotic disorders are less involved in making decisions than they would like. More knowledge of these patients' experiences of SDM may improve implementation. The study aim was to describe and explore experiences of SDM among patients with psychotic disorders in mental health care. METHODS Individual interviews were conducted with ten persons with a psychotic disorder. They were service users of two community mental health centres. The transcribed material was analysed using qualitative content analysis. RESULTS Four-fifths of the participants in this study found that they received insufficient information about their health situation and treatment options. All participants experienced that only one kind of treatment was often presented, which was usually medication. Although the study found that different degrees of involvement were practised, two thirds of the participants had little impact on choices to be made. This was despite the fact that they wanted to participate and felt capable of participating, even during periods of more severe illness. The participants described how important it was that SDM in psychosis was based on a trusting relationship, but stated that it took time to establish such a relationship. CONCLUSIONS This study with ten participants indicates that patients with psychotic disorders experienced that they were not allowed to participate as much as they wanted to and believed they were capable of. Some patients were involved, but to a lesser degree than in SDM. More and better tailored information communicated within a trusting relationship is needed to provide psychotic patients with a better basis for active involvement in decisions about their health care.
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Affiliation(s)
- Espen W. Haugom
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway ,grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Stensrud
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway
| | - Gro Beston
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway
| | - Torleif Ruud
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne S. Landheim
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, 2381 Brumunddal, Norway ,grid.477237.2Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
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Suutari AM, Nordin A, Kjellström S, Thor J, Areskoug Josefsson K. Using stakeholders' experiences to redesign health services for persons living with heart failure: a case study protocol in a Swedish cardiac care setting. BMJ Open 2022; 12:e058469. [PMID: 35292501 PMCID: PMC8928324 DOI: 10.1136/bmjopen-2021-058469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Clinical guidelines promote recognising persons with heart failure (referred to as PWHF) as coproducers of their own care. Coproduction of healthcare-involving PWHF, families and professionals in care processes-aims to promote the best possible health. Still, it is unclear how to coproduce heart failure (HF) care. This study explores whether and how Experience-Based Co-Design (EBCD) involving PWHF, family members and professionals can be undertaken online, in a Swedish cardiac care setting, to codesign improved experiences of HF care. METHODS AND ANALYSIS In EBCD, stakeholders' experiences are solicited to redesign healthcare services. First, we will undertake a thematic analysis of field notes from consultations and filmed/audio-recorded interviews with PWHF (n=10-12). This analysis will identify 'touchpoints' (emotionally positive/negative events that shape overall service experiences), edited into a 'trigger film'. Next, a thematic analysis of family members' (n=10-12) and professionals' (n=10-12) interviews will identify key themes mirroring their experiences. Separate feedback events with each stakeholder group will confirm identified touchpoints and key themes and identify areas for HF care improvement. At a joint event, prompted by the 'trigger film', stakeholders will agree on one area for HF care improvement. A team including PWHF, family members and professionals, led by an improvement adviser, will then plan, design, implement and evaluate an improvement activity addressing the identified problem area. A deductive thematic analysis of field notes, project documentation and stakeholder focus group interviews, underpinned by MUSIQ, will identify how organisational conditions influence the process. Quantitative measurements, describing the results of the improvement activity, will be integrated with qualitative data to strengthen the case. To reduce resource intensity, we will use online tools during the process. ETHICS AND DISSEMINATION The Swedish Ethical Review Authority approved the study in May 2021. The results will be disseminated through seminars, conference presentations and publications.
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Affiliation(s)
- Anne-Marie Suutari
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Internal Medicine and Geriatrics, the Highland Hospital (Höglandssjukhuset), Region Jönköpings län, Eksjö, Sweden
| | - Annika Nordin
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Sofia Kjellström
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Johan Thor
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Health Services Department, Stockholm County Council, Stockholm, Sweden
| | - Kristina Areskoug Josefsson
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Faculty of Health Studies, VID Specialized University, Oslo, Akershus, Norway
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Brennan A, Broughan JM, Mccombe G, Brennan J, Collins C, Fawsitt R, Gallagher J, Guérandel A, O'kelly B, Quinlan D, Lambert JS, Cullen W. Enhancing the management of long COVID in general practice: a scoping review. BJGP Open. [DOI: 10.3399/bjgpo.2021.0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/13/2021] [Indexed: 10/31/2022] Open
Abstract
BackgroundLong COVID is a multifaceted condition, and it has impacted a considerable proportion of those with acute-COVID-19. Affected patients often have complex care needs requiring holistic and multidisciplinary care, the kind routinely provided in general practice. However, there is limited evidence regarding GP interventions.AimThis study aimed to address this issue by conducting a scoping review of literature on GP management of Long COVID.Design & settingArksey and O’Malley’s six-stage scoping review framework with recommendations by Levac et al. was used.MethodPubMed, Google Scholar, the Cochrane Library, SCOPUS, and Google searches were conducted to identify relevant peer-reviewed/grey literature, and study selection process was conducted according to the PRISMA Extension for Scoping Reviews guidelines. Braun and Clarke’s ‘Thematic Analysis’ approach was used to interpret data.ResultsNineteen of 972 identified papers were selected for review. These included peer-reviewed articles and grey literature spanning a wide range of countries. Six themes were identified regarding GP management of Long COVID, these being: (i) GP uncertainty, (ii) Listening and empathy, (iii) Assessment and monitoring of symptoms, (iv) Coordinating access to appropriate services, (v) Facilitating provision of continual and integrated multi-disciplinary care and (vi) Need to facilitate psychological support.ConclusionThe findings show that GPs can and have played a key role in the management of Long COVID, and that patient care can be improved through better understanding of patient experiences, standardised approaches for symptom identification/treatment, and facilitation of access to multidisciplinary specialist services when needed. Future research evaluating focused GP interventions is needed.
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Yildirim-Toruner C, Pooni R, Goh YI, Becker-Haimes E, Dearing JW, Fernandez ME, Morgan EM, Parry G, Burnham JM, Ardoin SP, Barbar-Smiley F, Chang JC, Chiraseveenuprapund P, Del Gaizo V, Eakin G, Johnson LC, Kimura Y, Knight AM, Kohlheim M, Lawson EF, Lo MS, Pan N, Ring A, Ronis T, Sadun RE, Smitherman EA, Taxter AJ, Taylor J, Vehe RK, Vora SS, Weiss JE, von Scheven E. Translating research into practice-implementation recommendations for pediatric rheumatology; Proceedings of the childhood arthritis and rheumatology research alliance 2020 implementation science retreat. Pediatr Rheumatol Online J 2022; 20:10. [PMID: 35130904 PMCID: PMC8822721 DOI: 10.1186/s12969-022-00665-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
The translation of research findings into clinical practice is challenging, especially fields like in pediatric rheumatology, where the evidence base is limited, there are few clinical trials, and the conditions are rare and heterogeneous. Implementation science methodologies have been shown to reduce the research- to- practice gap in other clinical settings may have similar utility in pediatric rheumatology. This paper describes the key discussion points from the inaugural Childhood Arthritis and Rheumatology Research Alliance Implementation Science retreat held in February 2020. The aim of this report is to synthesize those findings into an Implementation Science Roadmap for pediatric rheumatology research. This roadmap is based on three foundational principles: fostering curiosity and ensuring discovery, integration of research and quality improvement, and patient-centeredness. We include six key steps anchored in the principles of implementation science. Applying this roadmap will enable researchers to evaluate the full range of research activities, from the initial clinical design and evidence acquisition to the application of those findings in pediatric rheumatology clinics and direct patient care.
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Affiliation(s)
| | - Rajdeep Pooni
- grid.414123.10000 0004 0450 875XStanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford Children’s Health, Palo Alto, CA USA
| | - Y. Ingrid Goh
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children, Toronto, Ontario Canada
| | - Emily Becker-Haimes
- grid.25879.310000 0004 1936 8972University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA USA
| | - James W. Dearing
- grid.17088.360000 0001 2150 1785Michigan State University, Michigan, MI USA
| | - Maria E. Fernandez
- grid.267308.80000 0000 9206 2401University of Texas Health Science Center at Houston, Houston, TX USA
| | - Esi M. Morgan
- grid.34477.330000000122986657University of Washington, Seattle, WA USA
| | - Gareth Parry
- grid.418700.a0000 0004 0614 6393Boston Children’s Hospital, (formerly at Institute for Healthcare Improvement (IHI)), Boston, MA USA
| | - Jon M. Burnham
- grid.239552.a0000 0001 0680 8770Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Stacy P. Ardoin
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
| | - Fatima Barbar-Smiley
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
| | - Joyce C. Chang
- grid.239552.a0000 0001 0680 8770Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | | | - Vincent Del Gaizo
- grid.499903.eCARRA, Partnerships and Patient Engagement, Milwaukee, WI USA
| | - Guy Eakin
- grid.422901.c0000 0004 0371 5124Arthritis Foundation, Atlanta, GA USA
| | - Lisa C. Johnson
- grid.414049.c0000 0004 7648 6828The Dartmouth Institute for health policy and Clinical Practice, Lebanon, NH USA
| | - Yukiko Kimura
- grid.429392.70000 0004 6010 5947The Joseph M. Sanzari Children’s Hospital, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Andrea M. Knight
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children, Toronto, Ontario Canada
| | - Melanie Kohlheim
- grid.499903.eCARRA, Partnerships and Patient Engagement, Milwaukee, WI USA
| | - Erica F. Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, San Francisco, CA USA
| | - Mindy S. Lo
- grid.418700.a0000 0004 0614 6393Boston Children’s Hospital, (formerly at Institute for Healthcare Improvement (IHI)), Boston, MA USA
| | - Nancy Pan
- grid.5386.8000000041936877XHospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Andrea Ring
- grid.422901.c0000 0004 0371 5124Arthritis Foundation, Atlanta, GA USA
| | - Tova Ronis
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, George Washington University, Washington, DC USA
| | | | - Emily A. Smitherman
- grid.265892.20000000106344187University of Alabama/ Children’s of Alabama, Birmingham, AL USA
| | - Alysha J. Taxter
- grid.241167.70000 0001 2185 3318Wake Forest University, Winston-Salem, NC USA
| | - Janalee Taylor
- grid.239573.90000 0000 9025 8099Cincinnati Children’s Hospital, OH Cincinatti, USA
| | - Richard K. Vehe
- grid.17635.360000000419368657University of Minnesota, Minnesota, MN USA
| | - Sheetal S. Vora
- grid.17635.360000000419368657University of Minnesota, Minnesota, MN USA ,grid.415907.e0000 0004 0411 7193Atrium Health Levine Children’s Hospital, Charlotte, NC USA
| | - Jennifer E. Weiss
- grid.429392.70000 0004 6010 5947The Joseph M. Sanzari Children’s Hospital, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Emily von Scheven
- grid.266102.10000 0001 2297 6811University of California, San Francisco, San Francisco, CA USA
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Gama F, Tyskbo D, Nygren J, Barlow J, Reed J, Svedberg P. Implementation Frameworks for Artificial Intelligence Translation Into Health Care Practice: Scoping Review. J Med Internet Res 2022; 24:e32215. [PMID: 35084349 PMCID: PMC8832266 DOI: 10.2196/32215] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/02/2021] [Accepted: 12/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background Significant efforts have been made to develop artificial intelligence (AI) solutions for health care improvement. Despite the enthusiasm, health care professionals still struggle to implement AI in their daily practice. Objective This paper aims to identify the implementation frameworks used to understand the application of AI in health care practice. Methods A scoping review was conducted using the Cochrane, Evidence Based Medicine Reviews, Embase, MEDLINE, and PsycINFO databases to identify publications that reported frameworks, models, and theories concerning AI implementation in health care. This review focused on studies published in English and investigating AI implementation in health care since 2000. A total of 2541 unique publications were retrieved from the databases and screened on titles and abstracts by 2 independent reviewers. Selected articles were thematically analyzed against the Nilsen taxonomy of implementation frameworks, and the Greenhalgh framework for the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health care technologies. Results In total, 7 articles met all eligibility criteria for inclusion in the review, and 2 articles included formal frameworks that directly addressed AI implementation, whereas the other articles provided limited descriptions of elements influencing implementation. Collectively, the 7 articles identified elements that aligned with all the NASSS domains, but no single article comprehensively considered the factors known to influence technology implementation. New domains were identified, including dependency on data input and existing processes, shared decision-making, the role of human oversight, and ethics of population impact and inequality, suggesting that existing frameworks do not fully consider the unique needs of AI implementation. Conclusions This literature review demonstrates that understanding how to implement AI in health care practice is still in its early stages of development. Our findings suggest that further research is needed to provide the knowledge necessary to develop implementation frameworks to guide the future implementation of AI in clinical practice and highlight the opportunity to draw on existing knowledge from the field of implementation science.
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Affiliation(s)
- Fábio Gama
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden.,School of Administration and Economic Science, Santa Catarina State University, Florianópolis, Brazil
| | - Daniel Tyskbo
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - James Barlow
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Julie Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Van Citters AD, Holthoff MM, Kennedy AM, Melmed GY, Oberai R, Siegel CA, Weaver A, Nelson EC. Point-of-care dashboards promote coproduction of healthcare services for patients with inflammatory bowel disease. Int J Qual Health Care 2021; 33:ii40-ii47. [PMID: 34849970 DOI: 10.1093/intqhc/mzab067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Coproduction of healthcare services by patients and professionals is seen as an increasingly important mechanism to support person-centred care delivery. Coproduction invites a deeper understanding of what persons sometimes called 'patients' bring to development of a service. Yet, little is known about tools that may help elicit that information. OBJECTIVE Our objective was to explore potential benefits and limitations of an electronic pre-visit survey (PVS) and dashboard by studying uptake and experiences within the inflammatory bowel disease (IBD) community. METHODS We conducted a mixed-method evaluation of patients and clinicians using the IBD Qorus PVS and dashboard at 24 programmes participating in the IBD Qorus learning health system. We analysed (i) descriptive statistics and thematic analyses of 537 patient surveys, (ii) semi-structured interviews with seven patients and six care teams and (iii) usage data collected between 25 March 2019 and 26 April 2020. RESULTS Nearly two-thirds (64%; n = 38) of clinicians enrolled ≥25 patients into IBD Qorus; 59% (n = 29) of clinicians received ≥25 electronic PVS, with 3834 PVS received during the study period. Post-visit evaluation surveys were completed by patients following 26% (n = 993) of PVS completions. Among patients who reported using the dashboard for 1 or more months (n = 537), two-thirds (65%, n = 344) used the dashboard at a clinic visit and one-third used it outside the clinic (33%, n = 176). Most patients who used the dashboard during a clinic visit said it was helpful in discussions with their clinician (82%), in talking about what matters most (76%) and in making healthcare decisions (71%). Patients using the dashboard during the clinic visit reported higher levels of shared decision-making than those who did not use the dashboard (82% vs. 65%, P < 0.001). This relationship remained significant after controlling for receipt of care at a clinic with the highest levels of patient-reported shared decision-making (odds ratio: 2.1; confidence interval: 1.3-3.3). Patients and clinicians found the greatest value in using the PVS and dashboard to share concerns and symptoms, prepare for a visit and support discussions during the visit. The lack of integration with existing electronic health records (EHRs) limited clinician usage of the PVS and dashboard. CONCLUSIONS The PVS and dashboard created a shared language, which supported coproduction and shared decision-making and facilitated a shared understanding of goals, concerns, symptoms and well-being. To support uptake, future systems should reduce implementation burden for healthcare professionals and integrate seamlessly with existing EHR systems and workflows.
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Affiliation(s)
- Aricca D Van Citters
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH 03766, USA
| | - Megan M Holthoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH 03766, USA
| | - Alice M Kennedy
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH 03766, USA
| | - Gil Y Melmed
- Division of Digestive and Liver Diseases, Department of Medicine, Inflammatory Bowel and Immunobiology Research Institute, Cedar Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Ridhima Oberai
- Crohn's and Colitis Foundation, 733 Third Ave, Suite 510, New York, NY 10017, USA
| | - Corey A Siegel
- Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Alandra Weaver
- Crohn's and Colitis Foundation, 733 Third Ave, Suite 510, New York, NY 10017, USA
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH 03766, USA
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Batalden P, Ovalle A, Foster T, Elwyn G. Science-informed practice: an essential epistemologic contributor to health-care coproduction. Int J Qual Health Care 2021; 33:ii4-ii5. [PMID: 33755124 DOI: 10.1093/intqhc/mzab054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul Batalden
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, 2 Buck Rd, Hanover, NH 03755, USA.,Jönköping Academy for Improvement of Health and Welfare at Jönköping University, P.O. Box 1026, Jönköping SE- 551 11, Sweden
| | - Anais Ovalle
- Leadership Preventive Medicine Residency Program, Section of Infectious Disease, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Tina Foster
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, 2 Buck Rd, Hanover, NH 03755, USA.,Departments of Obstetrics and Gynecology and Community & Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Hanover and Lebanon, NH 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, 2 Buck Rd, Hanover, NH 03755, USA
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Hlongwa P, Rispel LC. Coproduction in the management of individuals with cleft lip and palate in South Africa: the Ekhaya Lethu model. Int J Qual Health Care 2021; 33:ii33-ii39. [PMID: 34849962 PMCID: PMC8633900 DOI: 10.1093/intqhc/mzab082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/31/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cleft lip and palate (CLP), one of the most common congenital anomalies of the craniofacial complex, has a worldwide prevalence rate of 1 in 700 live births. In South Africa, a middle-income country, the CLP prevalence rate is 0.3 per 1000 live births in the public health sector. The complexity of the condition requires that individuals with CLP be treated by a multi-disciplinary team of health professionals, with the integral involvement of caregivers and families. METHODS Between 2015 and 2018, we conducted a cross-sectional study entitled: The epidemiology and care of individuals with cleft lip and palate in South Africa, in fulfilment of a Doctor of Philosophy degree. The study setting consisted of 11 specialized academic centres (nine central hospitals and two specialized dental hospitals) that are situated in six of South Africa's nine provinces. The study used a combination of quantitative and qualitative methods and consisted of four distinct but inter-linked components. The first component consisted of a record review of CLP data over a 2-year period to determine the prevalence of CLP in the public sector of South Africa. The second component consisted of a survey of the leaders or heads of the health care teams in the 11 specialized centres to determine the current approach to CLP care provision. The third component consisted of a survey among CLP team members to measure inter-professional collaboration. The fourth component consisted of interviews with parents or caregivers on their perceptions of health service provision and support for children with CLP.We draw on the findings of this large empirical study on CLP in South Africa's public health sector and the theory and principles of health care service coproduction to present the Ekhaya Lethu model for the management of CLP. RESULTS The conceptual design of Ekhaya Lethu derives from the findings of each of the study components. We describe the possible application of the model in the coproduction of health care to examine the roles, relationships and aims of the multidisciplinary team in CLP management. We highlight both the implications and challenges of coproduction in the care and management of CLP for multidisciplinary health teams, the caregivers and families of individuals with CLP, and for health managers and policy makers. CONCLUSION The proposed Ekhaya Lethu model introduces a discourse on coproduction in the design and implementation of quality health care to individuals with CLP in South Africa and other low-and middle-income countries.
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Affiliation(s)
- Phumzile Hlongwa
- School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, 5 York Road, Johannesburg 2001, South Africa
| | - Laetitia C Rispel
- Centre for Health Policy & South African Research Chairs Initiative, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gremyr A, Andersson Gäre B, Thor J, Elwyn G, Batalden P, Andersson AC. The role of co-production in Learning Health Systems. Int J Qual Health Care 2021; 33:ii26-ii32. [PMID: 34849971 PMCID: PMC8849120 DOI: 10.1093/intqhc/mzab072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background Co-production of health is defined as ‘the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations’. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services. Objective We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications. Method First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development. Result Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization. Conclusions The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.
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Affiliation(s)
- Andreas Gremyr
- Address reprint requests to: Andreas Gremyr, Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, Mölndal, Västragötalandsregionen 431 80, Sweden. Tel: 0733664000; E-mail:
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Jönköpings län 55111, Sweden
| | - Johan Thor
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Glyn Elwyn
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Paul Batalden
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Jönköpings län 55111, Sweden
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Ann-Christine Andersson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Jönköpings län 55111, Sweden
- Department of Care Science, Malmö University, Nordenskiöldsgatan 1, Malmö, Skåne 211 19, Sweden
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Berntsen GR, Yaron S, Chetty M, Canfield C, Ako-Egbe L, Phan P, Curran C, Castro I. Person-centered care (PCC): the people's perspective. Int J Qual Health Care 2021; 33:ii23-ii26. [PMID: 34849959 PMCID: PMC8633901 DOI: 10.1093/intqhc/mzab052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gro Rosvold Berntsen
- Norwegian Center for E-Health Research, University Hospital of North Norway, NSE, PB 35, Tromsø 9038, Norway
- Institute of community medicine, UiT The Arctic University of Norway, Tromsø, UiT, PO Box 6050 Langnes, Tromsø N-9037, Norway
| | - Sara Yaron
- The Cochrane Collaboration St. Albans House, 57-59 Haymarket, London SW1Y 4QX, UK
- Reach to recovery, Israeli Cancer Association, St Revivim 7, Givatayim 5348505, Israel
- Patient for Patient Safety, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerl
- The International Society for Quality in Healthcare (ISQua), Huguenot House, 35-38 St. Stephens Green, Dublin 2 D02 NY63 IE, Ireland
| | - Morgan Chetty
- Independent Practitioner Association Foundation (IPAF), 61 Juniper Road, Overport, Durban 4067, South Africa
- Kwazulu-Natal Doctors Healthcare Coalition (KZNDHC), 61 Juniper Road, Overport, Durban 4067, South Africa
| | - Carolyn Canfield
- Department of Family Practice Faculty of Medicine, The University of British Columbia, Vancouver, 320 - 5950 University Blvd, British Columbia BC V6T 1Z3, Canada
| | - Louis Ako-Egbe
- The International Society for Quality in Healthcare (ISQua), Huguenot House, 35-38 St. Stephens Green, Dublin 2 D02 NY63 IE, Ireland
- Health System Strengthening Cluster, WHO Country Office, One UN House, PAP, 2nd Street Sinkor, Monrovia, Montserrado 1000, Liberia
| | - Phuk Phan
- University Medical Center, 215 Hồng Bàng, phường 11, Quận 5, Ho Chi Minh, Vietnam
| | - Caitriona Curran
- The International Society for Quality in Healthcare (ISQua), Huguenot House, 35-38 St. Stephens Green, Dublin 2 D02 NY63 IE, Ireland
| | - Isabela Castro
- Independent Practitioner Association Foundation (IPAF), 61 Juniper Road, Overport, Durban 4067, South Africa
- Global Patient & Family Advisory Board, The Beryl Institute, 831 12th Avenue South, #212, Nashville, Tennessee TN 37203, USA
- Planetree International, 130 Division St, Derby, Connecticut CT 06418, USA
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Taxter A, Johnson L, Tabussi D, Kimura Y, Donaldson B, Lawson E, Del Gaizo V, Vitelli D, Pinter C, Van Citters A, Nelson E, Lee T. Co-Design of an Electronic Dashboard to Support Coproduction of Care in Pediatric Rheumatic Disease: Human-Centered Design and Usability Testing (Preprint). J Particip Med 2021; 14:e34735. [PMID: 35133283 PMCID: PMC9077505 DOI: 10.2196/34735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/09/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alysha Taxter
- Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Doreen Tabussi
- Hackensack University Medical Center, Hackensack, NJ, United States
| | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ, United States
| | | | - Erica Lawson
- University of California San Francisco, San Francisco, CA, United States
| | - Vincent Del Gaizo
- Childhood Arthritis and Rheumatology Research Alliance (CARRA), Milwaukee, WI, United States
| | | | | | | | | | - Tzielan Lee
- Stanford Children's Health, Palo Alto, CA, United States
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Price A, Damaraju A, Kushalnagar P, Brunoe S, Srivastava U, Debidda M, Chu L. Coproduction, Coeducation, and Patient Involvement: Everyone Included Framework for Medical Education Across Age Groups and Cultures. JMIR Med Educ 2021; 7:e31846. [PMID: 34730539 PMCID: PMC8600436 DOI: 10.2196/31846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 05/12/2023]
Abstract
Medical education, research, and health care practice continue to grow with minimal coproduction guidance. We suggest the Commons Principle approach to medical education as modeled by Ostrom and Williamson, where we share how adapting these models to multiple settings can enhance empathy, increase psychological safety, and provide robust just-in-time learning tools for practice. We here describe patient and public coproduction in diverse areas within health care using the commons philosophy across populations, cultures, and generations with learning examples across age groups and cultures. We further explore descriptive, mixed methods participatory action in medical and research education. We adopt an "Everyone Included" perspective and sought to identify its use in continuing medical education, citizen science, marginalized groups, publishing, and student internships. Overall, we outline coproduction at the point of need, as we report on strategies that improved engagement. This work demonstrates coproduction with the public across multiple settings and cultures, showing that even with minimal resources and experience, this partnership can improve medical education and care.
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Affiliation(s)
- Amy Price
- Stanford Anesthesia Informatics and Media (AIM) Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Poorna Kushalnagar
- Center for Deaf Health Equity, Gallaudet University, Washington, DC, United States
| | | | - Ujwal Srivastava
- Stanford Anesthesia Informatics and Media (AIM) Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Larry Chu
- Stanford Anesthesia Informatics and Media (AIM) Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Abstract
The COVID-19 pandemic has been a challenge as well as an opportunity for healthcare. The pandemic has exposed the inherent weaknesses in health systems globally while, at the same time, revealing strengths on which post-pandemic health systems can be built. We propose lessons on improving quality and safety post-pandemic from a global perspective based on recent policy publications and our global experience. Nine possible lessons are discussed. These lessons can ensure that healthcare does not return to the old normal, but rather builds on what we have learnt as we deliver on the Sustainable Development Goals and universal health coverage. Quality and safety are an essential component of healthcare strategy. Post-pandemic systems require a transparent compassionate culture, with integration of care at its core. The workforce must be trained in the skills to improve care, and patient and healthcare worker protection (both physically and psychologically) needs to be a given. Any development of systems will best be co-produced with the people who receive and deliver care in an equal partnership. Finally, the new systems need to be conscious of emerging threats (such as the challenge of climate change), building sustainable health systems that also address the structural inequities that currently exist.
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Affiliation(s)
- Niki O'Brien
- Institute of Global Health Innovation, London, UK and Imperial College London, London, UK
| | - Mike Durkin
- and academic lead, Global Patient Safety Collaborative, London, UK
| | - Peter Lachman
- Royal College of Physicians of Ireland, Dublin, Ireland
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Cobianchi L, Dal Mas F, Massaro M, Fugazzola P, Coccolini F, Kluger Y, Leppäniemi A, Moore EE, Sartelli M, Angelos P, Catena F, Ansaloni L. Team dynamics in emergency surgery teams: results from a first international survey. World J Emerg Surg 2021; 16:47. [PMID: 34530891 PMCID: PMC8443910 DOI: 10.1186/s13017-021-00389-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma's causes or the patient's personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. METHODS An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients' and stakeholders' engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. DISCUSSION Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey's participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti" Viale Brambilla, 74, 27100, Pavia, Italy.
- IRCCS Policlinico San Matteo Foundation, General Surgery, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Francesca Dal Mas
- Department of Management, Lincoln International Business School, University of Lincoln, Lincoln, UK
| | | | - Paola Fugazzola
- IRCCS Policlinico San Matteo Foundation, General Surgery, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Federico Coccolini
- Department of Surgery, University of Pisa, Pisa, Italy
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari Leppäniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | | | - Massimo Sartelli
- Department of General Surgery, Macerata's Hospital, Macerata, Italy
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti" Viale Brambilla, 74, 27100, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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Abstract
BACKGROUND AND OBJECTIVES There is a growing interest to involve older adults in the co-design of technology to maintain their well-being and independence. What remains unknown is whether the beneficial effects of co-designed solutions are greater than those reported for non co-designed solutions. The aim of this study was to evaluate the effects and experiences of co-designed technology that support older adults to age in place. RESEARCH DESIGN AND METHODS We conducted a systematic review to (a) investigate the health and well-being outcomes of co-designed technology for older adults (≥60 years), (b) identify co-design approaches and contexts where they are applied, and (c) identify barriers and facilitators of the co-design process with older adults. Searches were conducted in MEDLINE, EMBASE, CINAHL, Science Citation Index (Web of Science), Scopus, OpenGrey, and Business Source Premiere. RESULTS We identified 14,649 articles and included 34 projects. Four projects reported health and well-being outcomes; the effects were inconsistent. Co-design processes varied greatly and in their intensity of older adult involvement. Common facilitators of and barriers to co-design included the building of relationships between stakeholders, stakeholder knowledge of problems and solutions, and expertise in the co-design methodology. DISCUSSION AND IMPLICATIONS The effect of co-designed technology on health and well-being was rarely studied and it was difficult to ascertain its impact. Future co-design efforts need to address barriers unique to older adults. Evaluation of the impact of co-designed technologies is needed and standardization of the definition of co-design would be helpful to researchers and designers.
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Affiliation(s)
- Jennifer Sumner
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Lin Siew Chong
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Anjali Bundele
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Yee Wei Lim
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
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