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Kim S, Kim M, Oh MY, Seo Y, Yum SK. Impact of increased paternal age on neonatal outcomes in very-low-birth-weight infants. J Matern Fetal Neonatal Med 2023; 36:2257836. [PMID: 37710984 DOI: 10.1080/14767058.2023.2257836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Despite the trend of increasing paternal age, its impact on neonatal outcomes, particularly in preterm infants, has not been thoroughly investigated. We aimed to evaluate the perinatal characteristics and neonatal outcomes associated with paternal age. METHODS Electronic medical records of very low-birthweight infants admitted to our unit from July 2013 to March 2022 were reviewed. Infants grouped according to paternal age (<35 years, 35-39 years, and ≥40 years) were analyzed for differences in perinatal findings and neonatal outcomes. RESULTS A total of 637 infants were included (194, 294, and 149 in the <35, 35-39, and ≥40 years groups, respectively). The increase in paternal age paralleled the increase in maternal age. The Z-score of head circumference at birth was significantly different between the groups, showing the lowest median value in the ≥40 years group. Small-for-gestational age (Odds ratio 71.074, p < .001, 95% confidence interval 19.337 - 261.236) and male sex (Odds ratio 3.309, p < .034, 95% confidence interval 1.089 - 8.425), but not paternal or maternal age groups were significant factors associated with head circumference Z-scores less than -2 standard deviation based on the multivariable logistic regression analysis. Infants affected by chromosomal or genetic anomaly were more frequently identified (3.4 vs 0.0 vs 0.5%) in the ≥40 years group than in the other two groups. When infants with anomalies or critical illnesses were excluded, overall neonatal outcomes did not statistically differ according to paternal age. CONCLUSION Although increased paternal age ≥40 years may be associated with relatively smaller head circumferences, the impact on fetal head growth does not imply a definite risk for microcephaly. Nonetheless, based on the possible negative impact on chromosomal/genetic anomaly, increased paternal age warrants attention, even though neonatal outcomes concerning prematurity were not significantly affected. A large-scale longitudinal study is needed to further elucidate the impact of advanced paternal age in preterm infants and provide guidelines for appropriate antenatal counseling and surveillance.
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Affiliation(s)
- Sol Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon-Yeon Oh
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yumi Seo
- Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Kyung Yum
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Needleman I, Sanz M, de Albornoz AC, Safii S, Hassan NHM, Qian S, Tonetti M. Involving people with lived experience in developing a core outcome set for implant dentistry research. The Impant Dentistry-Core Outcomes Sets and Measures (ID-COSM) project. J Clin Periodontol 2023; 50 Suppl 25:96-106. [PMID: 37143297 DOI: 10.1111/jcpe.13812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
AIMS The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS for dental implant research: the Implant Dentistry Core Outcome Sets and Measures project. MATERIALS AND METHODS Overall methods were guided by the Core Outcome Set Measures in Effectiveness Trials (COMET) initiative. Initial outcome identification was achieved from focus groups with PWLE employing calibrated methods across two low-middle-income countries (China and Malaysia) and two high-income countries (Spain and the United Kingdom). Following consolidation of the results, the outcomes were incorporated into a three-stage Delphi process with PWLE participation. Finally, consensus between PWLE and DPs was achieved using a mixed live and recorded platform. The experiences of PWLE involvement in the process was also evaluated. RESULTS Thirty-one PWLE participated in four focus groups. Thirty-four outcomes were suggested across the focus groups. Evaluation of the focus groups revealed a high level of satisfaction with the engagement process and some new learning. Seventeen PWLE contributed to the first 2 Delphi rounds and 7 to the third round. The final consensus included 17 PWLE (47%) and 19 DPs (53%). Out of the total of 11 final consensus outcomes considered essential by both PWLE and health professionals, 7 (64%) outcomes mapped across to ones that PWLE initially identified, broadening their definition. One outcome (PWLE effort required for treatment and maintenance) was entirely novel. CONCLUSIONS We conclude that engaging PWLE in COS development can be achieved across widely different communities. Furthermore, the process both broadened and enriched overall outcome consensus, yielding important and novel perspectives for health-related research.
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Affiliation(s)
- Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Mariano Sanz
- University Complutense of Madrid, ETEP Research Group, Madrid, Spain
| | | | - Syarida Safii
- Department of Restorative Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Shujiao Qian
- Shanghai Perio Implant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Maurizio Tonetti
- Shanghai Perio Implant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- European Research Group on Periodontology, Genoa, Italy
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Needleman I, Sanz M, de Albornoz AC, Safii S, Hassan NHM, Qian S, Tonetti M. Involving people with lived experience in developing a core outcome set for implant dentistry research. The Implant Dentistry-Core Outcomes Sets and Measures (ID-COSM) project. Clin Oral Implants Res 2023; 34 Suppl 25:97-107. [PMID: 37232118 DOI: 10.1111/clr.14079] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIMS The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS for dental implant research: the Implant Dentistry Core Outcome Sets and Measures project. MATERIALS AND METHODS Overall methods were guided by the Core Outcome Set Measures in Effectiveness Trials (COMET) initiative. Initial outcome identification was achieved from focus groups with PWLE employing calibrated methods across two low-middle-income countries (China and Malaysia) and two high-income countries (Spain and the United Kingdom). Following consolidation of the results, the outcomes were incorporated into a three-stage Delphi process with PWLE participation. Finally, consensus between PWLE and DPs was achieved using a mixed live and recorded platform. The experiences of PWLE involvement in the process was also evaluated. RESULTS Thirty-one PWLE participated in four focus groups. Thirty-four outcomes were suggested across the focus groups. Evaluation of the focus groups revealed a high level of satisfaction with the engagement process and some new learning. Seventeen PWLE contributed to the first 2 Delphi rounds and 7 to the third round. The final consensus included 17 PWLE (47%) and 19 DPs (53%). Out of the total of 11 final consensus outcomes considered essential by both PWLE and health professionals, 7 (64%) outcomes mapped across to ones that PWLE initially identified, broadening their definition. One outcome (PWLE effort required for treatment and maintenance) was entirely novel. CONCLUSIONS We conclude that engaging PWLE in COS development can be achieved across widely different communities. Furthermore, the process both broadened and enriched overall outcome consensus, yielding important and novel perspectives for health-related research.
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Affiliation(s)
- Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Mariano Sanz
- University Complutense of Madrid, ETEP Research Group, Madrid, Spain
| | | | - Syarida Safii
- Department of Restorative Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Shujiao Qian
- Shanghai Perio Implant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Maurizio Tonetti
- Shanghai Perio Implant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- European Research Group on Periodontology, Genoa, Italy
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Fonseca Medeiros A, Margotto Bertollo C, Moreira Reis AM, Costa MA, Meireles Leite EM, da Silva Gonçalves S, Nogueira Guimarães de Abreu MH, Pedra de Souza R, Parreiras Martins MA. Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective. Front Pharmacol 2023; 14:1074389. [PMID: 37025495 PMCID: PMC10070795 DOI: 10.3389/fphar.2023.1074389] [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: 10/19/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world's major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption. Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements. Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of "structure", "process" and "result" proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021. Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44). Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations.
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Affiliation(s)
- Amanda Fonseca Medeiros
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
| | - Caryne Margotto Bertollo
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Monica Aparecida Costa
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Renan Pedra de Souza
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- *Correspondence: Maria Auxiliadora Parreiras Martins,
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Muzzana C, Mantovan F, Huber MK, Trevisani K, Niederbacher S, Kugler A, Ausserhofer D. Delirium in elderly postoperative patients: A prospective cohort study. Nurs Open 2022; 9:2461-2472. [PMID: 35716398 PMCID: PMC9374408 DOI: 10.1002/nop2.1263] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022] Open
Abstract
AIM To describe the incidence, time in days and risk factors for postoperative delirium in elderly patients. DESIGN Prospective cohort study. METHODS Patients over 65 years were daily screened with the 4A's Test and the Delirium Observation Screening Scale for postoperative delirium. A psychiatrist assessed according to the DSM-V. We performed descriptive and logistic regression analyses. RESULTS From 202 patients, 7.5% (N = 15) had a diagnosed postoperative delirium, whereby 73.3% (N = 11) developed the delirium during the first 48 hr after surgery. The median duration was 1 day. Patients over 80 years suffering from heart failure with surgical drains, bladder catheter, central venous catheter had higher odds for developing a postoperative delirium. The incidence of postoperative delirium in our sample was lower compared with other surgical and ortho-geriatric populations. Despite age, several modifiable postoperative factors were associated with the occurrence of postoperative delirium.
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Affiliation(s)
- Chiara Muzzana
- College of Healthcare Professions Claudiana, Bolzano-Bozen, Italy
| | - Franco Mantovan
- College of Healthcare Professions Claudiana, Bolzano-Bozen, Italy.,Hospital of Bruneck-Brunico, SABES-ASDAA, Bruneck-Brunico, Italy
| | | | - Katia Trevisani
- College of Healthcare Professions Claudiana, Bolzano-Bozen, Italy
| | | | - Alexander Kugler
- Hospital of Bruneck-Brunico, SABES-ASDAA, Bruneck-Brunico, Italy
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Wootten S, Wiseman N, Harris N. Measuring the outcomes for aged care residents' participation in physical activity interventions: A systematic review of randomised controlled trials. Australas J Ageing 2022; 41:165-187. [PMID: 34921588 DOI: 10.1111/ajag.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 10/13/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Lack of physical activity presents substantial health risks to older adults living in residential aged care facilities. The objective of this review was to examine the suitability of physical activity outcome measurement instruments among cognitively sound residents. METHODS Search terms were used to explore health, nursing and social science databases to identify applicable English-language research from January 2000 to July 2020. RESULTS Sixteen papers met the inclusion criteria. The findings show that a diverse range of outcome measurement instruments have been used to evaluate physical activity intervention effectiveness. Most were found not to be validated for use specifically with residential aged care populations. CONCLUSIONS A range of Outcome Measurement Instruments (OMI) appear to effectively measure physical activity intervention outcomes among residential aged care older adults. Results highlighted the need for greater rigour in study design and selection of valid and population-appropriate instruments for use with this population.
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Affiliation(s)
- Steven Wootten
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicola Wiseman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Neil Harris
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Rogier C, Wouters F, van Boheemen L, van Schaardenburg D, de Jong PHP, van der Helm-van Mil AHM. Subclinical synovitis in arthralgia: how often does it result in clinical arthritis? Reflecting on starting points for disease-modifying anti-rheumatic drug treatment. Rheumatology (Oxford) 2021; 60:3872-3878. [PMID: 33331633 PMCID: PMC8328495 DOI: 10.1093/rheumatology/keaa774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/07/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives According to guidelines, clinical arthritis is mandatory for diagnosing RA. However, in the absence of clinical synovitis, imaging-detected subclinical synovitis is increasingly used instead and is considered as a starting point for DMARD therapy. To search for evidence we studied the natural course of arthralgia patients with subclinical synovitis from three longitudinal cohorts and determined the frequencies of non-progression to clinically apparent inflammatory arthritis (IA) (i.e. ‘false positives’). Methods Subclinical synovitis in the hands or feet of arthralgia patients was visualized with US (two cohorts; definition: greyscale ≥2 and/or power Doppler ≥1) or MRI (one cohort; definition: synovitis score ≥1 by two readers). Patients were followed for 1 year on for IA development; two cohorts also had 3 year data. Analyses were stratified for ACPA. Results Subclinical synovitis at presentation was present in 36%, 41% and 31% in the three cohorts. Of the ACPA-positive arthralgia patients with subclinical synovitis, 54%, 44% and 68%, respectively, did not develop IA. These percentages were even higher in the ACPA-negative arthralgia patients: 66%, 85% and 89%, respectively. Similar results were seen after 3 years of follow-up. Conclusion Replacing clinical arthritis with subclinical synovitis to identify RA introduces a high false-positive rate (44–89%). These data suggest an overestimation regarding the value of ACPA positivity in combination with the presence of subclinical synovitis in patients with arthralgia, which harbours the risk of overtreatment if DMARDs are initiated in the absence of clinical arthritis.
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Affiliation(s)
- Cleo Rogier
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fenne Wouters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Pascal H P de Jong
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Richards A, Jackson NJ, Cheng EM, Bryg RJ, Brown A, Towfighi A, Sanossian N, Barry F, Li N, Vickrey BG. Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk. Stroke 2020; 51:1563-1569. [PMID: 32200759 PMCID: PMC7185059 DOI: 10.1161/strokeaha.119.027160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Lowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke.
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Affiliation(s)
- Adam Richards
- From the UCLA David Geffen School of Medicine, Los Angeles, CA (A.R., N.J.J., E.M.C., A.B., F.B., N.L.)
| | - Nicholas J. Jackson
- From the UCLA David Geffen School of Medicine, Los Angeles, CA (A.R., N.J.J., E.M.C., A.B., F.B., N.L.)
| | - Eric M. Cheng
- From the UCLA David Geffen School of Medicine, Los Angeles, CA (A.R., N.J.J., E.M.C., A.B., F.B., N.L.)
| | - Robert J. Bryg
- Olive View-UCLA Medical Center, Sylmar, CA (R.J.B., A.B.)
| | - Arleen Brown
- From the UCLA David Geffen School of Medicine, Los Angeles, CA (A.R., N.J.J., E.M.C., A.B., F.B., N.L.)
- Olive View-UCLA Medical Center, Sylmar, CA (R.J.B., A.B.)
| | - Amytis Towfighi
- Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.)
| | | | - Frances Barry
- From the UCLA David Geffen School of Medicine, Los Angeles, CA (A.R., N.J.J., E.M.C., A.B., F.B., N.L.)
| | - Ning Li
- From the UCLA David Geffen School of Medicine, Los Angeles, CA (A.R., N.J.J., E.M.C., A.B., F.B., N.L.)
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Carmichael JM, Meier J, Robinson A, Taylor J, Higgins DT, Patel S. Leveraging electronic medical record data for population health management in the Veterans Health Administration: Successes and lessons learned. Am J Health Syst Pharm 2019; 74:1447-1459. [PMID: 28887346 DOI: 10.2146/ajhp161048] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The process and operational elements to establish a population health program using electronic medical record data in a Veterans Health Administration region are described. SUMMARY Pharmacists are uniquely qualified to assume important roles in population health through the use of their clinical knowledge, assisted by electronic tools that consolidate and report patient-specific data for clinical care. Veterans Integrated Services Network (VISN) 21 has developed 300 dashboards and reports to improve the quality, safety, and value of healthcare to veterans. Within a group of specialty task forces, physicians, nurses, and pharmacists assist in the design and development of evidence-based tools to leverage timely electronic health information into metrics, benchmarks, and targets to assist with goal achievement. Examples of programs designed to improve care in 3 areas were selected for further description and review of outcomes. Population health improvement using Healthcare Effectiveness Data and Information Set and hepatitis C metrics were used to describe populations that may have an indication for evidence-based care but are not receiving it. Deprescribing efforts are described, as are medication safety monitoring efforts to prevent potential adverse events known to be associated with therapy. CONCLUSION Quality, safety, and value outcomes are the measures of success for population health programs in VISN 21. Data-rich project dashboards and reports are developed by pharmacist data analysts and implemented and used by teams of clinicians who provide continuous feedback and support to improve population health. The use of task forces, metrics, benchmarks, targets, and teams is instrumental in the successful application of these tools.
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Affiliation(s)
| | - Joy Meier
- VA Sierra Pacific Network, Martinez, CA
| | | | | | | | - Shardool Patel
- Postgraduate Year 2 Pharmacy Outcomes and Healthcare Analytics, VA Sierra Pacific Network, Reno, NV
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10
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Neunert C, Noroozi N, Norman G, Buchanan GR, Goy J, Nazi I, Kelton JG, Arnold DM. Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review. J Thromb Haemost 2015; 13:457-64. [PMID: 25495497 PMCID: PMC4991942 DOI: 10.1111/jth.12813] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND The burden of severe bleeding in adults and children with immune thrombocytopenia (ITP) has not been established. OBJECTIVES To describe the frequency and severity of bleeding events in patients with ITP, and the methods used to measure bleeding in ITP studies. PATIENTS/METHODS We performed a systematic review of all prospective ITP studies that enrolled 20 or more patients. Two reviewers searched Medline, Embase, CINAHL and the Cochrane registry up to May 2014. Overall weighted proportions were estimated using a random effects model. Measurement properties of bleeding assessment tools were evaluated. RESULTS We identified 118 studies that reported bleeding (n = 10 908 patients). Weighted proportions for intracerebral hemorrhage (ICH) were 1.4% for adults (95% confidence interval [CI], 0.9-2.1%) and 0.4% for children (95% CI, 0.2-0.7%; P < 0.01), most of whom had chronic ITP. The weighted proportion for severe (non-ICH) bleeding was 9.6% for adults (95% CI, 4.1-17.1%) and 20.2% for children (95% CI, 10.0-32.9%; P < 0.01) with newly-diagnosed or chronic ITP. Methods of reporting and definitions of severe bleeding were highly variable in primary studies. Two bleeding assessment tools (Buchanan 2002 for children; Page 2007 for adults) demonstrated adequate inter-rater reliability and validity in independent assessments. CONCLUSIONS ICH was more common in adults and tended to occur during chronic ITP; other severe bleeds were more common in children and occurred at all stages of disease. Reporting of non-ICH bleeding was variable across studies. Further attention to ITP-specific bleeding measurement in clinical trials is needed to improve standardization of this important outcome for patients.
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Affiliation(s)
- C Neunert
- Department of Pediatrics and Cancer Center, Georgia Regents University, Augusta, GA, USA
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11
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Bos N, Sturms LM, Stellato RK, Schrijvers AJP, van Stel HF. The Consumer Quality Index in an accident and emergency department: internal consistency, validity and discriminative capacity. Health Expect 2013; 18:1426-38. [PMID: 24102915 DOI: 10.1111/hex.12123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients' experiences are an indicator of health-care performance in the accident and emergency department (A&E). The Consumer Quality Index for the Accident and Emergency department (CQI A&E), a questionnaire to assess the quality of care as experienced by patients, was investigated. The internal consistency, construct validity and discriminative capacity of the questionnaire were examined. METHODS In the Netherlands, twenty-one A&Es participated in a cross-sectional survey, covering 4883 patients. The questionnaire consisted of 78 questions. Principal components analysis determined underlying domains. Internal consistency was determined by Cronbach's alpha coefficients, construct validity by Pearson's correlation coefficients and the discriminative capacity by intraclass correlation coefficients and reliability of A&E-level mean scores (G-coefficient). RESULTS Seven quality domains emerged from the principal components analysis: information before treatment, timeliness, attitude of health-care professionals, professionalism of received care, information during treatment, environment and facilities, and discharge management. Domains were internally consistent (range: 0.67-0.84). Five domains and the 'global quality rating' had the capacity to discriminate among A&Es (significant intraclass correlation coefficient). Four domains and the 'global quality rating' were close to or above the threshold for reliably demonstrating differences among A&Es. The patients' experiences score on the domain timeliness showed the largest range between the worst- and best-performing A&E. CONCLUSIONS The CQI A&E is a validated survey to measure health-care performance in the A&E from patients' perspective. Five domains regarding quality of care aspects and the 'global quality rating' had the capacity to discriminate among A&Es.
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Affiliation(s)
- Nanne Bos
- Stichting Miletus, Zeist, The Netherlands
| | | | - Rebecca K Stellato
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Augustinus J P Schrijvers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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