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McCalman P, Forster D, Newton M, McLardie-Hore F, McLachlan H. "Safe, connected, supported in a complex system." Exploring the views of women who had a First Nations baby at one of three maternity services offering culturally tailored continuity of midwife care in Victoria, Australia. A qualitative analysis of free-text survey responses. Women Birth 2024; 37:101583. [PMID: 38302389 DOI: 10.1016/j.wombi.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND In Australia, continuity of midwife care is recommended for First Nations women to address the burden of inequitable perinatal outcomes experienced by First Nations women and newborns. AIMS This study aimed to explore the experiences of women having a First Nations baby who received care at one of three maternity services in Naarm (Melbourne), Victoria, where culturally tailored midwife continuity models had been implemented. METHODS Women having a First Nations baby who were booked for care at one of three study sites were invited to participate in an evaluation of care. Thematic analysis was used to analyse qualitative data from responses to free-text, open ended questions that were included in a follow-up questionnaire at 3-6 months after the birth. RESULTS In total, 213 women (of whom 186 had continuity of midwife care) participated. The global theme for what women liked about their care was 'Safe, connected, supported' including emotional and clinical safety, having a known midwife and being supported 'my way'. The global theme for what women did not like about their care was 'A complex, fragmented and unsupportive system' including not being listened to, things not being explained, and a lack of cultural safety. CONCLUSIONS Culturally tailored caseload midwifery models appear to make maternity care feel safer for women having a First Nations baby, however, the mainstream maternity care system remained challenging for some. These models should be implemented for First Nations women, and evidence-based frameworks, such as the RISE framework, should be used to facilitate change.
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Affiliation(s)
- P McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3052, Australia.
| | - D Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - M Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3052, Australia
| | - F McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - H McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3052, Australia
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Dundon NA, Al Ghazwi AH, Davey MG, Joyce WP. Rectal cancer surgery: does low volume imply worse outcome-a single surgeon experience. Ir J Med Sci 2023; 192:2673-2679. [PMID: 37154997 PMCID: PMC10165279 DOI: 10.1007/s11845-023-03372-z] [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: 11/29/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The centralisation of rectal cancer management to high-volume oncology centres has translated to improved oncological and survival outcomes. We hypothesise that individual surgeon caseload, specialisation, and experience may be as significant in determining oncologic and postoperative outcomes in rectal cancer surgery. METHODS A prospectively maintained colorectal surgery database was reviewed for patients undergoing rectal cancer surgery between January 2004 and June 2020. Data studied included demographics, Dukes' and TNM staging, neoadjuvant treatment, preoperative risk assessment scores, postoperative complications, 30-day readmission rates, length of stay (LOS), and long-term survival. Primary outcome measures were 30-day mortality and long-term survival compared to national and international standards and best practice guidelines. RESULTS In total, 87 patients were included (mean age: 66 years [range: 36-88]). The mean length of stay (LOS) was 16.5 days (SD 6.0). The median ICU LOS was 3 days (range 2-17). Overall, 30-day readmission rate was 16.4%. Twenty-four patients (26.4%) experienced ≥ 1 postoperative complication. The 30-day operative mortality rate was 3.45%. Overall 5-year survival rate was 66.6%. A significant correlation was observed between P-POSSUM scores and postoperative complications (p = 0.041), and all four variants of POSSUM, CR-POSSUM, and P-POSSUM scores and 30-day mortality. CONCLUSION Despite improved outcomes seen with centralisation of rectal cancer services at an institutional level, surgeon caseload, experience, and specialisation is of similar importance in obtaining optimal outcomes within institutions.
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Affiliation(s)
| | | | | | - William P Joyce
- Department of Surgery, Galway Clinic, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Yakac A, Lebentrau S, Lusuardi L, Sarcan S, Burger M, Merseburger AS, Wiegland J, Gilfrich C, Wolff I, Ahyai S, May M, Thomas C. Centralizing Penile Cancer Care in Germany and Austria: Just a Dream or a Fast-Approaching Reality? Results of a Survey Study among Urological Department Chairs and Modeling of Real Treatment Numbers of Penile Cancer Patients. Urol Int 2023; 107:916-923. [PMID: 37918360 DOI: 10.1159/000534089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/02/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION In countries characterized by a centralization of therapy management, patients with penile cancer (PeCa) have shown improvements in guideline adherence and ultimately, improved carcinoma-specific survival. Germany and Austria (G + A) have no state-regulated centralization of PeCa management, and the perspectives of urological university department chairs (UUDCs) in these countries, who act as drivers of professional and political developments, on this topic are currently unknown. METHODS Surveys containing 36 response options, including specific questions regarding perspectives on PeCa centralization, were sent to the 48 UUDC in G + A in January 2023. In addition to analyzing the responses, closely following the CROSS checklist, a modeling of the real healthcare situation of in-house PeCa patients in G + A was conducted. RESULTS The response rate was 75% (36/48). 94% and 89% of the UUDCs considered PeCa centralization meaningful and feasible in the medium term, respectively. Among the UUDCs, 72% estimated centralization within university hospitals as appropriate, while 28% favored a geographically oriented approach. Additionally, 97% of the UUDCs emphasized the importance of bridging the gap until implementation of centralization by establishing PeCa second-opinion portals. No country-specific differences were observed. The median number of in-house PeCa cases at the university hospitals in G + A was 13 (interquartile range: 9-26). A significant positive correlation was observed between the annual number of in-house PeCa cases at a given university hospital and the perspective of the UUDCs that centralization as meaningful by its UUDC (0.024). Under assumptions permissible for modeling, the average number of in-house PeCa cases in academic hospitals in G + A was approximately 30 times higher than in nonacademic hospitals. CONCLUSION This study provides the first data on the perspectives of UUDCs in G + A concerning centralization of PeCa therapy management. Even without state-regulated centralization in G + A, there is currently a clear focusing of PeCa treatments in university hospitals. Further necessary steps toward a structured PeCa centralization are discussed in this manuscript.
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Affiliation(s)
- Abdulbaki Yakac
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Steffen Lebentrau
- Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Department of Urology, Werner Forssmann Hospital, Eberswalde, Germany
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg, Austria
| | - Semih Sarcan
- Department of Urology, University Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Axel S Merseburger
- Department of Urology, University Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jens Wiegland
- St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Christian Gilfrich
- St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Sascha Ahyai
- Department of Urology, University of Graz, Graz, Austria
| | - Matthias May
- St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Fonseca J, Froes G, Moraes-Fontes MF, Rebola J, Lúcio R, Almeida M, Muresan C, Palmas A, Gaivão A, Matos C, Santos T, Dias D, Sousa I, Oliveira F, Ribeiro R, Lopez-Beltran A, Fraga A. Urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy in relation to surgeon experience. J Robot Surg 2023; 17:2503-2511. [PMID: 37528286 PMCID: PMC10492722 DOI: 10.1007/s11701-023-01687-8] [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: 06/19/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
Urinary incontinence is one of the main concerns for patients after radical prostatectomy. Differences in surgical experience among surgeons could partly explain the wide range of frequencies observed. Our aim was to evaluate the association between the surgeons` experience and center caseload with relation to urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Prospective observational single-center study. Five surgeons consecutively operated 405 patients between July 2017 and February 2022. Continence recovery was evaluated with pad count and by employing the short form of the International Consultation on Incontinence Questionnaire (ICIQ-SF), pre- and postoperatively at 1 year. Non-parametric tests were used. Median age was 63 years, 30% of patients presented with local advanced disease; the positive surgical margin rate (over 3 mm length) was 16%. Complication rate was 1% (Clavien-Dindo > II). One year after surgery, continence was assessed in 282 patients, of whom 87% were pad free and 51% never leaked (ICIQ-SF = 0). With respect to the mean annual number of procedures per surgeon, divided in < 20, 20-39 and ≥ 40, pad-free rates were achieved in 93%, 85%, and 84% and absence of urine leak rates in 47%, 62% and 48% of patients, respectively. Postoperative median ICIQ-SF was five. We acknowledge the limitation of a 12-month follow-up and the fact that we are a medium-volume center. There is no statistically significant association between continence recovery, surgeon's experience and center caseload. Continence recovery at 1 year after surgery is adequate and robust to surgeon's experience.
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Affiliation(s)
- Jorge Fonseca
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
| | - Gonçalo Froes
- Faculté de Médecine et Médecine Dentaire, Université Catholique de Louvain, Brussels, Belgium
| | | | - Jorge Rebola
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Rui Lúcio
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Miguel Almeida
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Ciprian Muresan
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Artur Palmas
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Ana Gaivão
- Serviço de Imagiologia, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Celso Matos
- Serviço de Imagiologia, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Tiago Santos
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Daniela Dias
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Inês Sousa
- Unidade de Investigação Clínica, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Francisco Oliveira
- Serviço de Medicina Nuclear, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Ribeiro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Antonio Lopez-Beltran
- Unidade de Anatomia Patológica, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Avelino Fraga
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Hildingsson I, Fahlbeck H, Larsson B, Johansson M. 'A perfect fit' - Swedish midwives' interest in continuity models of midwifery care. Women Birth 2023; 36:e86-e92. [PMID: 35504815 DOI: 10.1016/j.wombi.2022.04.014] [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: 02/07/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Midwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives' attitudes about working in continuity models must be investigated. OBJECTIVE to investigate Swedish midwives' interests in working in midwifery continuity models of care and factors influencing the midwifery workforce's readiness for such models. METHODS A cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis. RESULTS A total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents' ages 24-35 years (OR 1.73) or 35-45 years (OR 1.46); years of work experience 0-3 years (OR 5.81) and 3-10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest. CONCLUSION A sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women's interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Hanna Fahlbeck
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Johansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Rizvanovic D, Waldén M, Forssblad M, Stålman A. Surgeon's experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries. Knee Surg Sports Traumatol Arthrosc 2023; 31:475-86. [PMID: 35896755 DOI: 10.1007/s00167-022-07057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the influence of surgeon-related factors and clinic routines on autograft choice in primary anterior cruciate ligament reconstruction (ACLR). METHODS Data from the Swedish National Knee Ligament Registry (SNKLR), 2008-2019, were used to study autograft choice (hamstring; HT, patellar; PT, or quadriceps tendon; QT) in primary ACLR. Patient/injury characteristics (sex, age at surgery, activity at time of injury and associated injuries) and surgeon-/clinic-related factors (operating volume, caseload and graft type use) were analyzed. Surgeon/clinic volume was divided into tertiles (low-, mid- and high-volume categories). Multivariable logistic regression was performed to assess variables influencing autograft choice in 2015-2019, presented as the odds ratio (OR) with a 95% confidence interval (CI). RESULTS 39,964 primary ACLRs performed by 299 knee surgeons in 91 clinics were included. Most patients received HT (93.7%), followed by PT (4.2%) and QT (2.1%) grafts. Patients were mostly operated on by high-volume (> 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of ≥ 50 ACLRs (85.1%) and surgeons with the ability to use ≥ two autograft types (85.9%) (all p < 0.001). Most patients underwent ACLR at high-volume (> 55 ACLRs/year) clinics (72.2%) and at clinics capable of using ≥ two autograft types (93.1%) (both p < 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of ≥ 50 ACLRs (OR 1.41, 95% CI 1.11-1.79), but also for injury during handball (OR 1.31, 95% CI 1.02-1.67), various other pivoting sports (basketball, hockey, rugby and American football) (OR 1.59, 95% CI 1.24-2.03) and a concomitant medial collateral ligament (MCL) injury (OR 4.93, 95% CI 4.18-5.80). In contrast, female sex (OR 0.87, 95% CI 0.77-0.97), injury during floorball (OR 0.71, 95% CI 0.55-0.91) and ACLR by mid-volume relative to high-volume surgeons (OR 0.62, 95% CI 0.53-0.73) had significantly reduced odds of receiving PT/QT autografts. CONCLUSION An HT autograft was used in the vast majority of cases, but PT/QT autografts were used more frequently by experienced surgeons. Prior research has demonstrated significant differences in autograft characteristics. For this reason, patients might benefit if surgery is performed by more experienced surgeons. LEVEL OF EVIDENCE Level III.
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Groeben C, Koch R, Baunacke M, Flegar L, Borkowetz A, Thomas C, Huber J. [Trends in uro-oncological surgery in Germany-comparative analyses from population-based data]. Urologe A 2021; 60:1257-68. [PMID: 34490495 DOI: 10.1007/s00120-021-01623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
Obwohl urologische maligne Erkrankungen mit etwa 100.000 Neuerkrankungen pro Jahr eine relevante gesundheitsökonomische Aufgabe darstellen, existieren kaum Erkenntnisse über die Struktur und Entwicklung der entsprechenden tumorchirurgischen Eingriffe an den mehr als 400 urologisch-chirurgisch tätigen Kliniken in Deutschland. Somit erfassten wir mittels Datenbankabfrage der DRG-Datenbank („diagnosis related groups“) des statistischen Bundesamtes sämtliche Fälle von 5 großen tumorchirurgischen Eingriffen in Deutschland (Prostatektomie, Zystektomie, Nierentumoroperation, retroperitoneale Lymphadenektomie, penischirurgische Eingriffe) von 2006 bis 2013 (bzw. 2016) und untersuchten die Einflüsse von technischen Neuerungen sowie Leitlinienänderungen auf die Entwicklungen der Fallzahlen. Zudem analysierten wir die Zusammenhänge zwischen jährlicher Fallzahl und perioperativem Ergebnis. Die Ergebnisse zeigten eine deutliche Korrelation zwischen Fallzahlvolumen (und damit Expertise) einer Klinik und einem verbesserten perioperativen Ergebnis. Dennoch existiert kaum Tendenz zur Zentralisierung bei diesen uroonkologischen Eingriffen. Die Fallzahlentwicklungen scheinen vielmehr vom Werbeeffekt durch technische Innovationen oder auch vom regionalen Bezug der Patienten zu einer bestimmten Klinik abhängig zu sein. Zentral gesteuerte Versuche mittels Einführung von Mindestfallzahlen oder der freiwilligen Zertifizierung von Zentren hatten in der Vergangenheit nur geringen Einfluss auf die Fallzahlverteilungen.
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Kontopodis N, Galanakis N, Akoumianakis E, Ioannou CV, Tsetis D, Antoniou GA. Editor's Choice - Systematic Review and Meta-Analysis of the Impact of Institutional and Surgeon Procedure Volume on Outcomes After Ruptured Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2021; 62:388-398. [PMID: 34384687 DOI: 10.1016/j.ejvs.2021.06.015] [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: 02/12/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether there is a correlation between institutional or surgeon case volume and outcomes in patients with ruptured abdominal aortic aneurysm (rAAA). DATA SOURCES The Healthcare Database Advanced Search interface developed by the National Institute of Health and Care Excellence was used to search MEDLINE, Embase, CINAHL, and CENTRAL. REVIEW METHODS The systematic review complied with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines with the protocol registered in PROSPERO (CRD42020213121). Prognostic studies were considered comparing outcomes of patients with rAAA undergoing repair in high and low volume institutions or by high and low volume surgeons. Pooled estimates for peri-operative mortality were calculated using the odds ratio (OR) and 95% confidence intervals (CI), applying the Mantel-Haenszel method. Analysis of adjusted outcome estimates was performed with the generic inverse variance method. RESULTS Thirteen studies reporting a total of 120 116 patients were included. Patients treated in low volume centres had a statistically significantly higher peri-operative mortality than those treated in high volume centres (OR 1.39; 95% CI 1.22 - 1.59). Subgroup analysis showed a mortality difference in favour of high volume centres for both endovascular aneurysm repair (EVAR; OR 1.61, 95% CI 1.11 - 2.35) and open repair (OR 1.50, 95% CI 1.25 - 1.81). Adjusted analysis showed a benefit of treatment in high volume centres for open repair (OR 1.68, 95% CI 1.21 - 2.33) but not for EVAR (OR 1.42, 95% CI 0.84 - 2.41). Differences in peri-operative mortality between low and high volume surgeons were not statistically significant for either EVAR (OR 1.06, 95% CI 0.59 - 1.89) or open surgical repair (OR 1.18, 95% CI 0.87 - 1.63). CONCLUSION A high institutional volume may result in a reduction of peri-operative mortality following surgery for rAAA. This peri-operative survival advantage is more pronounced for open surgery than EVAR. Individual surgeon caseload was not found to have a significant impact on outcomes.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete, Heraklion, Greece
| | - Evangelos Akoumianakis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete, Heraklion, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK.
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Hewitt L, Dahlen HG, Hartz DL, Dadich A. Leadership and management in midwifery-led continuity of care models: A thematic and lexical analysis of a scoping review. Midwifery 2021; 98:102986. [PMID: 33774389 DOI: 10.1016/j.midw.2021.102986] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/10/2020] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although midwifery-led continuity of care is associated with superior outcomes for mothers and babies, it is not available to all women. Issues with implementation and sustainability might be addressed by improving how it is led and managed - yet little is known about what constitutes the optimal leadership and management of midwifery-led continuity models. DESIGN Following a systematic search of academic databases for relevant publications, 25 publications were identified. These were analysed, thematically to clarify (dis)similar themes, and lexically, to clarify how words within the publications travelled together. FINDINGS The publications were replete with three key themes. First, leadership - important yet challenged. Second, management of organisational change; barriers and enhancers. Third, promotors of sustainable models of care. Complementarily, the lexical analysis suggests that references to midwives and leadership among the publications did not typically travel together, as reported in the publications and were distant to one another, although management was inter-connected to both and to change. Leadership and management were not closely coupled with midwives or relationships with women. KEY CONCLUSIONS Midwifery leadership matters and can be enacted irrespective of position or seniority. Midwifery-led continuity of care models can be better managed via a multipronged approach. Improved leadership and management can help sustain such care. Although there was a perceived need for midwifery leadership, there did not seem to be an association between leadership and midwives in the lexical analysis. Many publications focused on the style theory of leadership and the transformational style theory. IMPLICATIONS FOR PRACTICE Instead of focusing on leaders and the presumption of a leadership scarcity, it might be more beneficial to start focusing within, looking with a new lens on leadership within midwifery at all levels. It might also be constructive for the profession to investigate a more progressive form of leadership, one that is relational and focuses on leadership rather than on the leader.
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Affiliation(s)
- Leonie Hewitt
- School of Nursing and Midwifery Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Hannah G Dahlen
- School of Nursing and Midwifery Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Donna L Hartz
- School of Nursing and Midwifery Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; College of Nursing and Midwifery Charles Darwin University, 815 George Street Haymarket, NSW 2000, Australia.
| | - Ann Dadich
- School of Business Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
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Affiliation(s)
- Soichiro Obara
- Department of Anesthesia, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1, Minami-ohtsuka, Toshima-ku, Tokyo, 170-8476, Japan.
- Teikyo University Graduate School of Public Health, Tokyo, Japan.
| | - Norifumi Kuratani
- Teikyo University Graduate School of Public Health, Tokyo, Japan
- Department of Anesthesia, Saitama Children's Medical Center, Saitama, Japan
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Abstract
Background In a previous article (10.1007/s00701-019-03888-3), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses. Methods Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency. Results Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries (p = 0.443). Conclusion The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency. Electronic supplementary material The online version of this article (10.1007/s00701-020-04513-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland.
- Clinical Neuroscience Center, University of Zürich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland.
| | | | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Torstein Meling
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Gunda B, Sipos I, Stang R, Böjti P, Dobronyi L, Takács T, Berényi T, Futácsi B, Barsi P, Rudas G, Kis B, Szikora I, Bereczki D. Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes-a prospective single-centre study. Neuroradiology 2020; 63:603-607. [PMID: 32935174 PMCID: PMC7966226 DOI: 10.1007/s00234-020-02531-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Abstract
Purpose New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window. Methods All consecutive ischemic stroke patients within 24 h from onset in an 11-month period were included. Thrombectomy eligibility in the 0–6 h time window was based on current guidelines; in the 6–24 h time window, it was based on a combination of DEFUSE 3 and DAWN study criteria using MRI to identify target mismatch. Clinical outcome in treated patients was assessed at 3 months. Results Within 24 h of onset, 437 patients were admitted. In the 0–6 h time window, 238 patients (54.5%) arrived of whom 221 (92.9%) underwent CTA or MRA, 82 (34.5%) had large vessel occlusion (LVO), 30 (12.6%) had thrombectomy and 11 (36.6%) became independent (mRS ≤ 2). In the extended 6–24 h time window, 199 patients (45.5%) arrived of whom 127 (63.8%) underwent CTA or MRA, 44 (22.1%) had LVO, 8 (4%) had thrombectomy and 4 (50%) became independent. Conclusion Extending the time window from 6 to 24 h results in a 26.7% increase in patients receiving thrombectomy and a 36.4% increase of independent clinical outcome in treated patients at the price of a significantly increased burden of clinical and imaging screening due to the similar caseload but a smaller proportion of treatment eligible patients in the extended as compared with the standard time window. Electronic supplementary material The online version of this article (10.1007/s00234-020-02531-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bence Gunda
- Department of Neurology, Semmelweis University, Budapest, Hungary.
| | - Ildikó Sipos
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Rita Stang
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Péter Böjti
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Levente Dobronyi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Tímea Takács
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Tamás Berényi
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
| | - Balázs Futácsi
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Péter Barsi
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Gábor Rudas
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Balázs Kis
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - István Szikora
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary.,MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
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Hildingsson I, Karlström A, Larsson B. A continuity of care project with two on-call schedules: Findings from a rural area in Sweden. Sex Reprod Healthc 2020; 26:100551. [PMID: 32950811 DOI: 10.1016/j.srhc.2020.100551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In many countries, various continuity models of midwifery care arrangements have been developed to benefit women and babies. In Sweden, such models are rare. AIM To evaluate two on-call schedules for enabling continuity of midwifery care during labour and birth, in a rural area of Sweden. METHOD A participatory action research project where the project was discussed, planned and implemented in collaboration between researchers, midwives and the project leader, and refined during the project period. Questionnaires were collected from participating women, in mid pregnancy and two months after birth. RESULT One of the models resulted in a higher degree of continuity, especially for women with fear of birth. Having a known midwife was associated with higher satisfaction in the medical (aOR 2.02 (95% CI 1.14-4.22) and the emotional (aOR 2.05; 1.09-3.86) aspects of intrapartum care, regardless of the model. CONCLUSION This study presented and evaluated two models of continuity with different on-call schedules and different possibilities for women to have access to a known midwife during labour and birth. Women were satisfied with the intrapartum care, and those who had had a known midwife were the most satisfied. Introducing a new model of care in a rural area where the labour ward recently closed challenged both the midwives' working conditions and women's access to evidence-based care.
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McGill N, McLeod S, Ivory N, Davis E, Rohr K. Randomised Controlled Trial Evaluating Active versus Passive Waiting for Speech-Language Pathology. Folia Phoniatr Logop 2020; 73:335-354. [PMID: 32756053 DOI: 10.1159/000508830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION High demand for speech-language pathology means children sometimes wait over 12 months for services, missing out on timely support. Waiting can be a time of stress, concern, and powerlessness for caregivers. Provision of information via a website may support families and encourage active waiting. OBJECTIVE The aim of this study was to compare children's speech, intelligibility, language, and literacy outcomes, and caregivers' satisfaction and empowerment in active versus passive waiting conditions. METHODS Ninety-seven preschool-aged children referred to a community health speech-language pathology service in Australia were screened for eligibility. Eligible children (n =42) with speech/language difficulties were randomly allocated to: (a) active waiting (provision of a purpose-built website; n = 20), or (b) passive waiting (control group; n = 22). Pre- and post-assessments (after 6 months on a waiting list) were completed with children and caregivers by a speech-language pathologist blinded to group allocations. RESULTS Intention to treat (n =36) and per-protocol analyses (n =30) were conducted to measure group differences in child and caregiver outcomes at post-assessment using one-way ANCOVA, controlling for baseline scores. There were no statistically significant differences between groups for children's speech, intelligibility, language, and literacy, or caregivers' empowerment and satisfaction. Children in both groups made minimal gains over 6 months. CONCLUSIONS Provision of an active waiting website did not lead to statistically significant change in child or caregiver outcomes, and children in both groups made little progress over a 6-month period. Early speech-language pathology intervention delivered with appropriate dosage is needed to optimise children's outcomes. Until timely and effective speech-language pathology intervention can be provided for all who need it, provision of early assessments may be beneficial. There remains a need for effective ways to support children and families on waiting lists.
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Affiliation(s)
- Nicole McGill
- Charles Sturt University, Bathurst, New South Wales, Australia,
| | - Sharynne McLeod
- Charles Sturt University, Bathurst, New South Wales, Australia
| | - Nicola Ivory
- Charles Sturt University, Bathurst, New South Wales, Australia
| | - Emily Davis
- Western NSW Local Health District, Bathurst, New South Wales, Australia
| | - Katrina Rohr
- Western NSW Local Health District, Bathurst, New South Wales, Australia
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Noureldine MHA, Pressman E, Krafft PR, Greenberg MS, Agazzi S, van Loveren H, Alikhani P. Impact of the COVID-19 Pandemic on Neurosurgical Practice at an Academic Tertiary Referral Center: A Comparative Study. World Neurosurg 2020; 139:e872-e876. [PMID: 32450314 PMCID: PMC7244435 DOI: 10.1016/j.wneu.2020.05.150] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neurosurgical services have been affected by the 2019 novel coronavirus disease (COVID-19) pandemic, and several departments have reported their experiences and responses to the COVID-19 crisis in an attempt to provide insights from which other impacted departments can benefit. The goals of this study were to report the load and variety of emergent/urgent neurosurgical cases after implementing the "Battle Plan" at an academic tertiary referral center during the COVID-19 pandemic and to compare these variables with previous practice at the same institution. METHODS The clinical data of all patients who underwent a neurosurgical intervention between March 23, 2020, and April 20, 2020, were obtained from a prospectively maintained database. Data of the control group were retrospectively collected from the medical records to compare the types of surgeries/interventions performed by the same neurosurgical service before the COVID-19 pandemic started. RESULTS Over a 4-week period during the COVID-19 pandemic, 91 patients underwent emergent, urgent, and essential neurosurgical interventions. Patient screening at teleclinics identified 11 urgent surgical cases. The implementation of the Battle Plan led to a significant decrease in the caseload, and the variation of cases by subspecialty was evident when compared with a control group comprising 214 patients. CONCLUSIONS Delivery of optimal care and safe practice and education at an academic neurosurgical department can be well maintained with proper execution of crisis protocols. Teleclinics proved to be efficient in screening patients for urgent neurosurgical conditions, but in-person clinic visits may still be necessary for some cases in the immediate postoperative period.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Elliot Pressman
- Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA
| | - Paul R Krafft
- Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA
| | - Mark S Greenberg
- Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA
| | - Siviero Agazzi
- Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA
| | - Harry van Loveren
- Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA
| | - Puya Alikhani
- Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA.
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Schraknepper J, Dimitriou D, Helmy N, Hasler J, Radzanowski S, Flury A. Influence of patient selection, component positioning and surgeon's caseload on the outcome of unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2020; 140:807-13. [PMID: 32193676 DOI: 10.1007/s00402-020-03413-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Implant malpositioning, low surgical caseload, and improper patient selection have been identified as essential factors, which could negatively affect the longevity of unicompartmental knee arthroplasty (UKA). The aim of the current study was to evaluate the impact of the surgeon's caseload on patient selection, component positioning, as well as component survivorship and functional outcomes following a PSI-UKA. METHODS A total of 125 patient-specific instrumented (PSI) UKA were included. One hundred and two cases were treated by a high-volume surgeon (usage 40%) and 23 cases by a low-volume surgeon (< 10 cases/year, usage 34%). Preoperative UIS, as well as the postoperative clinical and radiologic outcome, were assessed retrospectively. RESULTS Irrespective of the surgeon's UKA caseload, PSI allowed good accuracy in component positioning (p > 0.05). The high-volume surgeon had a more strict indication for UKA with 89% showing a UIS > 25 (considered a good indication) compared to 70% for the low-volume surgeon (p = 0.016). The low-volume surgeon achieved worse results regarding functional outcome (p < 0.05) and a tendency toward an increased risk for UKA failure (p = 0.11) compared to the high-volume surgeon. CONCLUSION Due to potential selection errors, mostly connected to a low UKA-caseload, low-volume UKA surgeons might achieve worse outcomes. Very strict indications for UKA might be recommended in low-volume surgeons to achieve excellent clinical outcomes following a UKA.
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Larsson B, Rubertsson C, Hildingsson I. A modified caseload midwifery model for women with fear of birth, women's and midwives' experiences: A qualitative study. Sex Reprod Healthc 2020; 24:100504. [PMID: 32120329 DOI: 10.1016/j.srhc.2020.100504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/10/2020] [Accepted: 02/23/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although fear of birth is common during pregnancy and childbirth, the best treatment for fear of birth in clinical care remain unclear. Strong evidence suggests that continuity models of midwifery care can benefit women and birth outcomes, though such models are rare in Sweden. Because women with fear of birth could benefit from such models, the aim of this qualitative study was to examine how women with fear of birth and their midwives experienced care in a modified caseload midwifery model. METHODS A qualitative interview study using thematic analysis. Participants were recruited from a pilot study in which women assessed to have fear of birth received antenatal and intrapartum care, from a midwife whom they knew. Eight women and four midwives were interviewed. RESULTS An overarching theme-"A mutual relationship instilled a sense of peace and security"-and three themes-"Closeness, continuity, and trust," "Preparation and counselling," and "Security, confidence, and reduced fear"-reflect the views and experiences of women with fear of birth and their midwives after participating in a modified caseload midwifery model. CONCLUSIONS For both women with fear of birth and their midwives, the caseload midwifery model generated trustful woman-midwife relationships, which increased women's confidence, reduced their fear, and contributed to their positive birth experiences. Moreover, the midwives felt better equipped to address women's needs, and their way of working with the women became more holistic. Altogether, offering a continuity model of midwifery care could be an option to support women with fear of birth.
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Punshon G, Sopala J, Hannan G, Roberts M, Vernon K, Pearce A, Leary A. Modeling the Multiple Sclerosis Specialist Nurse Workforce by Determination of Optimum Caseloads in the United Kingdom. Int J MS Care 2020; 23:1-7. [PMID: 33658899 DOI: 10.7224/1537-2073.2019-058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background It is estimated that there are more than 100,000 people in the United Kingdom who have multiple sclerosis (MS). Patient experience and outcome are improved by access to a specialist nursing service. The aim of this study was to perform demand modeling to understand the need for MS nursing interventions, and thus inform modeling of the future UK MS nursing workforce. Methods Existing national data and specific workload and service data were collected from 163 MS specialist nurses who completed a questionnaire on activity and complexity of work both done and left undone. Results Data were received from across all of the United Kingdom. Twenty-nine percent of respondents were specialist nurses in the field for 3 years or less. Unpaid overtime was regularly performed by 83.4% of respondents. The MS specialist nurse was part of all areas of the patient journey. Areas of work left undone were psychological interventions, physical assessments, social interventions/benefits, and recommending or prescribing medications. Conclusions The current recommended caseload of 358 people with MS per full-time equivalent seems to be too high, with a considerable amount of work left undone, particularly psychosocial care. Factors such as travel time, complexity of caseload, changing drug therapies, and societal issues such as the benefits system contributed to driving demand/workload.
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Pye V. Caseload management framework for public health nurses in the Republic of Ireland. Br J Community Nurs 2020; 25:27-33. [PMID: 31874084 DOI: 10.12968/bjcn.2020.25.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article outlines the steps taken in a change management project to develop and implement a national caseload management framework for clinical nursing activities within public health nursing services in the Republic of Ireland. It involved the development of metrics, definitions, data collection resources and relevant written procedures. It was developed and implemented over a period of 12 months and involved the engagement and involvement of approximately 2000 frontline, management and administrative staff. Implementation was challenging due to the lack of software systems to collect and return data and support caseload management. Alternative IT-based data collection systems were identified, and work is ongoing to develop additional metrics and resources that will continue to support caseload management.
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Affiliation(s)
- Virginia Pye
- National Lead for Public Health Nursing, Republic of Ireland
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20
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White C, Tarrant M, Hodges R, Wallace EM, Kumar A. A pathway to establish a publicly funded home birth program in Australia. Women Birth 2019; 33:e420-e428. [PMID: 31668870 DOI: 10.1016/j.wombi.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Home births provide women a birth choice where they may feel more comfortable and confident in their ability to give birth. PROBLEM Most women in Victoria do not have publicly funded access to appropriately trained health professionals if they choose to give birth at home. METHODS This paper describes the process of setting up a publicly funded home birth service and provide details of description of the set up and governance. We also report outcomes over 9 years with respect to parity, transfer to hospital, adverse maternal and neonatal outcomes. RESULTS Of the 191 women who were still booked into the home birth program at 36 weeks gestation, 148 (77.5%) women gave birth at home and 43 (22.5%) women were transferred into the hospital. The overall rate of vaginal birth was also high among the women in the home birth program, 185 (96.9%) with no added complications ascribed to home births. Such as severe perineal trauma [n=1] 0.6% PPH [n=4] 2.7%, Apgar score less than 7 at 5min [n=0] admissions post home birth to special care nursery [n=2] 1.35%. DISCUSSION This unique study provides a detailed road map of setting up a home birth practice to facilitate other institutions keen to build a publicly funded home birth service. The birth outcome data was found to be consistent with other Australian studies on low risk home births. CONCLUSION Well-designed home birth programs following best clinical practices and procedures can provide a safe birthing option for low risk women.
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Affiliation(s)
- Colleen White
- Department of Obstetrics and Gyanecology, Monash Health, Australia
| | - Mark Tarrant
- Department of Obstetrics and Gyanecology, Monash Health, Australia
| | - Ryan Hodges
- Department of Obstetrics and Gyanecology, Monash Health, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gyanecology, Monash University, Australia; Safer Care Victoria, Department of Health and Human Services, Victorian Government, Australia
| | - Arunaz Kumar
- Department of Obstetrics and Gyanecology, Monash Health, Australia; Department of Obstetrics and Gyanecology, Monash University, Australia.
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Abstract
Despite educational focus regarding orthopedic oncology during residency, assessment of resident orthopedic oncology caseload has not been performed. The purpose of this study was to evaluate orthopedic oncology caseload trends and variation among residents. The Accreditation Council for Graduate Medical Education case log reports for orthopedic surgery residents were reviewed for graduating years 2007 to 2013. Trends in orthopedic oncology cases and variation in the median number of cases performed by residents in the 90th, 50th, and 10th percentiles of caseload were evaluated. The proportion of orthopedic oncology caseload among all cases performed by residents increased significantly (P = 0.005) from 2007 to 2013. Likewise, the mean number of adult (P = 0.002), pediatric (P = 0.003), and total orthopedic oncology cases increased significantly (P = 0.002). On average, residents in the 90th, 50th, and 10th percentiles performed 83, 28, and 3 cases, respectively. The current study demonstrates a significant increase in adult, pediatric, and total orthopedic oncology caseload. There is also evidence of substantial caseload variation among residents. Caseload variation may influence the education and technical proficiency of orthopedic residents.
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Affiliation(s)
- Richard M Hinds
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA.
| | - Timothy B Rapp
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA
| | - John T Capo
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA
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Hildingsson I, Rubertsson C, Karlström A, Haines H. Caseload midwifery for women with fear of birth is a feasible option. Sex Reprod Healthc 2018; 16:50-5. [PMID: 29804775 DOI: 10.1016/j.srhc.2018.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Continuity with a known midwife might benefit women with fear of birth, but is rare in Sweden. The aim was to test a modified caseload midwifery model of care to provide continuity of caregiver to women with fear of birth. METHODS A feasibility study where women received antenatal and intrapartum care from a known midwife who focused on women's fear during all antenatal visits. The study was performed in one antenatal clinic in central Sweden and one university hospital labor ward. Data was collected with questionnaires in mid and late pregnancy and two months after birth. The main outcome was fear of childbirth. RESULT Eight out of ten women received all antenatal and intrapartum care from a known midwife. The majority had a normal vaginal birth with non-pharmacological pain relief. Satisfaction was high and most women reported that their fear of birth alleviated or disappeared. CONCLUSION Offering a modified caseload midwifery model of care seems to be a feasible option for women with elevated levels of childbirth fear as well as for midwives working in antenatal clinics as it reduces fear of childbirth for most women. Women were satisfied with the model of care and with the care provided.
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Bulti A, Briend A, Dale NM, De Wagt A, Chiwile F, Chitekwe S, Isokpunwu C, Myatt M. Improving estimates of the burden of severe acute malnutrition and predictions of caseload for programs treating severe acute malnutrition: experiences from Nigeria. ACTA ACUST UNITED AC 2017; 75:66. [PMID: 29152260 PMCID: PMC5679511 DOI: 10.1186/s13690-017-0234-4] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/28/2017] [Indexed: 10/25/2022]
Abstract
Background The burden of severe acute malnutrition (SAM) is estimated using unadjusted prevalence estimates. SAM is an acute condition and many children with SAM will either recover or die within a few weeks. Estimating SAM burden using unadjusted prevalence estimates results in significant underestimation. This has a negative impact on allocation of resources for the prevention and treatment of SAM. A simple method for adjusting prevalence estimates intended to improve the accuracy of burden estimates and caseload predictions has been proposed. This method employs an incidence correction factor. Application of this method using the globally recommended incidence correction factor has led to programs underestimating burden and caseload in some settings. Methods A method for estimating a locally appropriate incidence correction factor from prevalence, population size, program caseload, and program coverage was developed and tested using data from the Nigerian national SAM treatment program. Results Applying the developed method resulted in errors in caseload prediction of about 10%. This is a considerable improvement upon the current method, which resulted in a 79.5% underestimate. Methods for improving the precision of estimates are proposed. Conclusions It is possible to considerably improve predictions of caseload by applying a simple model to data that are readily available to program managers. This implies that more accurate estimates of burden may also be made using the same methods and data.
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Affiliation(s)
- Assaye Bulti
- United Nations Children's Fund (UNICEF), Abuja, Nigeria
| | - André Briend
- University of Tampere School of Medicine and Tampere University Hospital, University of Tampere, Center for Child Health Research, Lääkärinkatu 1, Arvo Building, FI-33014 University of Tampere, Tampere, Finland.,Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, DK-1958 Frederiksberg, Denmark
| | - Nancy M Dale
- University of Tampere School of Medicine and Tampere University Hospital, University of Tampere, Center for Child Health Research, Lääkärinkatu 1, Arvo Building, FI-33014 University of Tampere, Tampere, Finland
| | - Arjan De Wagt
- United Nations Children's Fund (UNICEF), Abuja, Nigeria
| | | | - Stanley Chitekwe
- United Nations Children's Fund (UNICEF), Nepal Country Office, UN House, Pulchowk, Lalitpur, Kathmandu, Nepal
| | - Chris Isokpunwu
- Department of Family Health, Head of Nutrition/SUN Focal Point, Federal Ministry of Health, Abuja, Nigeria
| | - Mark Myatt
- Brixton Health, Alltgoch Uchaf, Llawryglyn, Powys, Wales, SY17 5RJ UK
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Borowski DW, Cawkwell S, Zaidi SMA, Toward M, Maguire N, Gill TS. Volume-outcome relationship for colorectal cancer in primary care: a prospective cohort study. Int J Health Care Qual Assur 2017; 30:398-409. [PMID: 28574322 DOI: 10.1108/ijhcqa-01-2016-0001] [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] [Indexed: 11/17/2022]
Abstract
Purpose Higher caseloads are associated with better outcomes for many conditions treated in secondary and tertiary care settings, including colorectal cancer (CRC). There is little known whether such volume-outcome relationship exist in primary care settings. The purpose of this paper is to examine general practitioner (GP) CRC-specific caseload for possible associations with referral pathways, disease stage and CRC patients' overall survival. Design/methodology/approach The paper retrospectively analyses a prospectively maintained CRC database for 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services. Findings Of 1,145 CRC patients, 937 (81.8 per cent) were diagnosed as symptomatic cancers. In total, 210 GPs from 44 practices were stratified according to their CRC caseload over the study period into low volume (LV, 1-4); medium volume (MV, 5-7); and high volume (HV, 8-21 cases). Emergency presentation (LV: 49/287 (17.1 per cent); MV: 75/264 (28.4 per cent); HV: 105/386 (27.2 per cent); p=0.007) and advanced disease at presentation (LV: 84/287 (29.3 per cent); MV: 94/264 (35.6 per cent); HV: 144/386 (37.3 per cent); p=0.034) was more common amongst HV GPs. Three-year mortality risk was significantly higher for HV GPs (MV: (hazard ratio) HR 1.185 (confidence interval=0.897-1.566), p=0.231, and HV: HR 1.366 (CI=1.061-1.759), p=0.016), but adjustment for emergency presentation and advanced disease largely accounted for this difference. There was some evidence that HV GPs used elective cancer pathways less frequently (LV: 166/287 (57.8 per cent); MV: 130/264 (49.2 per cent); HV: 182/386 (47.2 per cent); p=0.007) and more selectively (CRC/referrals: LV: 166/2,743 (6.1 per cent); MV: 130/2,321 (5.6 per cent); HV: 182/2,508 (7.3 per cent); p=0.048). Originality/value Higher GP CRC caseload in primary care may be associated with advanced disease and poorer survival; more work is required to determine the reasons and to develop targeted intervention at local level to improve elective referral rates.
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Affiliation(s)
- David W Borowski
- Surgery Department, University Hospital North Tees , Stockton-on-Tees, UK
| | - Sarah Cawkwell
- Finance department, University Hospital of North Tees , Stockton-on-Tees, UK
| | - Syed M Amir Zaidi
- Surgery Department, University Hospital of North Tees , Stockton-on-Tees, UK
| | - Matthew Toward
- Upper GI/Bariatric Surgery Department, University Hospital of North Tees , Stockton-on-Tees, UK
| | - Nicola Maguire
- Surgery Department, University Hospital of North Tees , Stockton-on-Tees, UK
| | - Talvinder S Gill
- Surgery Department, University Hospital of North Tees , Stockton-on-Tees, UK
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Leow JJ, Leong EK, Serrell EC, Chang SL, Gruen RL, Png KS, Beaule LT, Trinh QD, Menon MM, Sammon JD. Systematic Review of the Volume-Outcome Relationship for Radical Prostatectomy. Eur Urol Focus 2017; 4:775-789. [PMID: 28753874 DOI: 10.1016/j.euf.2017.03.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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: 03/01/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Radical prostatectomy (RP) is one of the most complex urological procedures performed. Higher surgical volume has been found previously to be associated with better patient outcomes and reduced costs to the health care system. This has resulted in some regionalization of care toward high-volume facilities and providers; however, the preponderance of RPs is still performed at low-volume institutions. OBJECTIVE To provide an updated systematic review of the association of hospital and surgeon volume on patient and system outcomes after RP, including robot-assisted RP. EVIDENCE ACQUISITION A systematic review of literature was undertaken, searching PubMed (1959-2016) for original articles. Selection criteria included RP, hospital and/or surgeon volumes as predictor variables, categorization of hospital and/or surgeon volumes, and measurable end points. EVIDENCE SYNTHESIS Overall 49 publications fulfilled the inclusion criteria. Most of the studies demonstrated that higher-volume surgeries are associated with better outcomes including reduced mortality, morbidity, postoperative complications, length of stay, readmission, and cost-associated factors. The volume-outcome relationship is maintained in robotic surgery. Eleven studies assessed hospital and surgeon volume simultaneously, and findings reflect that neither is an independent predictor variable affecting outcomes. The studies varied in how volume cutoffs were categorized as well as how the volume-outcome relationship was methodologically evaluated. CONCLUSIONS Contemporary evidence continues to support the relationship between high-volume surgeries with improved RP outcomes. Recent studies demonstrate that the volume-outcome relationship applies to robot-assisted RP and may be applied for potential cost savings in health care. An increase in the number of international studies suggests reproducibility of the association. Although regionalization of surgical care remains a contentious issue, there is an increasing body of evidence that short-term outcomes are improved at high-volume centers for RP. PATIENT SUMMARY This systematic review of the latest literature found that higher surgical volume was associated with improved outcomes for radical prostatectomy.
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Affiliation(s)
- Jeffrey J Leow
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Eugene K Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore-Imperial College London, Singapore
| | | | - Steven L Chang
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russell L Gruen
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore-Imperial College London, Singapore
| | - Keng Siang Png
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Lisa T Beaule
- Tufts University School of Medicine, Boston, MA, USA; Division of Urology, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mani M Menon
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- Tufts University School of Medicine, Boston, MA, USA; Division of Urology, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA.
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Martin-Misener R, Kilpatrick K, Donald F, Bryant-Lukosius D, Rayner J, Valaitis R, Carter N, Miller PA, Landry V, Harbman P, Charbonneau-Smith R, McKinlay RJ, Ziegler E, Boesveld S, Lamb A. Nurse practitioner caseload in primary health care: Scoping review. Int J Nurs Stud 2016; 62:170-82. [PMID: 27494430 DOI: 10.1016/j.ijnurstu.2016.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/19/2015] [Revised: 05/20/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify recommendations for determining patient panel/caseload size for nurse practitioners in community-based primary health care settings. DESIGN Scoping review of the international published and grey literature. DATA SOURCES The search included electronic databases, international professional and governmental websites, contact with experts, and hand searches of reference lists. Eligible papers had to (a) address caseload or patient panels for nurse practitioners in community-based primary health care settings serving an all-ages population; and (b) be published in English or French between January 2000 and July 2014. Level one testing included title and abstract screening by two team members. Relevant papers were retained for full text review in level two testing, and reviewed by two team members. A third reviewer acted as a tiebreaker. Data were extracted using a structured extraction form by one team member and verified by a second member. Descriptive statistics were estimated. Content analysis was used for qualitative data. RESULTS We identified 111 peer-reviewed articles and grey literature documents. Most of the papers were published in Canada and the United States after 2010. Current methods to determine panel/caseload size use large administrative databases, provider work hours and the average number of patient visits. Most of the papers addressing the topic of patient panel/caseload size in community-based primary health care were descriptive. The average number of patients seen by nurse practitioners per day varied considerably within and between countries; an average of 9-15 patients per day was common. Patient characteristics (e.g., age, gender) and health conditions (e.g., multiple chronic conditions) appear to influence patient panel/caseload size. Very few studies used validated tools to classify patient acuity levels or disease burden scores. DISCUSSION The measurement of productivity and the determination of panel/caseload size is complex. Current metrics may not capture activities relevant to community-based primary health care nurse practitioners. Tools to measure all the components of these role are needed when determining panel/caseload size. Outcomes research is absent in the determination of panel/caseload size. CONCLUSION There are few systems in place to track and measure community-based primary health care nurse practitioner activities. The development of such mechanisms is an important next step to assess community-based primary health care nurse practitioner productivity and determine patient panel/caseload size. Decisions about panel/caseload size must take into account the effects of nurse practitioner activities on outcomes of care.
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Affiliation(s)
- Ruth Martin-Misener
- School of Nursing, Dalhousie University, Box 15000, 5869 University Ave., Halifax, NS, B3H 4R2, Canada.
| | - Kelley Kilpatrick
- Faculty of Nursing, Université de Montréal, Research Center Hôpital Maisonneuve-Rosemont CSA-RC-Aile bleue-Bureau F121, 5415 boul. l'Assomption, Montréal, QC H1T 2M4, Canada
| | - Faith Donald
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Denise Bryant-Lukosius
- School of Nursing & Dept. of Oncology, McMaster University, FHS-3N28G, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
| | - Jennifer Rayner
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, HSC-3N28G, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
| | - Nancy Carter
- School of Nursing, McMaster University, HSC-3N28G, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
| | - Patricia A Miller
- School of Nursing, McMaster University, HSC-3N28G, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
| | - Véronique Landry
- Faculty of Nursing, Université de Montréal, Research Center Hôpital Maisonneuve-Rosemont CSA-RC-Aile bleue-Bureau F121, 5415 boul. l'Assomption, Montréal, QC H1T 2M4, Canada
| | - Patricia Harbman
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Renee Charbonneau-Smith
- School of Nursing, McMaster University, HSC-3N28G, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
| | - R James McKinlay
- School of Nursing, McMaster University, HSC-3N28G, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
| | - Erin Ziegler
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Sarah Boesveld
- School of Nursing, McMaster University, HSC-3N28G, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
| | - Alyson Lamb
- School of Nursing, Dalhousie University, Box 15000, 5869 University Ave., Halifax, NS, B3H 4R2, Canada
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Stagg HR, Abubakar I, Brown J, Lalor MK, Thomas HL, Mohiyuddin T, Pedrazzoli D, Merle CS. Towards better guidance on caseload thresholds to promote positive tuberculosis treatment outcomes: a cohort study. BMC Med 2016; 14:52. [PMID: 27004514 PMCID: PMC4804548 DOI: 10.1186/s12916-016-0592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/25/2015] [Accepted: 03/07/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In low-incidence countries, clinical experience of tuberculosis is becoming more limited, with potential consequences for patient outcomes. In 2007, the Department of Health released a guidance 'toolkit' recommending that tuberculosis patients in England should not be solely managed by clinicians who see fewer than 10 cases per year. This caseload threshold was established to try to improve treatment outcomes and reduce transmission, but was not evidence based. We aimed to assess the association between clinician or hospital caseload and treatment outcomes, as well as the relative suitability of making recommendations using each caseload parameter. METHODS Demographic and clinical data for tuberculosis cases in England notified to Public Health England's Enhanced Tuberculosis Surveillance system between 2003 and 2012 were extracted. Mean clinician and hospital caseload over the past 3 years were calculated and treatment outcomes grouped into good/neutral and unfavourable. Caseloads over time and their relationship with outcomes were described and analysed using random effects logistic regression, adjusted for clustering. RESULTS In a fully adjusted multivariable model (34,707 cases)there was very strong evidence that management of tuberculosis by clinicians with fewer than 10 cases per year was associated with greater odds of an unfavourable outcome compared to clinicians who managed greater numbers of cases (cluster-specific odds ratio, 1.14; 95 % confidence interval, 1.05-1.25; P = 0.002). The relationship between hospital caseload and treatment outcomes was more complex and modified by a patient's place of birth and ethnicity. The clinician caseload association held after adjustment for hospital caseload and when the clinician caseload threshold was reduced down to one. CONCLUSIONS Despite the relative ease of making recommendations at the hospital level and the greater reliability of recorded hospital versus named clinician, our results suggest that clinician caseload thresholds are more suitable for clinical guidance. The current recommended clinician caseload threshold is functional. Sensitivity analyses reducing the threshold indicated that clinical experience is pertinent even at very low average caseloads, which is encouraging for low burden settings.
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Affiliation(s)
- Helen R Stagg
- Research Department of Infection and Population Health, University College London, London, UK.
| | - Ibrahim Abubakar
- Research Department of Infection and Population Health, University College London, London, UK
| | - James Brown
- Centre for Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK.,Division of Medicine, University College London, London, UK
| | - Maeve K Lalor
- Tuberculosis Section, Respiratory Diseases Department, Public Health England, London, UK
| | - H Lucy Thomas
- Tuberculosis Section, Respiratory Diseases Department, Public Health England, London, UK
| | - Tehreem Mohiyuddin
- Tuberculosis Section, Respiratory Diseases Department, Public Health England, London, UK
| | - Debora Pedrazzoli
- CMMID, London School of Hygiene and Tropical Medicine, London, UK.,TB Centre, London School of Hygiene and Tropical Medicine, London, UK.,TB Modelling Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Corinne S Merle
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Disease (TDR), Geneva, Switzerland.,London School of Hygiene and Tropical Medicine, London, UK
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Chang TR, Kowalski RG, Carhuapoma JR, Tamargo RJ, Naval NS. Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes. J Crit Care 2015; 30:469-72. [PMID: 25648904 DOI: 10.1016/j.jcrc.2015.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/03/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. MATERIALS AND METHODS Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents. RESULTS A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 ± 14.1 years, B: 53.1 ± 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%). CONCLUSIONS The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.
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Affiliation(s)
- Tiffany R Chang
- Departments of Neurosurgery and Neurology, University of Texas Medical School, Houston, TX.
| | - Robert G Kowalski
- Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - J Ricardo Carhuapoma
- Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Rafael J Tamargo
- Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Neeraj S Naval
- Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Forti A, Stapleton H, Kildea S. Mobile technologies and communication strategies in an urban Midwifery Group Practice setting. An exploratory study. Women Birth 2013; 26:235-9. [PMID: 24074760 DOI: 10.1016/j.wombi.2013.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 05/30/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Around-the-clock access to a known midwife is a distinct feature of Midwifery Group Practice (MGP) and caseload midwifery settings; although the literature suggests this aspect of working life may hinder recruitment and retention to this model of care. Mobile technologies, known as mHealth where they are used in health care, facilitate access and hence communication, however little is known about this area of midwifery practice. RESEARCH QUESTION Which communication modalities are used, and most frequently, by MGP midwives and clients? METHODS A prospective, cross sectional design included a purposive sample of MGP midwives from an Australian tertiary maternity hospital. Data on modes of midwife-client contact were collected 24h/day, for two consecutive weeks, and included: visits, phone-calls, texts and emails. Demographic data were also collected. FINDINGS Details about 1442 midwife-client contacts were obtained. The majority of contact was via text, between the hours of 07:00 and 14:59, with primiparous women, when the primary midwife was on-call. An average of 96 contacts per fortnight occurred. CONCLUSION The majority of contact was between the midwife and their primary clients, reiterating a key tenet of caseload models and confirming mobile technologies as a significant and evolving aspect of practice. The pattern of contact within social (or daytime) hours is reassuring for midwives considering caseload midwifery, who are concerned about the on-call burden. The use of text as the preferred communication modality raises issues regarding data security and retrieval, accountability, confidentiality and text management during off-duty periods. The development of Australian-wide guidelines to inform local policies and best practice is recommended.
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Affiliation(s)
- Amanda Forti
- Australian Catholic University, McAuley Campus, PO Box 456, Virginia, Qld 4014, Australia; Mater Research, Women's Health and Newborn Services (Maternity), Mater Health Services, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia.
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Dumonceau JM, Koessler T, van Hooft JE, Fockens P. Endoscopic ultrasonography-guided fine needle aspiration: Relatively low sensitivity in the endosonographer population. World J Gastroenterol 2012; 18:2357-63. [PMID: 22654426 PMCID: PMC3353369 DOI: 10.3748/wjg.v18.i19.2357] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/24/2011] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the characteristics and quality of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in a large panel of endosonographers.
METHODS: A survey was conducted during the 13th annual live course of endoscopic ultrasonography (EUS) held in Amsterdam, Netherlands. A 2-page questionnaire was developed for the study. Content validity of the questionnaire was determined based on input by experts in the field and a review of the relevant literature. It contained 30 questions that pertained to demographics and the current practice for EUS-FNA of responders, including sampling technique, sample processing, cytopathological diagnosis and sensitivity of EUS-FNA for the diagnosis of solid mass lesions. One hundred and sixty-one endosonographers who attended the course were asked to answer the survey. This allowed assessing the current practice of EUS-FNA as well as the self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions. We also examined which factors were associated with a self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions > 80%.
RESULTS: Completed surveys were collected from 92 (57.1%) of 161 endosonographers who attended the conference. The endosonographers had been practicing endoscopy and EUS for 12.5 ± 7.8 years and 4.8 ± 4.1 years, respectively; one third of them worked in a hospital with an annual caseload > 100 EUS-FNA. Endoscopy practices were located in 29 countries, including 13 countries in Western Europe that totaled 75.3% of the responses. Only one third of endosonographers reported a sensitivity for the diagnosis of solid mass lesions > 80% (interquartile range of sensitivities, 25.0%-75.0%). Factors independently associated with a sensitivity > 80% were (1) > 7 needle passes for pancreatic lesions or rapid on-site cytopathological evaluation (ROSE) (P < 0.0001), (2) a high annual hospital caseload (P = 0.024) and (3) routine isolation of microcores from EUS-FNA samples (P = 0.042). ROSE was routinely available to 27.9% of respondents. For lymph nodes and pancreatic masses, a maximum of three needle passes was performed by approximately two thirds of those who did not have ROSE. Microcores were routinely harvested from EUS-FNA samples by approximately one third (37.2%) of survey respondents.
CONCLUSION: EUS-FNA sensitivity was considerably lower than reported in the literature. Low EUS-FNA sensitivity was associated with unavailability of ROSE, few needle passes, absence of microcore isolation and low hospital caseload.
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