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Sibai, Abla Mehio, Thalia Arawi, Waleed Al Faisal, Jihad Makhoul, Hamid Yahya Hussain, Stephanie Haddad und Anthony Rizk. „Ethics Reporting Practices in Aging Research From the Arab Region“. Journal of Applied Gerontology 40, Nr. 1 (08.11.2019): 105–9. http://dx.doi.org/10.1177/0733464819886453.
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Objectives: This study aims to assess the extent of ethics reporting practices in aging research from Arab countries. Methods: A systematic scoping review of research on aging in 22 Arab countries from seven databases (1994-2013) identified 637 publications warranting institutional ethical approval and 612 publications warranting informed consent. We used multivariable regression analysis to examine variations by time, place, and study characteristics. Results: Only 36.6% of articles reported approval from a Research Ethics Committee and 38.7% reported informed consent. Reporting of ethical research practices increased significantly over time and as research collaborations and journal impact factor increased, and when sampling frame included institutionalized participants. In contrast, failure to report ethical research practices was significantly more common in non-English articles and those that did not report a funding source. Discussion: Despite gains across time, reporting of ethical research practices remains suboptimal in the Arab region. Further guidelines and capacity building are needed.
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Orumaa, Madleen, Kaire Innos, Maria Suurna, Liis Salumäe und Piret Veerus. „Quality Assessment of Cervical Cytology Practices in Estonia From 2007 to 2018“. Cancer Control 29 (Januar 2022): 107327482211417. http://dx.doi.org/10.1177/10732748221141794.
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Background Cervical cancer incidence and mortality in Estonia are among the highest in Europe, although the overall coverage with cervical cytology is high. This indicates potential issues with the quality of collection and/or laboratory evaluation of cervical cytology. Objectives The aim of the retrospective observational study was to assess the quality of cervical cytology specimen collection, evaluation, and reporting using laboratory reports in Estonia. Methods The study included women with a cervical cancer diagnosis in 2017−2018. Cervical cytology and histology reports for these women in 2007−2018 were obtained from ten laboratories. We described the quality of cytology specimen collection and reporting of cytology results. Multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) to identify factors associated with NILM as the last cervical cytology result within 5 or 2 years before the cervical cancer diagnosis. Also, we calculated cytology-histology correlation (CHC). Results We identified 503 cytology and 100 histology reports from 138 women. The laboratories differed greatly regarding human resources, work capacity and volume. Differences between local and regional laboratories were observed in reporting specimen adequacy (P < .001). We found that local laboratories had 3 times higher odds (OR = 2.95, 95% CI: 1.05−8.33) of reporting normal results 2 years before cancer diagnosis than regional laboratories. According to the CHC, 58.9% of pairs were in agreement. Conclusions The study showed considerable heterogeneity and suboptimal performance of cervical cytology practices in Estonia, particularly at local laboratories. Efforts to improve laboratory quality assurance are crucial.
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Uba, Belinda Vernyuy. „Predictors of Adverse Events Following Immunization Reporting amongst Healthcare Workers in Jigawa State, Northern Nigeria, 2022“. TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH 11, Nr. 1 (30.03.2023): 154–67. http://dx.doi.org/10.21522/tijph.2013.11.01.art015.
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An adverse event following immunization (AEFI) is any untoward medical occurrence that follows immunization and does not necessarily have a causal relationship with the usage of the vaccine. Reporting of AEFI is suboptimal amongst healthcare workers (HWs). This study aimed to determine predictors of HW’s reporting of AEFI. A descriptive cross-sectional study was conducted among HWs in selected health facilities (HFs) in Jigawa State using an open data kit self-administered questionnaire to collect data on socio-demographic characteristics, training, knowledge, and their practices on AEFI reporting. Analysis was conducted using Statistical Package for Social Sciences (SPSS) for frequencies, proportions, and associations using bivariate analysis and multivariate analysis using logistic regression to determine predictors of AEFI reporting with statistical significance set at p<0.05 and 95% confidence interval. Of the 400 respondents, 280 (70%) respondents had good knowledge of AEFI, 328(82%) sends routine AEFI reports and of 212 (53%) who recently encountered an AEFI, 174 (82.1%) exhibited some good reporting practices. Female gender (AOR 0.46, p=0.035), full-time employees (AOR 0.227, p=0.019), a recent encounter with an AEFI (AOR 3.087, p=0.007) and being trained on AEFI (AOR 5.54, p=0.011), reporting to elicit training (AOR 2.70, p=0.031) were predictors of routine reporting from health facility and reporting an encountered AEFI respectively. Overall, gender, employment status, being trained, and recent AEFI encounter to elicit training were predictors of AEFI reporting. To improve reporting of AEFI, there is a need to engage and train health workers on AEFI surveillance. Keywords: Adverse events following immunization, Knowledge, Practice, Predictors, Reporting.
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Weeks, Kate L., Darren C. Henstridge, Agus Salim, Jonathan E. Shaw, Thomas H. Marwick und Julie R. McMullen. „CORP: Practical tools for improving experimental design and reporting of laboratory studies of cardiovascular physiology and metabolism“. American Journal of Physiology-Heart and Circulatory Physiology 317, Nr. 3 (01.09.2019): H627—H639. http://dx.doi.org/10.1152/ajpheart.00327.2019.
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The exercise consisted of: 1) a short survey to acquire baseline data on current practices regarding the conduct of animal studies, 2) a series of presentations for promoting awareness and providing advice and practical tools for improving experimental design, and 3) a follow-up survey 12 mo later to assess whether practices had changed. The surveys were compulsory for responsible investigators ( n = 16; paired data presented). Other investigators named on animal ethics applications were encouraged to participate (2017, total of 36 investigators; 2018, 37 investigators). The major findings to come from the exercise included 1) a willingness of investigators to make changes when provided with knowledge/tools and solutions that were relatively simple to implement (e.g., proportion of responsible investigators showing improved practices using a structured method for randomization was 0.44, 95% CI (0.19; 0.70), P = 0.003, and deidentifying drugs/interventions was 0.40, 95% CI (0.12; 0.68), P = 0.010); 2) resistance to change if this involved more personnel and time (e.g., as required for allocation concealment); and 3) evidence that changes to long-term practices (“habits”) require time and follow-up. Improved practices could be verified based on changes in reporting within publications or documented evidence provided during laboratory visits. In summary, this exercise resulted in changed attitudes, practices, and reporting, but continued follow-up, monitoring, and incentives are required. Efforts to improve experimental rigor will reduce bias and will lead to findings with the greatest translational potential. NEW & NOTEWORTHY The goal of this exercise was to encourage preclinical researchers to improve the quality of their cardiac and metabolic animal studies by 1) increasing awareness of concerns, which can arise from suboptimal experimental designs; 2) providing knowledge, tools, and templates to overcome bias; and 3) conducting two short surveys over 12 mo to monitor change. Improved practices were identified for the uptake of structured methods for randomization, and de-identifying interventions/drugs. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/experimental-design-survey-training-practical-tools/ .
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Lemay, Jacinthe, Fatemah M. Alsaleh, Lulwa Al-Buresli, Mohammed Al-Mutairi, Eman A. Abahussain und Tania Bayoud. „Reporting of Adverse Drug Reactions in Primary Care Settings in Kuwait: A Comparative Study of Physicians and Pharmacists“. Medical Principles and Practice 27, Nr. 1 (2018): 30–38. http://dx.doi.org/10.1159/000487236.
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Objective: To investigate and compare knowledge, attitudes, and practices regarding pharmacovigilance (PV) and the reporting of adverse drug reactions (ADR) among physicians and pharmacists in primary care settings. Subjects and Methods: A cross-sectional study was conducted, in which a validated self-administered questionnaire was distributed to 386 physicians and 197 pharmacists in 38 primary care clinics in Kuwait. Categorical variables were described using numbers and percentages. The Pearson χ2 test, Fisher exact test, and Mann-Whitney U test were used as appropriate. p < 0.05 was considered statistically significant. Results: Of the 583 questionnaires distributed, 485 were completed (by 318 physicians and 167 pharmacists), giving an overall response rate of 83.2%. A total of 52.8% (n = 256) and 70.5% (n = 341) of the study participants were knowledgeable about the definitions of PV and ADR, respectively, with pharmacists demonstrating significantly better knowledge of PV (n = 105/167 vs. 151/318, i.e., 62.9 vs. 47.5%; p < 0.001) and purpose (n = 123/167 vs. 177/318, i.e., 74.1 vs. 55.7%; p < 0.001). However, the majority (n = 434/485; 89.4%) were not aware of an ADR reporting system in Kuwait. Almost every participant (n = 474/485; 97.7%) thought it was necessary to report ADR. However, significantly fewer physicians than pharmacists (n = 248/318 vs. 147/167, i.e., 78.0 vs. 88.0%; p < 0.01) believed that ADR reporting was a professional obligation. Only 27.8% (n = 133/485) had reported ADR, with pharmacists having reported significantly fewer than physicians (n = 35/167 vs. 98/318, i.e., 21.7 vs. 30.8%; p = 0.036). Conclusions: This study indicated that the attitude was positive but there was suboptimal knowledge and poor practice among primary care physicians and pharmacists with regard to ADR reporting. Targeted training about ADR reporting while ensuring a robust regulatory framework would encourage ADR reporting practices in the primary health care setting in Kuwait.
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Donner, Linsey M., W. Scott Campbell, Elizabeth Lyden und Trevor C. Van Schooneveld. „Assessment of Rapid-Blood-Culture-Identification Result Interpretation and Antibiotic Prescribing Practices“. Journal of Clinical Microbiology 55, Nr. 5 (01.03.2017): 1496–507. http://dx.doi.org/10.1128/jcm.02395-16.
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ABSTRACT Rapid pathogen identification can alter antibiotic prescribing practices if interpreted correctly. Microbiology reporting can be difficult to understand, and new technology has made it more challenging. Nebraska Medicine recently implemented the BioFire FilmArray blood culture identification panel (BCID) coupled with stewardship-based education on interpretation. Physician BCID result interpretation and prescribing were assessed via an electronic survey, with a response rate of 40.8% (156/382 surveys). Seven questions required respondents to interpret BCID results, identify the most likely pathogen, and then choose therapy based on the results. The tallied correct responses resulted in a knowledge score. General linear models evaluated the effect of role, specialty, and utilization of the BCID interpretation guide on the mean knowledge score. The specialties of the respondents included 55.7% internal medicine, 19.7% family medicine, and 24.6% other. Roles included 41.1% residents, 5.0% fellows, and 53.9% faculty. Most reported that they reviewed antimicrobial susceptibility results (89.4%) and adjusted therapy accordingly (81.6%), while only 60% stated that they adjusted therapy based on BCID results. The correct response rates ranged from 52 to 86% for the interpretation questions. The most common errors included misinterpretation of Enterobacteriaceae and Staphylococcus genus results. Neither role nor specialty was associated with total knowledge score in multivariate analysis ( P = 0.13 and 0.47, respectively). In conclusion, physician interpretation of BCID results is suboptimal and can result in ineffective treatment or missed opportunity to narrow therapy. With the implementation of new technology, improved reporting practices of BCID results with clinical decision support tools providing interpretation guidance available at the point of care is recommended.
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Niederstadt, Christina, und Sigrid Droste. „Reporting and presenting information retrieval processes: the need for optimizing common practice in health technology assessment“. International Journal of Technology Assessment in Health Care 26, Nr. 4 (Oktober 2010): 450–57. http://dx.doi.org/10.1017/s0266462310001066.
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Background: Information retrieval (IR) in health technology assessment (HTA) calls for transparency and reproducibility, but common practice in the documentation and presentation of this process is inadequate in fulfilling this demand.Objectives: Our objective is to promote good IR practice by presenting the conceptualization of retrieval and transcription readable to non-information specialists, and reporting of effectively processed search strategies.Methods: We performed a comprehensive database search (04/2010) to synthesize the current state-of-the-art. We then developed graphical and tabular presentation methods and tested their feasibility on existing research questions and defined recommendations.Results: No generally accepted standard of reporting of IR in HTA exists. We, therefore, developed templates for presenting the retrieval conceptualization, database selection, and additional hand-searching as well as for presenting search histories of complex and lengthy search strategies. No single template fits all conceptualizations, but some can be applied to most processes. Database interface providers report queries as entered, not as they are actually processed. In PubMed®, the huge difference between entered and processed query is shown in “Details.” Quality control and evaluation of search strategies using a validated tool such as the PRESS checklist is suboptimal when only entry-query based search histories are applied.Conclusions: Moving toward an internationally accepted IR reporting standard calls for advances in common reporting practices. Comprehensive, process-based reporting and presentation would make IR more understandable to others than information specialists and facilitate quality control.
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Fuller, Walter, Otridah Kapona, Aaron Oladipo Aboderin, Adeyemi Temitayo Adeyemo, Oluwadamilare Isaiah Olatunbosun, Laetitia Gahimbare und Yahaya Ali Ahmed. „Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review“. Antibiotics 12, Nr. 11 (10.11.2023): 1613. http://dx.doi.org/10.3390/antibiotics12111613.
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This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.
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Zhao, Yuxi, und Lifeng Lin. „Good Statistical Practices for Contemporary Meta-Analysis: Examples Based on a Systematic Review on COVID-19 in Pregnancy“. BioMedInformatics 1, Nr. 2 (23.07.2021): 64–76. http://dx.doi.org/10.3390/biomedinformatics1020005.
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Systematic reviews and meta-analyses have been increasingly used to pool research findings from multiple studies in medical sciences. The reliability of the synthesized evidence depends highly on the methodological quality of a systematic review and meta-analysis. In recent years, several tools have been developed to guide the reporting and evidence appraisal of systematic reviews and meta-analyses, and much statistical effort has been paid to improve their methodological quality. Nevertheless, many contemporary meta-analyses continue to employ conventional statistical methods, which may be suboptimal compared with several alternative methods available in the evidence synthesis literature. Based on a recent systematic review on COVID-19 in pregnancy, this article provides an overview of select good practices for performing meta-analyses from statistical perspectives. Specifically, we suggest meta-analysts (1) providing sufficient information of included studies, (2) providing information for reproducibility of meta-analyses, (3) using appropriate terminologies, (4) double-checking presented results, (5) considering alternative estimators of between-study variance, (6) considering alternative confidence intervals, (7) reporting prediction intervals, (8) assessing small-study effects whenever possible, and (9) considering one-stage methods. We use worked examples to illustrate these good practices. Relevant statistical code is also provided. The conventional and alternative methods could produce noticeably different point and interval estimates in some meta-analyses and thus affect their conclusions. In such cases, researchers should interpret the results from conventional methods with great caution and consider using alternative methods.
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Jonathan, Kivumbi. „Knowledge, Attitudes, and Practices of Family Planning among Mothers attending Antenatal Care in Rural Uganda: Implications for Maternal Health and Population Growth“. IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 9, Nr. 1 (11.04.2024): 55–62. http://dx.doi.org/10.59298/idosr/jbbaf/24/91.5562.
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Family planning remains a critical aspect of maternal health and population management in Uganda, particularly in rural areas. Despite concerted efforts to increase awareness and accessibility, utilization rates remain suboptimal. This descriptive cross-sectional study aimed to assess the knowledge, attitudes, and practices of family planning among mothers attending antenatal care in Kyotera district, Uganda. A sample of 138 participants completed questionnaires, revealing a nuanced landscape: while overall knowledge of family planning was high (73.9%), a significant minority demonstrated poor understanding (26.1%). Similarly, though the majority exhibited positive attitudes towards family planning (71.0%), a substantial proportion held negative views (29.0%). Notably, 62.3% of mothers were not utilizing any family planning methods, despite 37.7% reporting usage, with injectable contraceptives being the most common (42.3%). These findings underscore the need for targeted education campaigns, enhanced service accessibility, and dispelling misconceptions to promote informed decision-making and uptake of family planning methods. Addressing these challenges is vital for improving maternal health outcomes and managing population growth in rural Uganda. Keywords: Family planning, Maternal health, Kyotera district, Rural Uganda, Antenatal care, Knowledge, Attitudes, Practices.
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Mheissen, Samer, Jadbinder Seehra, Haris Khan und Nikolaos Pandis. „Do sample size calculations in longitudinal orthodontic trials use the advantages of this study design?“ Angle Orthodontist 92, Nr. 3 (04.02.2022): 402–8. http://dx.doi.org/10.2319/091321-707.1.
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ABSTRACT Objectives To examine whether optimal calculations of the sample size are being used in longitudinal orthodontic trials. Materials and Methods Longitudinal orthodontic trials with a minimum of three time points of outcome assessment published between January 1, 2017, and December 30, 2020, were sourced from a single electronic database. Study characteristics at the level of each trial were undertaken independently and in duplicate. Descriptive statistics and summary values were calculated. Inferential statistics (Fisher's exact test and logistic regression) were applied to detect associations between reporting of a sample size calculation and the study characteristics. Results A total of 147 trials were analyzed; 75.5% of these trials reported a sample size calculation with none reporting optimal sample size calculation for longitudinal trials. Most of the longitudinal orthodontic trials did not report the correlation and the number of longitudinal measurements in calculating the sample size. An association between reporting of a sample size calculation (yes or no) and the type of journal (orthodontic and non-orthodontic) was detected with higher odds of reporting a sample size calculation in orthodontic journals than in non-orthodontic journals (3.04; 95% confidence interval, 1.4-6.59; P < .01). Conclusions The findings of this study highlighted that the undertaking of optimal sample size calculations in longitudinal orthodontic trials is being underused. Greater awareness of the variables required for undertaking the correct sample size calculation in these trials is required to reduce suboptimal research practices.
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Michael Alurame Eruaga, Tabat Bature und Esther Oleiye Itua. „Pharmacovigilance in Nigeria: Addressing challenges in ensuring drug safety and monitoring adverse effects“. GSC Advanced Research and Reviews 18, Nr. 3 (30.03.2024): 078–82. http://dx.doi.org/10.30574/gscarr.2024.18.3.0093.
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This paper examines the specific challenges faced by Nigeria in implementing pharmacovigilance measures to ensure drug safety and monitor adverse effects. Despite the critical importance of pharmacovigilance in safeguarding public health, Nigeria grapples with several obstacles in its implementation. Through a nuanced exploration of literature and regulatory frameworks, this study sheds light on the unique hurdles encountered in pharmacovigilance practices within the Nigerian context. Challenges in Nigeria's pharmacovigilance landscape include limited awareness and understanding of pharmacovigilance principles among healthcare professionals and consumers, resulting in underreporting of adverse drug reactions. Additionally, there is a lack of robust infrastructure and resources for pharmacovigilance activities, including inadequate funding, shortage of trained personnel, and deficient pharmacovigilance databases. Regulatory enforcement and oversight are also hindered by issues such as weak regulatory frameworks, fragmented reporting systems, and suboptimal collaboration among regulatory agencies. Furthermore, Nigeria's pharmacovigilance efforts are compounded by factors such as the proliferation of counterfeit and substandard medicines, informal drug markets, and cultural beliefs influencing healthcare-seeking behaviors. These challenges pose significant barriers to effective pharmacovigilance implementation and compromise patient safety and public health outcomes in Nigeria. Addressing these challenges requires a multifaceted approach encompassing regulatory reforms, capacity building initiatives, public awareness campaigns, and collaboration with international partners. Strengthening regulatory frameworks, enhancing healthcare professional training on pharmacovigilance, establishing robust reporting systems, and fostering partnerships between regulatory agencies, healthcare institutions, and pharmaceutical companies are essential steps toward improving pharmacovigilance practices in Nigeria. Through a thorough examination of the Nigerian context, this paper aims to raise awareness of the specific challenges hindering pharmacovigilance implementation in the country and stimulate dialogue on potential solutions to enhance drug safety and monitoring of adverse effects in Nigeria's healthcare system.
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Hines, Stella E., Clayton H. Brown, Marc Oliver, Patricia Gucer, Melissa Frisch, Regina Hogan, Tracy Roth, James Chang und Melissa McDiarmid. „Cleaning and Disinfection Perceptions and Use Practices Among Elastomeric Respirator Users in Health care“. Workplace Health & Safety 68, Nr. 12 (19.08.2020): 572–82. http://dx.doi.org/10.1177/2165079920938618.
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Background: Reusable elastomeric respirator use in health care may represent one solution to address N95 respirator shortages experienced during infectious disease outbreaks, but cleaning and disinfection requirements may limit their utility. Evidence of respirator cleaning and disinfection behaviors and practices by health care workers may inform guidance on reusable respirator use. Methods: Medical system elastomeric respirator users were surveyed about respirator cleaning and disinfection practices and perceptions via an electronic survey. Respondents were subsequently classified based on reported compliance with their assigned respirator use. To explore whether respirator cleaning and disinfection issues affected compliance with assigned device use, responses were compared between user groups and adjusted for covariates. Results: A total of 432 of 2,024 (21%) eligible elastomeric respirator users completed the survey. Most (>90%) reported that their respirator was clean, but only 52% reported that they always disinfect their respirators after use according to the hospital’s expected practice. Only 40 respondents (9%) reported regularly cleaning the respirator with soap and water, in accordance with manufacturer recommendations. Reporting of suboptimal decontamination practice was not associated with assigned device compliance, however, except among providers and respiratory therapists. Conclusion/Application to Practice: Although perceptions of cleanliness and adherence to expected decontamination practices during routine use did not appear to influence compliance with assigned respirator use overall, this did predict compliance among providers and respiratory therapists, both of whom have nonfixed workstations. Practical and effective strategies to assure easy access to and availability of clean reusable respiratory protective devices are needed to facilitate their use in health care respiratory protection programs.
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Bisson, Kassandra R., Jennifer R. Won, Andrea Beharry, Michael D. Carter, Shaan Dudani, John G. Garratt, Jonathan M. Loree, Stephanie Snow, Stephen Yip und Brandon S. Sheffield. „Novel Approach to Proficiency Testing Highlights Key Practice Variations in Cancer Biomarker Delivery“. Journal of Molecular Pathology 5, Nr. 1 (05.01.2024): 1–10. http://dx.doi.org/10.3390/jmp5010001.
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Biomarkers are fundamental to modern oncology practice, forming a close link to pathology practice. Pathology results must be accurate, timely, comprehensive, and comprehendible. External proficiency testing is a key tool in maintaining biomarker quality. Here, we demonstrate the feasibility and utility of a novel end-to-end proficiency testing exercise exploring accuracy, turnaround time, and communication. Challenge specimens were made using resected colon cancer tissue, each paired with a fictional clinical vignette, and distributed to participants who were asked to provide all molecular testing required and return a final report for each case upon completion. Reports were redistributed to an assessor team including medical oncologists, each of whom was asked to recommend a systemic therapy based on each lab’s biomarker report. Participants were graded based on their ability to guide oncologists to the correct treatment. Eight laboratories participated. Three laboratories were found to have suboptimal results, two leading oncologists to incorrect therapeutic prescriptions, and one withdrawn. Turnaround time ranged from 6 to 86 days (median 24). Substantial qualitative reporting differences were identified. This study demonstrates the feasibility of end-to-end proficiency testing. The approach provides considerable value beyond analytic accuracy, including specimen management, turnaround time, and communication of results. Results suggest that reporting differences may lead to treatment disparities. This style of quality assurance will help reinforce good practices critical to the delivery of precision cancer care.
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O'Dwyer, Paul, Viveka Guzman, Emma Wallace und Frank Doyle. „A scoping review protocol of non-verbal communication utilised in peri-interventive dental and medical procedures“. HRB Open Research 5 (07.07.2022): 49. http://dx.doi.org/10.12688/hrbopenres.13373.1.
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Introduction: Dental operative procedures, by their interventive nature, impede the opportunity for peri-intervention verbal communication between patients and clinicians. This can impair trust, consent, and shared decision making with the potential of adversely affecting patient dignity, and potentially resulting in suboptimal clinical outcomes. This scoping review aims to interrogate the literature concerning non-verbal communication methods used in dental and medical practices during peri-interventive procedures, in aiding communication between clinician and patient. We will also ascertain how these align with the Limited Capacity Model of Motivated Mediated Message Processing (LC4MP) communication theory. Methods: The framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews, will be used to guide this scoping review and reporting methodology. Selected electronic databases (Medline, Embase, Cochrane Library and Scopus), PsychInfo, CINAHL and grey literature sources will be searched. Inclusion criteria are: articles written in the English language, publications between 2000 and 2020, peer-reviewed empirical studies, with either qualitative or quantitative data, mixed methods, reviews, book chapters and grey literature with a principal focus on non-verbal communication in the healthcare setting. A narrative synthesis will be conducted, with results reported according to elements of LCM4P theory: cognitive load, motivated messaging, message processing and memory. Conclusion: This scoping review will contribute to our methodological and theoretical understanding of the use of non-verbal communication strategies in clinical settings.
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Ramautar, Vijanti, Sergio España und Siamak Farshidi. „Navigating the Complex ESG Accounting Landscape: Engineering a Method Selection Framework“. Complex Systems Informatics and Modeling Quarterly, Nr. 38 (30.04.2024): 1–26. http://dx.doi.org/10.7250/csimq.2024-38.01.
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Environmental, social, and governance accounting (ESGA) aids organizations in achieving their sustainability goals through continuous improvement. Suitable method selection is crucial to prevent rework, additional expenses, trivial outcomes, and reduced confidence in sustainability practices. The current ESGA method selection process lacks comprehensive consideration of alternatives and criteria, occasionally resulting in suboptimal choices. This work aims to achieve optimal ESGA by engineering a method selection framework. The research approach is based on the design cycle, where engineering decisions are informed by empirical evidence. The main findings are that the framework, which includes a decision model and a supporting information system, can reduce the chances of organizations selecting an unsuitable method, whilst sparing decision-making managers time and effort. Firstly, the reusable elements of the framework can help managers of any organization select a suitable method more efficiently since they do not have to produce these elements themselves. Secondly, the results demonstrate how selection frameworks and tools can aid organizations in navigating the complex ESG accounting landscape. Lastly, this study lowers the barrier for organizational impact management; in particular, for measuring and reporting ESG impact, which is a rigorous assessment of the organization’s progress towards sustainable development goals.
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Boehmer, Kasey R., Kathleen H. Pine, Samantha Whitman, Paige Organick, Anjali Thota, Nataly R. Espinoza Suarez, Christina M. LaVecchia et al. „Do patients with high versus low treatment and illness burden have different needs? A mixed-methods study of patients living on dialysis“. PLOS ONE 16, Nr. 12 (28.12.2021): e0260914. http://dx.doi.org/10.1371/journal.pone.0260914.
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Background Approximately 750,000 people in the U.S. live with end-stage kidney disease (ESKD); the majority receive dialysis. Despite the importance of adherence to dialysis, it remains suboptimal, and one contributor may be patients’ insufficient capacity to cope with their treatment and illness burden. However, it is unclear what, if any, differences exist between patients reporting high versus low treatment and illness burden. Methods We sought to understand these differences using a mixed methods, explanatory sequential design. We enrolled adult patients receiving dialysis, including in-center hemodialysis, home hemodialysis, and peritoneal dialysis. Descriptive patient characteristics were collected. Participants’ treatment and illness burden was measured using the Illness Intrusiveness Scale (IIS). Participants scoring in the highest quartile were defined as having high burden, and participants scoring in the lowest quartile as having low burden. Participants in both quartiles were invited to participate in interviews and observations. Results Quantitatively, participants in the high burden group were significantly younger (mean = 48.4 years vs. 68.6 years respectively, p = <0.001). No other quantitative differences were observed. Qualitatively, we found differences in patient self-management practices, such as the high burden group having difficulty establishing a new rhythm of life to cope with dialysis, greater disruption in social roles and self-perception, fewer appraisal focused coping strategies, more difficulty maintaining social networks, and more negatively portrayed experiences early in their dialysis journey. Conclusions and relevance Patients on dialysis reporting the greatest illness and treatment burden have difficulties that their low-burden counterparts do not report, which may be amenable to intervention.
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McGovern, Margaret M., Marta Benach, Sylvan Wallenstein, Joe Boone und Ira M. Lubin. „Personnel Standards and Quality Assurance Practices of Biochemical Genetic Testing Laboratories in the United States“. Archives of Pathology & Laboratory Medicine 127, Nr. 1 (01.01.2003): 71–76. http://dx.doi.org/10.5858/2003-127-71-psaqap.
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Abstract Context.—It has been suggested that specific regulation of laboratories performing genetic testing may be needed to ensure standards and quality assurance, and to safeguard the rights of patients with regard to confidentiality and providing informed consent. Previously, a comprehensive analysis of current practices of molecular genetic testing laboratories was conducted, the results of which have assisted in the assessment of the need for regulation and its impact on access to testing. However, a study designed to determine clinical laboratory practices with regard to biochemical genetic testing has not been carried out. Objective.—To collect and analyze data regarding availability of clinical biochemical genetic testing, personnel standards, and laboratory quality assurance practices. Design.—A mail survey of biochemical genetic testing laboratory directors and assignment of a quality assurance score based on responses to genetic testing process items. Setting.—Hospital-based, independent, and research-based biochemical genetic testing laboratories in the United States. Participants.—Directors of biochemical genetic testing laboratories (n = 133; response rate 68.5%). Main Outcome Measure.—Laboratory process quality assurance score based on the standards defined by the American College of Medical Genetics Laboratory Practice Committee. Results.—Personnel qualifications varied, although all directors had doctoral degrees. The mean quality assurance score was 77% (range 28%–100%). Higher scores were associated with the following variables: test director having an MD degree versus PhD degree (P = .002), director board certification in biochemical genetics (P = .002), research and hospital laboratory versus independent laboratory setting (P < .001), and participation in a proficiency testing program (P = .03). Twelve percent of participants had a confidentiality policy, and 19% required informed consent before testing. Conclusion.—The finding that a number of laboratories had quality assurance scores that may reflect suboptimal laboratory practices, particularly with regard to reporting practices, suggests that personnel qualification and laboratory practice standards may be in need of improvement to ensure quality in clinical biochemical genetic testing laboratories, as well as the appropriate clinical use of the test results.
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Yilma, Mengistu, Girma Taye und Workeabeba Abebe. „Magnitude of standard precautions practices among healthcare workers in health facilities of Low and Middle Income Countries: A systematic review and meta-analysis“. PLOS ONE 19, Nr. 4 (30.04.2024): e0302282. http://dx.doi.org/10.1371/journal.pone.0302282.
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Background Standard precautions are the minimum standard of infection control to prevent transmission of infectious agents, protect healthcare workers, patients, and visitors regardless of infection status. The consistent implementation of standard precautions is highly effective in reducing transmission of pathogens that cause HAIs. Despite their effectiveness, compliance, resources, patient behavior, and time constraints are some of the challenges that can arise when implementing standard precautions. The main objective of this meta-analysis was to show the pooled prevalence of safe standard precaution practices among healthcare workers in Low and Middle Income Countries (LMICs). Methods A systematic review and meta-analysis was conducted for this study. We systematically searched observational study articles from PubMed Central and Google Scholar. We included articles published any year and involving healthcare workers. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The random effect model was used to estimate the pooled prevalence. The meta-analysis, sensitivity analysis, subgroup analysis, and publication bias (funnel plot, and Egger’s tests) were conducted. Results A total of 46 articles were included in this study. The pooled prevalence of standard precautions practices among healthcare workers in LMICs was 53%, with a 95% CI of (47, 59). These studies had a total sample size of 14061 with a minimum sample size of 17 and a maximum sample size of 2086. The majority of the studies (82.6%) were conducted in hospitals only (all kinds), and the remaining 17.4% were conducted in all health facilities, including hospitals. Conclusions The pooled prevalence of standard precautions practices among healthcare workers in LMICs was suboptimal. The findings of this study can have substantial implication for healthcare practice and policy making by providing robust evidence with synthesized and pooled evidence from multiple studies. Trial registration Registered on PROSPERO with record ID: CRD42023395129, on the 9th Feb. 2023.
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Carabaza, Ana Moyeda, Mary Murimi, Alemneh Kabeta Daba und Jessie Vipham. „Factors Associated With Recommended Complementary Feeding Practices Among Children in Sidama and Oromia Regions in Ethiopia“. Current Developments in Nutrition 5, Supplement_2 (Juni 2021): 164. http://dx.doi.org/10.1093/cdn/nzab035_072.
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Abstract Objectives To determine complementary feeding practices (CFP) among 6-to-23-month-old children and to identify associations between maternal and household characteristics with CFP. Methods Cross-sectional study conducted among rural communities located within the Sidama and Oromia regions in Ethiopia. Pairs of mothers and their children (N = 190) were randomly selected to participate in the survey. Data was collected using the WHO Infant and Young Child Feeding indicators, Household Food Insecurity Access Scale, and Knowledge on CFP. Multivariate logistic regressions were used to analyze factors associated with CFP. Results Most (87.4%) of the children achieved minimum meal frequency, while only 27.4% achieved minimum dietary diversity (MDD) and 26.8% minimum acceptable diet (MAD). Majority (80%) of the households were food insecure, with 40% of the households reporting severe food insecurity. Half (50.0%) of participating mothers showed poor levels of knowledge on CFP. Children of employed mothers were more likely to meet MDD (P = .014) and achieve MAD (P = .034). Furthermore, children of mothers that had adequate knowledge on the recommended CFP were more likely to achieve MDD (P < .001) and MAD (P < .001). In contrast, children living in households with an estimated annual income lower than $254 dollars were less likely to achieve MDD (P < .05) and MAD (P < .05). Similarly, children living in households with moderate to severe levels of food insecurity were less likely to achieve MDD (P = .003 and P = .012, respectively) and MAD (P = .005 and P = .023, respectively). Conclusions Complementary feeding practices were suboptimal in the Sidama and Oromia region in Ethiopia. Low household income and food insecurity seem to hinder the achievement of MDD and MAD, while maternal employment and knowledge on CFP contributed to a diversified and adequate diet among children. Thus, policies and interventions that target poverty, food insecurity, maternal unemployment, and nutrition education are necessary for the improvement of CFP. Funding Sources United States Agency for International Development (USAID) Bureau for Food Security as part of Feed the Future Innovation Lab for Livestock Systems.
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Aybars, Aslı. „The Relationship Between Institutional Investment and Earnings Management“. International Journal of Corporate Finance and Accounting 1, Nr. 1 (Januar 2014): 1–21. http://dx.doi.org/10.4018/ijcfa.2014010101.
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The emergence of corporate scandals at the end of the 20th and beginning of the 21th century raised doubts regarding the integrity of financial reporting and the soundness of firms' corporate governance practices. The practice of earnings management is considered to be one of the important causes of these scandals due to its harm to the transparency and quality of financial statements. The discretion exercised by managers in accounting result in agency costs arising from the mismatch between the goals and desires of the principle and the agent causing investors to make suboptimal decisions. The recent surge in institutional investors' shares and associated degree of activism increased their importance as an external control mechanism of corporate governance. Accordingly, the primary purpose of this study is to evaluate the role of these investors on earnings management and alignment of the interests of owners and managers within the context of agency theory. Consequently, two main hypotheses; namely, active monitoring and managerial myopia induced by institutional investors are tested by panel data analysis utilizing data belonging to the firms listed on Borsa Istanbul during the 7 year period between 2005 and 2011, inclusive. The absolute value of discretionary accruals obtained from the performance adjusted cross-sectional industry based accrual model proposed by Kothari, Leone and Wasley (2005) is used as the proxy of earnings management to evaluate whether the presence of institutional investors mitigate or stimulate managers' discretionary accounting practices. Additionally, further analysis is conducted to evaluate the existence of monitoring and clientele effects to better interpret the direction of the relationship between the associated variables of interest.
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Grimmond, T. „UK safety-engineered device use: changes since the 2013 sharps regulations“. Occupational Medicine 69, Nr. 5 (Juli 2019): 352–58. http://dx.doi.org/10.1093/occmed/kqz087.
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Abstract Background The 2013 UK sharps safety regulations require healthcare facilities to use safety-engineered devices (SEDs) to protect staff. The recent increase in UK-reported occupational exposures could indicate increased reporting or increased exposures from suboptimal SED use. Aims To ascertain SED use through examination of sharps container contents in a sample of UK hospitals. Methods Reusable sharps containers (RSCs) were selected from seven UK hospitals in 2013 and seven different hospitals in 2016. At licensed processing facilities, the operator, wearing protective apparel, decanted RSCs, separated hollow-bore needles (HBNs) from other sharps and enumerated HBNs into capped/uncapped non-SEDs, activated/non-activated/tampered SEDs, and blunt draw-up SEDs. Probability, risk ratios (RRs) and 95% confidence limits (95% CLs) were calculated using WinPepi v2.78. Results In 2013 and 2016, respectively, 2545 HBNs were categorized from 22 RSCs versus 2959 HBNs from 33 RSCs; 70% of HBNs were SEDs versus 93% (P < 0.001; RR 1.33; CL 1.30–1.37); 32% of activatable HBNs were not activated versus 22% (<0.001; 0.67; 0.60–0.76); 41% of HBNs were discarded ‘sharp’ versus 20% (<0.001; 0.48; 0.44–0.52); 25% of HBNs were uncapped needles versus 6% (<0.001; 0.22; 0.19–0.26); 5% of HBNs were capped needles versus 1% (P > 0.05); and 1% of SEDs were tampered with in both years (P > 0.05). Hospital practices varied widely. Conclusions SED use and activation have increased significantly since 2013. Of concern is that in 2016, 22% of SEDs were non-activated and 20% of sharps were discarded ‘sharp’. Increased training in SED handling, assiduous adherence to safe sharps work practices and a higher level of individual safety-ownership are indicated.
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Mitchell, Alex J., Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza und Brendon Stubbs. „Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake“. British Journal of Psychiatry 205, Nr. 6 (Dezember 2014): 428–35. http://dx.doi.org/10.1192/bjp.bp.114.147629.
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BackgroundThere is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening.AimsTo conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health.MethodMajor electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety.ResultsWe identified 24 publications reporting breast cancer screening practices in women with mental illness (n = 715 705). An additional 5 studies investigating screening for those with distress (n = 21 491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66–0.77), mood disorders (OR = 0.83, 95% CI 0.76–0.90) and particularly SMI (OR = 0.54, 95% CI 0.45–0.65). No disparity was evident among women with distress alone.ConclusionsRates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.
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Warren, Graham W., Jamie S. Ostroff, Timothy Mullett, Robert Adsit, Jessica Burris, Audrey Darville, Michael C. Fiore et al. „Just ASK: A quality improvement project to enhance smoking assessment and treatment.“ Journal of Clinical Oncology 41, Nr. 16_suppl (01.06.2023): 6571. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.6571.
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6571 Background: Persistent smoking after cancer diagnosis causes adverse clinical outcomes. ASCO and other organizations view smoking assessment and treatment as indicators of high-quality cancer care. Yet, adoption of clinical practice guidelines like the 3As (Ask, Advise and Assist) for smoking assessment and treatment has been slow and inconsistent in cancer care settings. Methods: Led by the American College of Surgeons Cancer Programs’ Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), the “Just ASK” national quality improvement project focuses on enhancing smoking assessment and treatment in cancer care settings. All CoC/NAPBC programs (n~2000) were invited to participate, which consisted of educational webinars, online resources, and 3 online surveys (baseline, 6- and 12-month) collecting information on smoking assessment and treatment practices, plus other variables (e.g., organizational priority, implementation barriers). Program participation was incentivized by fulfillment of accreditation standards. Results: In total, 776 programs (731 CoC, 45 NAPBC), participated. At baseline, most programs strongly endorsed the importance of addressing smoking within cancer care and the majority of programs reported routinely assessing smoking (90%) and advising all patients reporting current smoking to quit (71%). However, routine delivery of evidence-based smoking cessation assistance (e.g., quitline referral, cessation medications, counseling services) was low (all < 30%). Program retention was excellent (91%). As shown in the table, the 12-month follow-up revealed marked improvements in evidence-based Ask, Advise and Assist, practices. Conclusions: At enrollment, the importance of addressing smoking was evident and high rates of smoking assessment were reported. At 12-month follow-up, marked improvement was reported in all quality indicators of the 3As. These findings guided the sharing of strategies for improving patient assessment, clinical workflow and documentation. Suboptimal delivery of smoking cessation assistance persisted despite overall improvements, which highlight persistent challenges and opportunities for implementing smoking assessment and treatment in cancer care settings. [Table: see text]
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Tran, Dat, Maureen Cassidy, Tara Buehring und Rebecca Pierce. „1253. Healthcare-Associated Transmission of Burkholderia cepacia Complex Associated With Extrinsically Contaminated Nasal Spray“. Open Forum Infectious Diseases 5, suppl_1 (November 2018): S381—S382. http://dx.doi.org/10.1093/ofid/ofy210.1086.
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Abstract Background Burkholderia cepacia complex (Bcc) species can contaminate medical devices and water-based products, resulting in outbreaks of healthcare-associated infections. In March 2018, we investigated a cluster of 20 patients with a sinus culture positive for Bcc seen at two affiliated ENT clinics in Oregon over a 2-month period, based on reporting by a laboratorian in a central laboratory external to the clinics. Methods We conducted an epidemiologic investigation to identify potential causes for an apparent outbreak of Bcc, including review of health records and microbiologic reports, site visits, staff interviews, and cultures of common equipment and products. Results 20 patients (9 were female; age range 10 to 72 years, median age 54.5 years) had new positive Bcc cultures from the sinus. The absence of cystic fibrosis, immunosuppression or sinonasal polyposis in all patients, scant growth of Bcc in most cases with isolation of another organism in some, and the use of Bcc-directed antibiotics in a minority of patients suggested the presence of a contamination source. All patients had received lidocaine/phenylephrine (L/P) via multidose nasal spray atomizers prior to endoscopically-directed sinus cultures. Site visits revealed improper medication dispensing and storage practices (e.g., no expiration date for L/P stock, storage of L/P-containing atomizers at room temperature), and inadequate instrument reprocessing and environmental cleaning. Cultures of L/P in 2/2 in-use atomizers and 1/1 opened stock bottle, as well as swabs of 3/3 spray mechanisms, grew Bcc. Cultures of L/P from the unopened, refrigerated stock bottle, a flexible endoscope and a rigid endoscope did not yield Bcc. No negative clinical sequelae in these patients were reported. Conclusion Contaminated multidose L/P nasal spray with Bcc resulted in nosocomial transmission at these clinics. This investigation highlights the important role of laboratorians in detecting Bcc contamination events that lead to colonization, and suboptimal reporting by clinicians in the outpatient setting. It also raises the question of how often such contamination events go undetected. Injection safety training needs to be broadened to “medication administration safety” training as one and only principles could have prevented this incident. Disclosures All authors: No reported disclosures.
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Goel, Varun, Dinesh Kumar, Raghavendra Lingaiah und Sarman Singh. „Occurrence of Needlestick and Injuries among Health-care Workers of a Tertiary Care Teaching Hospital in North India“. Journal of Laboratory Physicians 9, Nr. 01 (Januar 2017): 020–25. http://dx.doi.org/10.4103/0974-2727.187917.
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ABSTRACT Introduction: Occupational hazards such as accidental exposure to sharp, cuts, and splashes are common among health-care workers (HCWs). Aims and Objectives: To determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. The second aim was to know the baseline antibody levels against hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) immediately after these accidents. Methods: An observational prospective study was done in the HCWs of a tertiary care academic health organization of North India from January 2011 to December 2013. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline HBV, HCV, and HIV serum markers. The exposed HCWs were followed up and repeat testing was done after 3–4 weeks for seroconversion up to 6 months. Results: A total of 476 injuries were reported. Needlestick injury of fingers was the most common. Doctors were found to have the highest exposure rate (73.7%) distantly followed by nurses (19.1%). A significant number of the HCWs (125, 26.3%) vaccinated in past had hepatitis B surface antibody (anti-HBs) titers ≥10 mIU/mL (protection defined as anti-HBs level ≥10 mIU/ml). Only 44 sources were found to be seropositive (11 for HIV, 9 for HCV, and 24 for HBV). No seroconversion was seen in any of the exposed HCWs after 6 months. Conclusions: The incidence of needlestick and sharp injuries is most often encountered in emergency wards. Anti-HBs titers were suboptimal in many of the HCWs requiring a booster dose of HBV vaccination.
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Logie, Carmen H., Moses Okumu, Isha Berry, Miranda Loutet, Robert Hakiza, Daniel Kibuuka Musoke, Simon Mwima, Uwase Mimy Kiera, Clara MacNamee und Peter Kyambadde. „Social contextual factors associated with lifetime HIV testing among the Tushirikiane urban refugee youth cohort in Kampala, Uganda: Cross-sectional findings“. International Journal of STD & AIDS 33, Nr. 4 (05.02.2022): 374–84. http://dx.doi.org/10.1177/09564624211069236.
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Background Urban refugee youth may live in social contexts characterized by structural drivers of HIV such as poverty and violence. Knowledge gaps remain regarding HIV testing practices among urban refugee youth, despite the increasing trend toward refugee settlement in urban contexts. This study examined social contextual factors associated with lifetime HIV testing among urban refugee youth in Kampala, Uganda. Methods We conducted a community-based study with a peer-recruited cohort of urban refugee youth aged 16–24 years living in Kampala’s informal settlements, and present baseline cross-sectional findings. We conducted descriptive statistics and logistic regression to examine socio-demographic (e.g., gender and age), material (e.g., income insecurity and education), relational (e.g., social support), and symbolic contexts (e.g., HIV-related stigma and intimate partner violence (IPV]) associated with lifetime HIV testing. Results Participants ( n = 450) had a mean age of 20.4 years (standard deviation: 2.4 years), most lived in Uganda for 1–5 years (53.2%), and less than half reported lifetime HIV testing (43.4%). In multivariable analyses, odds of lifetime HIV testing were higher among youth with secondary school education or higher (adjusted odds ratio (aOR]: 2.30, 95% confidence interval (CI]: 1.27–4.17), currently employed (aOR: 1.79, 95% CI: 1.03–3.10), and reporting IPV (aOR: 3.61, 95% CI: 1.43–9.10). Having children was marginally associated with HIV testing (aOR: 2.17, 95% CI: 0.98–4.81, p = 0.052). Conclusions Findings demonstrate suboptimal HIV testing and the importance of tailored strategies to reach urban refugee youth who are unemployed and have limited formal education. There is a need to meaningfully engage urban refugee youth to create enabling environments for sexual health.
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Tsangaris, Elena, Rakasa Pattanaik, Joanna O'Gorman, Jessica Means, Noah Sarucia, Elizabeth Frank, Laura Stewart Dominici, Michael J. Hassett, Maria Edelen und Andrea Pusic. „Outcomes in breast cancer from the patient perspective: Development of an innovative, user-centered platform for collection and reporting of patient-reported data.“ Journal of Clinical Oncology 39, Nr. 28_suppl (01.10.2021): 188. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.188.
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188 Background: Transition towards a patient-centered healthcare model has been recognized as an important step towards improving the quality and coordination of breast cancer care. Although evidence suggests that patient self-reporting of quality of life improves clinical care, there are significant barriers to successful collection and use of patient-reported data (PRD) including a lack of a technology designed to fully engage patients and providers, limited electronic health record (EHR) integration, and suboptimal clinical implementation strategies. To address this, our team developed imPROVE, an innovative and customizable patient-reported data (PRD) collection platform consisting of a patient web-application and a clinician portal. Methods: This study was performed as a quality improvement initiative at Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH). Multiple perspectives were sought from key stakeholders to ensure that the content and design of the platform target the needs of the end-users and garners the latest in technological advances. Development and testing were performed using best practices in user-centered design and agile development, and iterative programming sprints followed by stakeholder feedback and testing. Content was evaluated using probing questions about relevance, comprehensiveness, and clarity. Design was assessed through feedback about the look and feel of the platform and its usability. Results: A multidisciplinary team of 28 stakeholders in the field of breast cancer care, patient-reported outcomes research and value-based healthcare was assembled. Recurring group meetings (n = 8), individual patient interviews (n = 23), and two focus groups with the DF/HCC Breast Cancer Advocacy Group, were conducted. The resultant application is a hybrid mHealth application that is supported by iOS and Android and is comprised of five screens (myCare, myStory, myResources, myCommunity, myNotes). Patients are provided written and graphical displays of their PRD as well as tailored resources that are customized depending on their type and stage of treatment. The clinician portal is comprised of an overview table listing all patients enrolled for each individual clinician, as well as individual patient profiles demonstrating demographic, clinical, and outcomes data. Conclusions: imPROVE has the potential to create a paradigm shift in the delivery of care for breast cancer patients. Next steps will include implementation of imPROVE within the breast oncology and plastic surgery services at DFCI and BWH.
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Malkoff, Nicolas, Brigette Cannata, Dania B. Johnson, Deborah Choe, Maxwell B. Johnson und Justin Gillenwater. „765 Charting a Path to Enhanced Burn Care: Standardized Note Templates and Resident Perspectives“. Journal of Burn Care & Research 45, Supplement_1 (17.04.2024): 238. http://dx.doi.org/10.1093/jbcr/irae036.307.
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Abstract Introduction Common Data Elements (CDE) are standardized questions with a set of limited responses that are used systematically across multiple sites. They have been proposed as a means of standardizing clinical documentation and improving interinstitutional data sharing. Our previous work identified 33 CDEs relevant to burn care based on published recommendations and found that they were documented inconsistently in our burn center. Our aim was to assess current charting practices and attitudes toward CDE-focused note templates at our institution as part of a larger effort to standardize and improve clinical documentation quality. Methods Four note templates incorporating 33 CDEs were prepared for inpatient history and physical notes (H&P), floor daily progress notes (PN), intensive care unit progress notes (ICU PN), and discharge summary notes (DC). Prior to their implementation, residents who previously rotated through the burn unit from 1/1/2023 to 9/4/2023 were administered a pre-template survey to assess their experiences and attitudes relating to charting with and without templates. Results were summarized using descriptive statistics. Results The pre-template survey was completed by 14 residents. The majority reported spending 15-30 minutes on average documenting H&Ps (57%), ICU PNs (57%), and DC summaries (64%), while 86% spent less than 15 minutes documenting floor PNs. When asked to rate the burden of charting, 50% reported a 7 or higher on a 10-point scale. Only 7% were 90% confident or higher that they commonly document all 33 CDEs. Most (57%) claimed to record fewer than 20 of the CDEs on average. Assessing resident attitudes towards note templates, it was found 86% agreed or strongly agreed that they would reduce the time spent and the burden of charting. When asked if templates would improve their wellness, 57% agreed or strongly agreed. While 72% of residents agreed or strongly agreed that templates would help them more thoroughly evaluate patients, only 43% thought note templates would provide educational value. Conclusions Current charting practices in our burn unit are time-consuming and burdensome for rotating residents, which may contribute to suboptimal acquisition and reporting of critical data elements. Most residents expressed positive attitudes towards the implementation of standardized note templates. Future directions for this quality improvement initiative include implementing note templates to study the effects this has on the inclusion of CDEs in patient notes and residents' charting experiences. Applicability of Research to Practice Readers may consider the methodology and results of this study when evaluating charting practices at their own institutions.
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Hessels, Amanda, und Jingwen Guo. „A Large-Scale Snapshot of Standard Precaution Adherence: “Do as I Say Not as I Do”“. Infection Control & Hospital Epidemiology 41, S1 (Oktober 2020): s454—s455. http://dx.doi.org/10.1017/ice.2020.1127.
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Background: Nearly 1 in 25 patients has a hospital infection at any given time, and 1 in 25 nurses suffers and bloodborne exposure every year. Basic procedures, termed standard precautions (SP) may prevent these outcomes, but they are not often used by healthcare workers. Unfortunately, data are largely limited by self-reporting because no standardized tools exist to capture observational data. Objective: The specific aim of this study was to describe the relationship between self-reported and observed SP adherence. Methods: This multisite, cross-sectional study included 2 elements: (1) surveys of nurses in US hospital units on perceptions of patient safety climate and reported SP adherence and (2) observational SP data. Survey data included 12 items on SP practices (eg, “how often you perform hand hygiene before touching a patient”) and 10 items on SP environment (eg, “my work area is not cluttered”), rated on a 5-point scale from “never” to “always” or from “strongly disagree” to ”strongly agree,” respectively. Using novel tools developed and previously pilot tested, we recruited and trained hospital-based staff on observational surveillance methodology to foster the National Occupational Research Agenda goals. The 10 observational SP items represented the following 4 categories: (1) hand hygiene, (2) personal protective equipment (PPE), (3) sharps, and (4) soiled linen handling. Observations of healthcare worker–patient interactions followed training and interrater reliability testing. All data were aggregated, and analyses were conducted at the unit level. Pearson correlation coefficients were calculated to determine the relationship between reported and observed SP practices (level of significance, P < .05). Results: In total, 6,518 SP indications were observed and 500 surveys were collected from nurses on 54 units in 15 hospitals from 6 states. The final analytic sample included 5,285 SP indications and 452 surveys from 43 units in 13 hospitals that provided both types of data. Most indications observed were of HH (72.6%). Overall SP adherence was 64.4%. In descending order, adherence rates were PPE (81.8%), sharps handling (80.9%), linen handing (68.3%), and hand hygiene (58.3%). The aggregate of positive self-reported SP practices was 95.8%, and 77.3% rated unit environment for SP adherence positively. There was no correlation between observed adherence and reported adherence (r (41) = (−).024, P = .879). Conclusions: In this study, the largest study of SP adherence, observed practice was grossly suboptimal, particularly hand hygiene. Conversely, nurses on the same units rated adherence as high, despite the environment. In combination, both sources of surveillance data provide valuable and actionable insight to target interventions.Funding: and Disclosure Amanda Hessels reports that she is the principal investigator for the following studies: “Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes” (grant no. DHHS/CDC/NIOSH 1K01OH011186 to Columbia University) and “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial” (AHRQ grant no. R18: 1R18HS026418 to Columbia University).
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Caniza, M., J. Contreras, G. Santana, G. Mentor, P. Gassant, J. Gautier, M. Homsi et al. „#68: Outcomes of Establishing Infection Care and Prevention Standards in Pediatric Oncology Units in Three Hospitals on the Island of Hispaniola“. Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (01.03.2021): S21—S22. http://dx.doi.org/10.1093/jpids/piaa170.068.
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Abstract Background Survival of children with cancer goes hand-on-hand with cancer treatment and improvement of infection care and prevention (ICP). The Hispaniola Island project aims to improve the quality of care and survival for children with cancer in 3 pediatric cancer units by implementing ICP programs in these units with the long-term plan of absorbing such programs into the structure of the hospital care delivery process. We report the 1-year outcomes of establishing ICP standards in pediatric oncology units. Methods We followed the general steps for health promotion when engaging with the new sites, which are: (1) planning the process; (2) conducting a situational assessment; (3) identifying objectives; (4) identifying strategies; (5) developing indicators; and (6) tracking progress. Results The planning process included discussions with local leadership, timeline plans for ICP interventions, data gathering, and decision-making. Three healthcare providers were identified and trained through the St. Jude Global educational programs as local ICP champions and institutional contacts. Through site visits and focus group discussions, each unit developed a team consisting of the local ICP champion and an infection preventionist to lead the local unit ICP improvement. Situational analysis revealed no surveillance in infections, suboptimal practices hand hygiene, central-line management, and mechanical ventilation. To guide improvement, the local ICP team begun collecting surveillance of ICP indicators, such as infection rates, with monthly reporting to and mentoring by the St. Jude team. Since February 2019, the 3 sites ICP teams prospectively captured 17,532 patient-days (median: 365 patient-days per month; range: 209–573), 384 central-line days (median: 15 central-line days per month; range: 0–33), identified 278 healthcare-associated infections in 159 patients; monitored hand hygiene through direct (observations) and indirect (alcohol gel consumption) methodologies and provided monthly education sessions in ICP to hospital staff, patients and their families. Early results demonstrate the utility of a dedicated ICP team using a standardized ICP reporting system to guide focused improvement of care delivery. Conclusions Improving ICP standards is essential for any intervention which aims to improve the survival of children with cancer. A step-wise procedure in building local teams, engaging hospital leaders, evaluating on-site resources, and introducing methods to collect infection rates and other quality indicators for healthcare delivery will provide evidence-based guidance to improve the safety of cancer care delivery. We hope that the improvement could be sustained in the longer run by incorporating the created structure and processes to the hospital system.
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Kelamane, Santosha, Srinath Satyanarayana, Sharath Burugina Nagaraja, Vikas Panibatla, Ramesh Dasari, Rajeesham, Amera Khan und Vishnuvardhan Kamineni. „Engaging Informal Private Health Care Providers for TB Case Detection: Experiences from RIPEND Project in India“. Tuberculosis Research and Treatment 2021 (22.06.2021): 1–10. http://dx.doi.org/10.1155/2021/9579167.
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Background. Informal (unqualified) health care providers are an important source of medical care for persons with presumptive TB (PPTB) in India. A project (titled RIPEND) was implemented to engage informal providers for the identification of PPTBs and TB patients in 4 districts of Telangana State, India, during October 2018-December 2019 project period. Engagement involved sensitizing the informal providers about TB, providing them financial incentives to identify PPTBs, and linking these PPTBs to diagnostic and treatment services provided by the Government of India’s National TB Elimination Programme. Objectives. To describe (a) the characteristics of the informal providers, along with their self-reported practices on TB diagnosis, treatment, and challenges encountered by the RIPEND project staff in engaging them in the project and (b) the outputs and outcomes of this engagement. Methods. We used a combination of one-on-one interviews with informal providers, group interviews with RIPEND project staff, and secondary analysis of data available within the project’s recording and reporting systems. Results. A total of 555 informal providers were actively engaged under the project. The majority (87%) had a nonmedicine-related graduate degree and had been providing medical care for more than 10 years. Most (95%) were aware that a cough for 2 weeks or more is a symptom of pulmonary TB and that such patients should be referred for sputum-smear microscopy at a government health facility. Challenges in engaging the informal providers included motivating them to participate in the study, suboptimal mobile usage for referral services, and delays in providing financial incentives to them for referring PPTBs. During the project period (October 2018-December 2019), 8342 PPTBs were identified of which 1003 TB patients were detected and linked to TB treatment services. Conclusion. This project showed that engaging informal providers is feasible and that a large number of PPTB and TB patients can be identified through this effort. The Government of India should consider engaging informal providers for the early diagnosis of TB to reduce the missing TB cases in the country.
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Cooperberg, Matthew R., William Meeks, Raymond Fang, Franklin D. Gaylis, William J. Catalona und Danil V. Makarov. „Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US“. JAMA Network Open 6, Nr. 3 (02.03.2023): e231439. http://dx.doi.org/10.1001/jamanetworkopen.2023.1439.
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ImportanceActive surveillance (AS) is endorsed by clinical guidelines as the preferred management strategy for low-risk prostate cancer, but its use in contemporary clinical practice remains incompletely defined.ObjectiveTo characterize trends over time and practice- and practitioner-level variation in the use of AS in a large, national disease registry.Design, Setting, and ParticipantsThis retrospective analysis of a prospective cohort study included men with low-risk prostate cancer, defined as prostate-specific antigen (PSA) less than 10 ng/mL, Gleason grade group 1, and clinical stage T1c or T2a, newly diagnosed between January 1, 2014, and June 1, 2021. Patients were identified in the American Urological Association (AUA) Quality (AQUA) Registry, a large quality reporting registry including data from 1945 urology practitioners at 349 practices across 48 US states and territories, comprising more than 8.5 million unique patients. Data are collected automatically from electronic health record systems at participating practices.ExposuresExposures of interest included patient age, race, and PSA level, as well as urology practice and individual urology practitioners.Main Outcomes and MeasuresThe outcome of interest was the use of AS as primary treatment. Treatment was determined through analysis of electronic health record structured and unstructured clinical data and determination of surveillance based on follow-up testing with at least 1 PSA level remaining greater than 1.0 ng/mL.ResultsA total of 20 809 patients in AQUA were diagnosed with low-risk prostate cancer and had known primary treatment. The median age was 65 (IQR, 59-70) years; 31 (0.1%) were American Indian or Alaska Native; 148 (0.7%) were Asian or Pacific Islander; 1855 (8.9%) were Black; 8351 (40.1%) were White; 169 (0.8%) were of other race or ethnicity; and 10 255 (49.3%) were missing information on race or ethnicity. Rates of AS increased sharply and consistently from 26.5% in 2014 to 59.6% in 2021. However, use of AS varied from 4.0% to 78.0% at the urology practice level and from 0% to 100% at the practitioner level. On multivariable analysis, year of diagnosis was the variable most strongly associated with AS; age, race, and PSA value at diagnosis were all also associated with odds of surveillance.Conclusions and RelevanceThis cohort study of AS rates in the AQUA Registry found that national, community-based rates of AS have increased but remain suboptimal, and wide variation persists across practices and practitioners. Continued progress on this critical quality indicator is essential to minimize overtreatment of low-risk prostate cancer and by extension to improve the benefit-to-harm ratio of national prostate cancer early detection efforts.
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P., Rangachari, Dellsperger K.C., Fallaw D., Davis I., Sumner M., Ray W., Fiedler S., Nguyen T. und Rethemeyer R. „Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation“. Journal of Hospital Administration 7, Nr. 2 (28.03.2018): 36. http://dx.doi.org/10.5430/jha.v7n2p36.
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Background: In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from “limited use” of electronic health records (EHR) Medication Reconciliation (MedRec) Technology, to “meaningful use”. Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool, which, along with a Discussion Tool, was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1.Methods: Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health.Results: Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners’ importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated “Important” or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6)Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI.Conclusions: There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation.
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Ferhanoglu, Burhan, Marta Zerga, Mubarak Al-mansour, Tae Min Kim, Su-Peng Yeh, Yuqin Song, Amado J. Karduss et al. „Use of Positron Emission Tomography in Patients with Classical Hodgkin Lymphoma Outside of Europe and North America: Results from the International, Multi-Center, Retrospective B-Holistic Study“. Blood 138, Supplement 1 (05.11.2021): 1397. http://dx.doi.org/10.1182/blood-2021-145838.
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Abstract Background: Positron emission tomography-computed tomography (PET-CT) is used for staging and response assessment in classical Hodgkin lymphoma (cHL) and for evaluation and management of refractory/relapsed Hodgkin lymphoma (RRHL). According to the World Health Organization's Global Atlas of Medical Devices 2017 report, 92-95% of lower-middle and low-income countries have no PET/CT unit, and only 3% of upper-middle income countries have 1 PET scanner/million people, versus 29% of high-income countries. Real-world data on PET scan use in cHL and RRHL outside Europe and North America are limited. The B-CD30+ HOdgkin Lymphoma International Multi-center Retrospective Study of Treatment Pract Ices and Out Comes (B-HOLISTIC) study assessed real-world treatment practices and clinical outcomes in patients with stage IIB-IV cHL and RRHL in countries outside Europe and North America and imaging results are presented here. Methods: The B-HOLISTIC study retrospectively reviewed patients (≥18 years) with stage IIB-IV cHL or RRHL between 2010 and 2013. Patients initially diagnosed with cHL who progressed to RRHL during the study were included in both groups. Details of PET and CT scans at baseline and during/end of frontline/salvage treatment, were reported in both groups. Results: Overall, 1703 patients (cHL: 1598, RRHL: 426, both: 321) were enrolled (East Asia: 426, Latin America: 366, Middle East and South Africa: 694, Australia: 56, Russia: 161). Median follow-up was 5.4 and 4.4 years in the cHL and RRHL groups, respectively. PET and CT results for cHL and RRHL groups are shown in Tables 1 and 2, respectively. The proportion of patients with PET scan was 73.2% in the cHL group with a median (interquartile range [IQR]) frequency of 2.0 (2.0-4.0) and 72.3% in the RRHL group with a median (IQR) frequency of 3.0 (2.0-5.0). In both groups, the proportion of PET scans at baseline was lower (cHL: 54.4%; RRHL: 32.8%) than during/ end of frontline treatment (cHL: 85.8%; RRHL: 58.8%) and at relapse/refractory diagnosis (54.5%). In contrast, the proportion of CT scans was higher (cHL: 76.4%; RRHL: 79.1%), particularly at baseline (cHL: 66%; RRHL: 51.6%). The highest proportion of PET scans was reported in Australia and lowest in Russia. The highest proportion of CT scans was in Russia in the cHL group and in Australia and East Asia in the RRHL group, while the lowest was in Middle East and South Africa in both groups. The frequency of interim PET scans was low in both cHL and RRHL groups, and were rarely used in cHL surveillance. In the RRHL group, interim PET scans during the frontline therapy were higher after cycles 3-4 and 5-6 than after cycles 1-2. Deauville 5-point scale (5-PS) was used for PET assessment at interim treatment cycles, end of frontline/salvage treatment, relapse, and surveillance in both groups with increased scans reporting a 5-PS rating towards the end of treatment and surveillance. However, its overall use was suboptimal with a minority (<50%) reporting a specific Deauville score. Discussion and Conclusion: This study provides real-world evidence on PET use in cHL and RRHL outside Europe and North America, which is suboptimal. Although PET is part of standard care for cHL now, during 2010-2013 it was more commonly used only in RRHL, as reflected in the higher PET use in RRHL than cHL in this study. Lower overall PET use than CT and the regional differences may reflect the comparatively limited access and availability of PET, especially in low-income countries. Lower PET use at baseline may have been due to low accessibility of PET at the beginning of the study, which improved over time. Higher PET use at the end of frontline treatment in cHL is in line with the literature, and suggestive of its recognized benefits in guiding further treatment if used early in treatment. Lack of data on Deauville ratings could be because its use was uncommon during the time of the study. However, the increased Deauville score reporting towards the end of the study suggests a trend for its use. Overall, the low interim PET use, regional differences, and lack of data on use of Deauville rating in this study, suggest an existing gap in real-world practice and highlight the global inequities in access to PET. These findings suggest the need for upscaling numbers and access to PET scanners outside Europe and North America through careful planning and in-depth assessment of socioeconomic, demographic, and epidemiological circumstances of each country. Figure 1 Figure 1. Disclosures Ferhanoglu: Takeda Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees. Zerga: Takeda: Honoraria; Sandoz: Honoraria; Bristol Myers Squib: Honoraria; Jansen: Honoraria; Roche: Honoraria. Kim: Bayer: Consultancy, Membership on an entity's Board of Directors or advisory committees; BeyondBIO: Consultancy, Membership on an entity's Board of Directors or advisory committees; Boryung: Consultancy, Membership on an entity's Board of Directors or advisory committees; Hanmi: Consultancy, Membership on an entity's Board of Directors or advisory committees; GI CELL: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche/Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees; AstraZeneca-KHIDI: Research Funding; AstraZeneca/MedImmune: Consultancy, Membership on an entity's Board of Directors or advisory committees. Karduss: Takeda: Honoraria; Amgen: Honoraria; Janssen: Honoraria; Novartis: Membership on an entity's Board of Directors or advisory committees. Kwong: Amgen: Consultancy, Honoraria, Research Funding; Astellas: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; BeiGene: Consultancy, Honoraria, Research Funding; Bristol Myers Squibb: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Merck: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Gilead: Consultancy, Honoraria, Research Funding. Wu: Takeda: Current Employment, Current equity holder in publicly-traded company. Huang: Takeda: Current Employment, Current equity holder in publicly-traded company. Hertzberg: Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; MSD: Honoraria, Membership on an entity's Board of Directors or advisory committees.
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Lai, Catherine, Adam Bagg, Lindsay Gurska, Shelby Sullivan, Jeffrey Carter und Cherilyn Heggen. „Optimizing the Integration of Genetic Testing in AML Care in Community Practice: Insights from a Quality Improvement Initiative“. Blood 142, Supplement 1 (28.11.2023): 7277. http://dx.doi.org/10.1182/blood-2023-172976.
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Background The treatment landscape for acute myeloid leukemia (AML) is rapidly evolving, and with many of the more recently FDA approved treatments being targeted therapies, timely and actionable molecular and cytogenetic testing is critical to the management of AML patients. However, many challenges and barriers to optimal testing workflows impede clinicians' ability to integrate genetic testing in treatment decision-making. To improve quality care related to genetic testing in AML, we conducted a quality improvement (QI) study focused on evidence-based integration of genetic testing into routine practice for AML patients in community oncology clinics. Methods This QI initiative is comprised of baseline (N = 72) and follow-up provider surveys, and pre- and post-surveys of providers participating in small-group, team-based audit-feedback (AF) sessions across 5 community clinics. Survey questions were designed to assess knowledge, confidence, and experiences with genetic testing in AML. Care teams from each clinic, along with an expert AML oncologist and a hematopathologist, participated in AF sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Results Provider Surveys: Providers top reported challenges encountered with integrating genetic testing into routine practice include determining whether to begin treatment prior to receipt of genetic testing result (56%)and applying genetic testing results to treatment decision-making (29%). For patients with AML, 70% of providers stated they were likely to start treatment prior to receiving testing results. When asked to report routine molecular testing practice patterns, 72% of providers reported testing for FLT3 mutations, 62% for IDH1/2 mutations, 65% for TP53 mutations, and 63% for NPM1 mutations; with further suboptimal reported practices in the use of NGS panels (58%; average turnaround time 15 days) and PCR (52%; average turnaround time 8 days). Overall, providers reported a 56% satisfaction rate with the processes implemented in the clinic related to sample preparation, timely review, and turnaround time of molecular diagnostics testing reports. AF Sessions: Providers participating in the AF sessions also reported determining whether to begin treatment prior to receipt of molecular testing results, long turnaround times and deciding on the appropriate molecular tests as top barriers to integrating testing in routine AML care. Clinicians reported improvements in high/very high confidence in their ability to select appropriate genetic tests to order for patients with AML (35% to 50%) and select targeted therapies based on genetic test results for AML patients (34% to 59%). Care teams set goals to improve turnaround times and testing workflows with pathology partners, as well as to maximize opportunities for patients to receive AML therapies for their specific mutation profile. Action plans to achieve these goals include improve team skills in choosing guideline-based genetic testing methods and targeted therapies and collaborate among clinical teams to improve ordering workflow and diagnostic sample preparation for genetic testing. Follow-Up Surveys: In 90-day follow up surveys, 100% of clinic champions reported upshifts in patients with targetable driver mutations receiving guideline-recommended treatment based on genetic testing results, and 4/5 clinics reported improved selection of guideline-recommended genetic testing prior to treatment initiation for AML patients. Conclusions Through this QI initiative, clinical teams identified barriers to integrating genetic testing into routine AML care, creating and implementing action plans to optimize genetic testing workflows and guideline-recommended targeted therapy selection. While meaningful confidence and action plan gains were demonstrated, these data underscore clinical practice gaps to address in future initiatives to support the integration of evidence-based genetic testing into AML care, including integrated education sessions with clinicians and pathologists. Study Sponsor Statement The study reported in this abstract was funded by independent educational grants from AbbVie, Inc. and Astellas Pharma Global Development, Inc., who had no role in the study design, execution, analysis, or reporting.
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Manga, M. M., M. Ibrahim, U. M. Hassan, R. H. Joseph, A. S. Muhammad, M. A. Danimo, O. Ganiyu, A. Versporten und O. O. Oduyebo. „Empirical antibiotherapy as a potential driver of antibiotic resistance: observations from a point prevalence survey of antibiotic consumption and resistance in Gombe, Nigeria“. African Journal of Clinical and Experimental Microbiology 22, Nr. 2 (08.04.2021): 273–78. http://dx.doi.org/10.4314/ajcem.v22i2.20.
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Background: Empirical use of antibiotics is a standard practice in the treatment of infections worldwide. However, its over utilization without subsequent culture and antibiotic susceptibility testing could be a major driver of resistance.Over reliance on empirical antibiotherapy is common in most developing countries where antibiotic policies and availability or utilization of clinical microbiology laboratory are suboptimal. A standardized approach to point prevalence survey (PPS) on antimicrobial use (AMU) in hospitals was employed to assess the antimicrobial prescribing practices in Federal Teaching Hospital Gombe (FTHG), Nigeria.Methodology: A PPS was conducted in April 2019 at FTHG by recruiting all in-patients present in the hospital on the day of survey. Data obtained from patients’ records included details of the type and indication for antibiotherapy. A customized online application developed by the University of Antwerp (www.global-pps.be) was used for data-entry, validation, analysis and reporting.Results: Of the total 326 patients who were on admission on the day of survey, 70.6% and 73.4% were on at least one antibiotic in adult and paediatric wards respectively. Most commonly used antibiotics include beta lactams such as cephalosporins (29.2%) and penicillins (22.8%), fluoroquinolones (12.4%), aminoglycosides (9.1%) and macrolides (3.4%). Among patients on antibiotics, route of administration was mainly parenteral (71.6%) while 44.8% were on more than one antibiotic. Overall, 91.3% of the antibiotic treatments were empirical with adults, children and neonates accounting for 96.4%, 77.6% and 100.0% respectively. Empirical antibiotic use is also high in medical wards (86.3%), surgical wards (89.9%) and intensive care unit (100.0%).Conclusion: There is predominance and over-reliance on empirical antibiotherapy in our hospital. It further exposes the poor utilization of clinical microbiology laboratory and the potential for development of antibiotic resistance with resultant increase in morbidity/mortality and poor patient safety. There is need for further studies to highlight the dangers of over-reliance on empirical antibiotherapy and herald improvement in development and implementation of antibiotic stewardship programme.
Keywords: Empirical antibiotherapy, antimicrobial resistance, point prevalence survey, antimicrobial stewardship
French title:L'antibiothérapie empirique comme moteur potentiel de la résistance aux antibiotiques: observations d'une enquêteponctuelle de prévalence de la consommation et de la résistance aux antibiotiques à Gombe, au Nigéria
Contexte: L'utilisation empirique d'antibiotiques est une pratique courante dans le traitement des infections dans le monde entier. Cependant, sa surutilisation sans culture ultérieure ni test de sensibilité aux antibiotiques pourrait être un facteur majeur de résistance. Le recours excessif à l'antibiothérapie empirique est courant dans la plupart des pays en développement où les politiques d'antibiotiques et la disponibilité ou l'utilisation du laboratoire de microbiologie clinique sont sous-optimales. Une approche standardisée de l'enquête de prévalence ponctuelle (PPS) sur l'utilisation des antimicrobiens (AMU) dans les hôpitaux a été utilisée pour évaluer les pratiques de prescription d'antimicrobiens au Federal Teaching Hospital Gombe (FTHG), au Nigéria.Méthodologie: Un PPS a été réalisé en avril 2019 au FTHG en recrutant tous les patients hospitalisés présents à l'hôpital le jour de l'enquête. Les données obtenues à partir des dossiers des patients comprenaient des détails sur le type et l’indication de l’antibiothérapie. Une application en ligne personnalisée développée par l'Université d'Anvers (www.global-pps.be) a été utilisée pour la saisie, la validation, l'analyse et le reporting des données.Résultats: Sur les 326 patients au total qui étaient admis le jour de l'enquête, 70,6% et 73,4% prenaient au moins un antibiotique dans les services pour adultes et pédiatriques respectivement. Les antibiotiques les plus couramment utilisés comprennent les bêta-lactamines telles que les céphalosporines (29,2%) et les pénicillines (22,8%), les fluoroquinolones (12,4%), les aminosides (9,1%) et les macrolides (3,4%). Parmi les patients’ sous antibiotiques, la voie d'administration était principalement parentérale (71,6%) tandis que 44,8% prenaient plus d'un antibiotique. Dans l'ensemble, 91,3% des traitements antibiotiques étaient empiriques, les adultes, les enfants et les nouveau-nés représentant respectivement 96,4%, 77,6% et 100,0%. L'utilisation empirique d'antibiotiques est également élevée dans les services médicaux (86,3%), les services chirurgicaux (89,9%) et les unités de soins intensifs (100,0%).Conclusion: Il y a une prédominance et une dépendance excessive à l'antibiothérapie empirique dans notre hôpital. Il expose en outre la mauvaie utilisation du laboratoire de microbiologie clinique et le potentiel de développement d'une résistance aux antibiotiques avec une augmentation résultante de la morbidité/mortalité et une mauvaise sécurité des patients. Des études supplémentaires sont nécessaires pour mettre en évidence les dangers d'une dépendance excessive à l'antibiothérapie empirique et annoncer une amélioration dans le développement et la mise en œuvre d'un programme de gestion des antibiotiques.
Mots clés: antibiothérapie empirique, résistance aux antimicrobiens, enquête ponctuelle de prévalence, gestion des antimicrobiens
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Poh, Kian-Keong, Hong Yang, Abdul Razakjr Omar, James WL Yip, Yiong-Huak Chan und Lieng-Hsi Ling. „Clinically Compressed Digital Echocardiography: A Patient-safe Alternative to Videotape Review“. Annals of the Academy of Medicine, Singapore 36, Nr. 8 (15.08.2007): 662–71. http://dx.doi.org/10.47102/annals-acadmedsg.v36n8p662.
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Introduction: Digital storage of echocardiographic data offers logistical advantages over videotape archival. However, limited information is available on the accuracy of clinically compressed digitised examinations, an important consideration for patient safety. Materials and Methods: Transthoracic echocardiograms of 520 consecutive patients were prospectively acquired digitally and on videotape. Two echocardiologists, in consensus, reported studies in both formats sequentially. Using the videotape as a reference, the significance of any reported differences was graded from both imaging and clinical standpoints, and the reasons for these differences identified. Results: From an imaging perspective, differences between digital and videotaped studies were absent or minor in 459 cases (88%), fairly significant in 55 (11%) and very significant in 6 (1%). The main reasons for the observed differences were inadequate acquisition of optimal views (59%), an insufficient number of acquired cardiac cycles (25%) and suboptimal image quality (9%). These differences were considered to be of possible or definite clinical importance in 21 (4%) and 8 (2%) cases, respectively. In multinominal logistic regression models, the only independent predictor of significant difference between digitised and videotaped images was study complexity. Regardless of case complexity, most diagnostic errors arising from digital review were attributable to technical failure rather than observer error. Conclusions: The potential for important errors arising from exclusive reporting of clinically compressed digital echocardiograms is small. Digital echocardiography, as practiced in a routine clinical setting, offers a patient-safe alternative to videotape review. Key words: Clinical implications, Digital echocardiography, Patient safety, Videotape
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Budiarto, Arif, Kevin C. H. Tsang, Andrew M. Wilson, Aziz Sheikh und Syed Ahmar Shah. „Machine Learning–Based Asthma Attack Prediction Models From Routinely Collected Electronic Health Records: Systematic Scoping Review“. JMIR AI 2 (07.12.2023): e46717. http://dx.doi.org/10.2196/46717.
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Background An early warning tool to predict attacks could enhance asthma management and reduce the likelihood of serious consequences. Electronic health records (EHRs) providing access to historical data about patients with asthma coupled with machine learning (ML) provide an opportunity to develop such a tool. Several studies have developed ML-based tools to predict asthma attacks. Objective This study aims to critically evaluate ML-based models derived using EHRs for the prediction of asthma attacks. Methods We systematically searched PubMed and Scopus (the search period was between January 1, 2012, and January 31, 2023) for papers meeting the following inclusion criteria: (1) used EHR data as the main data source, (2) used asthma attack as the outcome, and (3) compared ML-based prediction models’ performance. We excluded non-English papers and nonresearch papers, such as commentary and systematic review papers. In addition, we also excluded papers that did not provide any details about the respective ML approach and its result, including protocol papers. The selected studies were then summarized across multiple dimensions including data preprocessing methods, ML algorithms, model validation, model explainability, and model implementation. Results Overall, 17 papers were included at the end of the selection process. There was considerable heterogeneity in how asthma attacks were defined. Of the 17 studies, 8 (47%) studies used routinely collected data both from primary care and secondary care practices together. Extreme imbalanced data was a notable issue in most studies (13/17, 76%), but only 38% (5/13) of them explicitly dealt with it in their data preprocessing pipeline. The gradient boosting–based method was the best ML method in 59% (10/17) of the studies. Of the 17 studies, 14 (82%) studies used a model explanation method to identify the most important predictors. None of the studies followed the standard reporting guidelines, and none were prospectively validated. Conclusions Our review indicates that this research field is still underdeveloped, given the limited body of evidence, heterogeneity of methods, lack of external validation, and suboptimally reported models. We highlighted several technical challenges (class imbalance, external validation, model explanation, and adherence to reporting guidelines to aid reproducibility) that need to be addressed to make progress toward clinical adoption.
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Stocchi, Luca, Heidi Nelson, Daniel J. Sargent, Michael J. O’Connell, Joel E. Tepper, James E. Krook und Robert Beart. „Impact of Surgical and Pathologic Variables in Rectal Cancer: A United States Community and Cooperative Group Report“. Journal of Clinical Oncology 19, Nr. 18 (15.09.2001): 3895–902. http://dx.doi.org/10.1200/jco.2001.19.18.3895.
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PURPOSE: Substantial and successful effort has been focused on decreasing the risk of local failure after rectal cancer surgery through the use of adjuvant therapies. Our study examined data from studies conducted by United States cooperative groups to investigate the impact of surgical and pathologic variables in rectal cancer outcomes. PATIENTS AND METHODS: Surgical and pathologic reports from 673 patients with stage II/III rectal cancer enrolled onto three adjuvant clinical trials were reviewed for tumor and surgical variables. Additional information on individual institutions and operating surgeon was collected. Variables were tested for association with 5-year local recurrence and survival after adjustment for adjuvant treatments and other important prognostic factors. RESULTS: Five-year local recurrence and survival rates were 16% and 59%, respectively. Surgeons treating more than 10 study cases had lower local recurrence rates than those treating ≤ 10 (11% v 17%, P = .02). Free radial margins also correlated with local recurrence (P = .01). Type of surgery, distal margins, and tumor radial spread were not significant. Tumor adherence to adjacent structures predicted local recurrence (35% v 14%, P < .001) and survival (30% v 63%, P < .001), regardless of en bloc resection. Although T and N classification predicted survival (P < .001), only N classification correlated with local recurrence. The number and percentage of positive nodes correlated with survival, but only the percentage independently predicted local recurrence. Several pathologic and surgical variables were reported suboptimally. CONCLUSION: Moderate variability in outcomes among surgeons was detected in this high-risk population. Efforts to improve surgical results will require changes in reporting practices to allow for more accurate assessment of the quality of surgery.
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El-Kotob, Rasha, Justin Rodriguez Pagcanlungan, B. Catharine Craven, Catherine Sherrington, Marina Mourtzakis und Lora Giangregorio. „Researchers’ Perspectives on Adverse Event Reporting in Resistance Training Trials: A Qualitative Study“. Applied Physiology, Nutrition, and Metabolism, 20.04.2022. http://dx.doi.org/10.1139/apnm-2022-0012.
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The objectives of our study were to understand researchers' current practices and perspectives on adverse event (AE) reporting in clinical trials of resistance training (RT), and identify barriers and facilitators of AE reporting. We conducted web conference or telephone-based one-on-one semi-structured interviews with 14 researchers who have published RT studies in individuals with or without health conditions. We audio-recorded and transcribed the interviews, and analyzed data using the thematic framework method. Four themes were identified in the context of RT studies: 1) researchers lack guidance and/or motivation for rigorous AE reporting; 2) researchers who undertake AE reporting educate and value participants, use trained personnel, and implement standardized guidelines; 3) suboptimal implementation of existing AE reporting standards and the perception that available guidelines do not apply to exercise trials; and 4) acceptability and feasibility of an exercise-specific guide for AE reporting depends on its content and format. In conclusion, AE reporting methods in the field of exercise science do not align with best practice. Strategies to reduce inconsistent and suboptimal AE reporting in RT trials are urgently needed and could be based on the barriers and facilitators identified in this study.
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ALFadhalah, Talal, und Hossam Elamir. „Patient safety and leadership style in the government general hospitals in Kuwait: a multi-method study“. Leadership in Health Services, 04.11.2021. http://dx.doi.org/10.1108/lhs-07-2021-0062.
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Purpose This study aims to evaluate the relationships between leadership style and reported incidents, reporting practices and patient safety initiatives in Kuwaiti hospitals. Design/methodology/approach This cross-sectional and retrospective quantitative multi-centre study was conducted in a secondary care setting. The multifactor leadership questionnaire and the patient safety questionnaire were distributed in six general hospitals to a sample of physicians, nurses and pharmacists. Incident reports were reviewed in each hospital to assess reporting practices. Findings The hospital with the most safety incident reports scored the highest on good reporting practices, whereas the hospital with the lowest score of poor reporting practices had reported fewer incidents. Reporting was better if an error reached the patient but caused no harm. Overall, reporting practices and implementation of patient safety initiatives in the hospitals were suboptimal. Nevertheless, a transformational leadership style had a positive effect on patient safety and reporting practices. Practical implications This study represents a baseline for researchers to assess the relationship between leadership style and patient safety. Moreover, it highlights significant considerations to be addressed when planning patient safety improvement programmes. More investment is needed to understand how to raise transformational leaders who are more effective on patient safety. Further studies that include primary and tertiary health-care settings and the private sector are required. Originality/value To the best of the authors’ knowledge, this study is the first in Kuwait to report on the relationship between transformational leadership and safety practices.
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Song, Junmin, Marco Solmi, Andre F. Carvalho, Jae Il Shin und John PA Ioannidis. „Twelve years after the ARRIVE guidelines: Animal research has not yet arrived at high standards“. Laboratory Animals, 20.09.2023. http://dx.doi.org/10.1177/00236772231181658.
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The reproducibility crisis across animal studies jeopardizes the credibility of the main findings derived from animal research, even though these findings are critical for informing human studies. To clarify and improve transparency among animal studies, the ARRIVE reporting guidelines were first announced in 2010 and upgraded to version 2.0 in 2020. However, compliance with and awareness of those reporting guidelines has remained suboptimal. Journal editors should encourage the authors to adhere to those guidelines. Authors, editors, referees, and reviewers should be aware of the ARRIVE guideline 2.0 when assessing and evaluating the methodology and findings of animal studies. However, we should also question whether reporting guidelines alone can change a research culture and improve the reproducibility of animal investigations. Reported research may not reflect actual research. Large segments of animal research efforts are wasted because of poor design choices and because of non-publication rather than suboptimal reporting. Better training of the scientific workforce, interventions at improving animal research at the design stage, registration practices, and alignment of the reward system with the publication of rigorous animal research may achieve more than reporting guidelines alone.
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Khan, Mohammed I. U., Hartirath K. Brar, Cynthia Y. Sun, Rebecca He, Hussein A. El-Khechen, Katie Mellor, Lehana Thabane und Carlos Quiñonez. „The reporting of pilot and feasibility studies in the top dental specialty journals is suboptimal“. Pilot and Feasibility Studies 8, Nr. 1 (04.10.2022). http://dx.doi.org/10.1186/s40814-022-01182-1.
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Abstract Background Pilot and feasibility studies (PAFS) are smaller investigations seeking to assess the feasibility of conducting a larger more definitive study. In late 2016, the CONSORT statement was extended to disseminate good practices for reporting of randomized pilot and feasibility trials. In this quality assurance review, we assessed whether PAFS in the top dental speciality journals adhere to good practices of conduct and reporting, by prioritizing assessment of feasibility and stating pre-defined progression criteria to inform the decision to pursue funding for a larger trial. Methods With the help of a librarian, we searched MEDLINE and EMBASE from 2017 to 2020, inclusive, for PAFS in the top 3 journals from each of the 10 dental specialties. We collected data on methodological and general characteristics of the studies, their objectives, and reporting of items recommended in the CONSORT extension. Results Of the 111 trials included, 51.4% (95% CI 41.7–61.0%) stated some indication of intent to assess feasibility while zero reported progression criteria; 74.8% (95% CI 65.6–82.5%) of trials used the terms “pilot” or “feasibility” in their titles and 82.9% (95% CI 74.6–89.4%) of studies stated there is a need for a future trial, but only 9.0% (95% CI 4.4–15.9%) stated intent to proceed to one. Most of the studies, 53.2% (95% CI 43.4–62.7%), reported hypothesis testing without cautioning readers on the generalizability of the results. Studies that used the terms “pilot” or “feasibility” in their title were less likely to have feasibility objectives, compared to trials that did not, with an odds ratio (OR) of 0.310 (95% CI 0.103–0.930; p = 0.037). Compared to trials that did not conduct hypothesis testing, trials that conducted hypothesis testing were significantly less likely to assess feasibility, among them, trials that cautioned readers on the generalizability of their results had an OR of 0.038 (95% CI 0.005–0.264; p < 0.001) and trials that did not caution readers on the generalizability of their results had an OR of 0.043 (95% CI 0.008–0.238; p = 0.001). Conclusion Many PAFS in dentistry are not conducted with the intent of assessing feasibility, nor do they state progression criteria, and few report intent to proceed to a future trial. Misconceptions about PAFS can lead to them being poorly conducted and reported, which has economic and ethical implications. Research ethics boards, funding agencies, and journals need to raise their standards for the conduct and reporting of PAFS, and resources should be developed to address misconceptions and help guide researchers on the best practices for their conduct and reporting.
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Sharif, Muhammad Junaid Hassan, Ghulam Murtaza, Zelal Kharaba, Nihal Abdalla Ibrahim, Mohammad Ismail, Abdul Mannan, Manal Buabeid, Xianju Huang, Shujaat Ali Khan und Khezar Hayat. „An Exploration of Knowledge, Attitude, and Practices of Physicians toward Pharmacovigilance at Tertiary Care Hospitals in Khyber-Pakhtunkhwa Province, Pakistan“. American Journal of Tropical Medicine and Hygiene, 07.09.2021. http://dx.doi.org/10.4269/ajtmh.21-0336.
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Drug safety assures the effectiveness, safety, and security of drugs, vaccines, and other biologicals to protect public health. Medication-related errors coupled with unjudicial medication practices often cause a catastrophic impact on the healthcare system globally. The present study aimed to assess the knowledge, attitude, and practice of physicians toward pharmacovigilance and barriers to adverse drug reaction (ADR) reporting at tertiary care hospitals in Khyber-Pakhtunkhwa (KP) province, Pakistan. A descriptive cross-sectional study was conducted among registered doctors working in seven tertiary care hospitals from seven administrative divisions of KP province of Pakistan from July 2019 to March 2020. During the study period, 358 physicians who fulfilled the inclusion criteria and agreed to participate completed and returned the validated structured questionnaires. Descriptive and inferential statistics were applied for data analysis. The majority of physicians had poor knowledge (81.3%) regarding pharmacovigilance along with poor reporting practices (94.9%), although (96.5%) had a positive attitude toward ADR reporting. A significant barrier identified was the unavailability of reporting forms (95.9%), whereas mandatory ADR reporting (96.2%) was the major factor to encourage ADR reporting. Physicians aged ≥ 41 and experience ≥ 11 years had significantly more knowledge than other categories (P < 0.001). Significant association (P < 0.001) of physicians’ knowledge and practice were found where 77.2% of the participants having poor knowledge reported poor practices. Physicians’ understanding of pharmacovigilance was suboptimal, although they have a positive attitude toward ADR reporting. Thus, there is a need for continuous education and training programs to support pharmacovigilance activities that could improve physicians’ understanding.
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Sandgren, A., V. Hollo, E. Huitric und C. Ködmön. „Epidemiology of tuberculosis in the EU/EEA in 2010 – monitoring the progress towards tuberculosis elimination“. Eurosurveillance 17, Nr. 12 (22.03.2012). http://dx.doi.org/10.2807/ese.17.12.20124-en.
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The 2012 combined tuberculosis (TB) surveillance and monitoring report for the European Union and European Economic Area identifies a mean annual decline in TB notification rate by 4.4% from 2006 to 2010. Culture confirmation for new pulmonary cases and drug susceptibility testing have increased to 65.6% and 70.8%, but remain under their targets of 80% and 100%, respectively. Reporting of treatment outcome and co-infection with human immunodeficiency virus also remain suboptimal. Strengthened control practices are needed to allow progress towards TB elimination.
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Beaudoin, Ann-Marie, Jan Kee Ho, Adrienne Lam und Vincent Thijs. „Radiomics Studies on Ischemic Stroke and Carotid Atherosclerotic Disease: A Reporting Quality Assessment“. Canadian Association of Radiologists Journal, 29.02.2024. http://dx.doi.org/10.1177/08465371241234545.
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Objective: To assess the reporting quality of radiomics studies on ischemic stroke, intracranial and carotid atherosclerotic disease using the Image Biomarker Standardization Initiative (IBSI) reporting guidelines with the aim of finding avenues of improvement for future publications. Method: PubMed database was searched to identify relevant radiomics studies. Of 560 articles, 41 original research articles were included in this analysis. Based on IBSI radiomics reporting guidelines, checklists for CT-based and MRI-based studies were created to allow a structured and comprehensive evaluation of each study’s adherence to these guidelines. Results: The main topics covered by the included radiomics studies were ischemic stroke, intracranial artery disease, and carotid atherosclerotic disease. The reporting checklist median score was 17/40 for the 20 CT-based radiomics studies and 22.5/50 for the 20 MRI-based studies. Basic items like imaging modality, region of interest, and image biomarker set utilized were included in all studies. However, details regarding image acquisition and reconstruction, post-acquisition image processing, and image biomarkers computation were inconsistently detailed across studies. Conclusion: The overall reporting quality of the included radiomics studies was suboptimal. These findings underscore a pressing need for improved reporting practices in radiomics research, to ensure validation and reproducibility of results. Our study provides insights into current reporting standards and highlights specific areas where adherence to IBSI guidelines could be significantly improved.
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Ashkir, Z., Z. Teoh, S. Ganesananthan, F. Ahmed-Jushuf, C. J. Beattie, A. Asher, M. Kelshiker, J. Howard und R. Al-Lamee. „Medication adherence assessment and reporting in cardiovascular randomised controlled trials“. European Heart Journal 43, Supplement_2 (01.10.2022). http://dx.doi.org/10.1093/eurheartj/ehac544.2865.
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Abstract Background Despite the knowledge that suboptimal adherence to medications may have an impact on the impact of treatment interventions, the assessment and reporting of medication adherence in cardiovascular randomised controlled trials has not been well studied. In this review we sought to study the differences in medication adherence assessment and reporting in cardiovascular randomised controlled trials (RCTs) comparing interventional procedures to medical therapy alone in four major cardiovascular conditions: coronary disease (CAD), atrial fibrillation (AF), heart failure (HF) and hypertension (HTN). Methods Comprehensive searches of PUBMED/MEDLINE, Clinicaltrials.gov and Cochrane Central Register of Controlled Trials (CENTRAL) were performed. Two independent authors screened and extracted general study data, adherence assessment methodology and adherence reporting characteristics from eligible RCTs. Results A total of 568 studies (257 HTN, 120 HF, 116 CAD and 75 AF RCTs) published between 2014–2019 were included in the review. Overall, only 44.7% of RCTs assessed adherence, 14.1% defined “good” adherence and 21.1% reported adherence results. HTN and CAD trials performed significantly better than HF and AF studies in all three parameters. Compared to drug trials, procedural trials were significantly less likely to assess adherence (21.1% vs 45.7%, p<0.001), define good adherence (7% vs 15.5%, p<0.001) or report adherence results (10.5% vs 21.3%, p=0.046). Adherence assessment practices were further significantly influenced by funding, placebo status and study outcome. Pill count/return of packaging was the most utilised method (49.5%) and direct observation the least utilised (1.1%). Adherence was calculated in 55.9% of RCTs with studies using different formulas and setting different thresholds for “good” adherence but most setting this at 80% adherence. Adherence reporting practices also varied significantly between RCTs. Most studies (53%) that assessed adherence, did not in fact report their results. Conclusion Our findings expose significant inconsistencies in adherence assessment and reporting practices amongst cardiovascular RCTs. This is a systemic problem with important implications on research quality and reliability. We therefore recommend the incorporation of mandatory adherence assessment and reporting into international reporting guidelines for RCTs such as the CONSORT statement. We also propose a grading system which once validated may be used to appraise standards of adherence assessment and reporting in RCTs. Funding Acknowledgement Type of funding sources: None.
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Najjar-Debbiny, Ronza, Bibiana Chazan, Rona Lobl, M. Todd Greene, David Ratz, Sanjay Saint, Yehuda Carmeli et al. „Healthcare-associated infection prevention and control practices in Israel: results of a national survey“. BMC Infectious Diseases 22, Nr. 1 (16.09.2022). http://dx.doi.org/10.1186/s12879-022-07721-8.
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Abstract Background Healthcare-associated infection (HAI) is a common and largely preventable cause of morbidity and mortality. The COVID-19 pandemic has presented unprecedented challenges to health systems. We conducted a national survey to ascertain hospital characteristics and the use of HAI prevention measures in Israel. Methods We e-mailed surveys to infection prevention and control (IPC) leads of acute care hospitals in Israel. The survey included questions about the use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). The survey also assessed COVID-19 impact and healthcare worker well-being. Results IPC leads from 15 of 24 invited hospitals (63%) completed the survey. Only one-third of respondents reported strong support for IPC from hospital leadership. Although several prevention practices were used by all hospitals (e.g., maximum sterile barrier precautions for CLABSI and real-time assessment of environmental cleaning for CDI), use of other practices was suboptimal—particularly for CAUTI and VAP. COVID-19 had a profound impact on Israeli hospitals, with all hospitals reporting opening of new units to care for COVID patients and most reporting moderate to extreme financial hardship. All hospitals reported highly successful plans to vaccinate all staff and felt confident that the vaccine is safe and effective. Conclusion We provide a status report of the IPC characteristics and practices Israeli hospitals are currently using to prevent HAIs during the COVID-19 era. While many globally accepted IPC practices are widely implemented, opportunities to increase the use of certain IPC practices in Israeli hospitals exist.
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Oliveira, Nórton Luís, Cíntia Ehlers Botton, Angélica Trevisan De Nardi und Daniel Umpierre. „Methodological quality and reporting standards in systematic reviews with meta-analysis of physical activity studies: a report from the Strengthening the Evidence in Exercise Sciences Initiative (SEES Initiative)“. Systematic Reviews 10, Nr. 1 (Dezember 2021). http://dx.doi.org/10.1186/s13643-021-01845-9.
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Abstract Background Several resources have been developed (e.g., reporting guidelines) to promote high-standard practices in health research. However, there was no continuous and systematic assessment of recommended practices in published systematic reviews with meta-analysis (SRMAs), which increases the usability of the available resources. Therefore, we aimed to assess the methodological and reporting standards in SRMAs of physical activity studies. This report presents the main results of the SEES Initiative in 2019. Methods Our approach is based on a prospective systematic review methodology to implement post-publication surveillance of research practices in exercise sciences. Briefly, during the year 2019, pre-specified searches were conducted monthly (PubMed/MEDLINE) in journals from the exercise sciences (n = 9) and medicine (n = 5). The assessments were independently conducted by two authors, based on 36 items/practices derived from established statements/tools (PRISMA, AMSTAR 2, ROBIS). To be eligible, SRMAs should summarize studies that had, at least, one arm consisting of physical activity interventions/exposures and one health or behavioral outcome. Results Out of 1028 studies assessed for eligibility, 103 SRMAs were included. The minimum adherence was 13/36 items, whereas only one SRMA adhered to all items. Some highly contemplated items included identification of title as SRMA (97.1%) and descriptions of the main outcome in the abstract (95.1%) and risk of bias (RoB) assessment (95.1%). Some poorly contemplated items included publicly available protocol (4.9%), discussion of the results in light of RoB in studies included (32.0%), and data sharing statements (35.9%). Conclusion In summary, there is a suboptimal adherence to recommended practices on methodological quality and reporting standards in the SRMAs of physical activity intervention/exposure evaluated from the selected journals in 2019, which likely reduce the reproducibility and usefulness of these studies. This incipient evidence from our first 12 months of post-publication surveillance should serve as a call for attention and action for multiple stakeholders (e.g., authors, reviewers, editors, funders, academic institutions) in this important health research field.