Journal articles: 'Absence Intervention Teams'

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Glenn, A., and R. Urquhart. "Adoption of Patient-Centered Tools by Cancer Care Teams: A Closer Look at Survivorship Care Plans and Patient Decision Aids." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 62s. http://dx.doi.org/10.1200/jgo.18.17400.

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Background: Moving interventions (i.e., new knowledge, tools, and technologies) into clinical practice are often lengthy and challenging processes, even when they are strongly supported by research evidence. Conversely, organizations and providers sometimes adopt interventions in the absence of strong research evidence. Understanding decision-making around the adoption of new interventions is paramount to developing more effective strategies to facilitate the use of evidence-based interventions in practice. Aim: To illuminate the decision-making processes involved in the adoption of patient-centered interventions by cancer care teams, including how research evidence is considered, and identify additional factors influencing these decisions. We focused on two interventions (survivorship care plans [SCPs] and patient decision aids [PtDAs]) due to their differing levels of research evidence and real-world adoption: SCPs = low evidence; high adoption; PtDAs = high evidence; low adoption. Methods: Guided by the principles of grounded theory, we conducted semistructured interviews with clinicians, managers, and administrators of cancer care programs across Canada (n=21). Data were collected and analyzed concurrently, using a constant comparative approach. Data collection ended upon reaching theoretical saturation. Results: Participants emphasized that high-quality research evidence is often unnecessary when making adoption decisions around interventions that are intuitively “good ideas.” Six key factors contributed to adoption/nonadoption decisions around SCPs and PtDAs: 1) alignment (or misalignment) of research evidence with clinical experiences, patient experiences/preferences, and local data; 2) perceived benefit to clinicians themselves; 3) endorsement by respected organizations; 4) existence of local champions; 5) ability to adapt the intervention to local contexts; and 6) ability to routinize the intervention across a large patient population. Conclusion: Many factors influence decisions to adopt patient-centered interventions, including clinicians' experiences and perceived benefits, the existence of organizational and extraorganizational advocates, and ease/reach of implementation.

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Teodorczuk, Andrew, Mark Welfare, Sally Corbett, and Elizabeta Mukaetova-Ladinska. "Developing effective educational approaches for Liaison Old Age Psychiatry teams: a literature review of the learning needs of hospital staff in relation to managing the confused older patient." International Psychogeriatrics 22, no. 6 (December 15, 2009): 874–85. http://dx.doi.org/10.1017/s1041610209991475.

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ABSTRACTBackground:Deficiencies in the knowledge, skills and attitudes of all healthcare professionals working within the general hospital contribute towards the suboptimal care of older hospitalized patients with confusion. In the U.K., policy dictates that Liaison Old Age Psychiatry teams deliver effective education to general hospital clinical staff. The purpose of this paper is to review the literature concerning the learning needs of healthcare professionals in relation to managing confusion in the older patient in order to inform effective educational approaches for Liaison Old Age Psychiatry teams.Methods:A broad range of medical and educational databases were searched. Identified English language studies were selected for further analysis if they had a specific educational focus in the hospital setting and then further subdivided into intervention and naturalistic studies. The impact of intervention studies was evaluated by Kirkpatrick's system. Learning needs, as determined from the naturalistic studies, were mapped to identify themes.Results:13 intervention studies were identified. Despite a high level of effectiveness for educational interventions, it was unclear what the active components were. A further 23 naturalistic studies were identified; their findings focused on knowledge gaps, diagnostic behaviors and experiences, attitudes and training issues. Few studies specifically researched learning needs or the educational role of liaison teams. Conspicuous by its absence was reference to relevant educational theories.Conclusions:The findings of this review can be incorporated in the planning of local curricula by Liaison Teams in order to design educational strategies. There is a need for further research, especially studies exploring the learning needs ofallhealthcare professionals.

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Biz, Carlo, Pietro Nicoletti, Giovanni Baldin, Nicola Luigi Bragazzi, Alberto Crimì, and Pietro Ruggieri. "Hamstring Strain Injury (HSI) Prevention in Professional and Semi-Professional Football Teams: A Systematic Review and Meta-Analysis." International Journal of Environmental Research and Public Health 18, no. 16 (August 4, 2021): 8272. http://dx.doi.org/10.3390/ijerph18168272.

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Hamstring Strain Injuries (HSIs) are the most common type of lesion in professional footballers and the leading cause of absence days from sports. However, recent studies have shown that high-level football teams apparently do not apply any HSI prevention protocol. The aim of the study was to determine the effect of preventive strategies and protocols in reducing the incidence of hamstring muscle injuries in professional and semi-professional football teams. A literature search of PubMed/MEDLINE, ISI/Web of Science and Scopus databases was conducted with the keywords “hamstring* and (injury* or strain) and prevent* and (soccer or football)”. Quality and bias assessment was completed through the Kennelly modified scale. The Injury Incidence Rate (IIR) and the Incidence Rate Ratio (IRR) were assessed in the statistical analysis. In the meta-analysis, data were extracted, pooled and analysed with “Comprehensive Meta-Analysis Version 3.3.070” software. In total, 8 of the 1017 original search studies met the inclusion criteria of this review. The total exposure of the studies was 170,221.8 h, while the number of HSIs recorded was 165 in the intervention groups and 224 in the control groups. The average score of the quality assessment was 23.6/34. The meta-analysis of six of the eight included studies provided strong evidence that interventions are effective in reducing hamstring injuries. The IRR of the effect size was 0.443, with p-value = 0.001. The studies analysed applied different preventive strategies: the Nordic hamstring exercise, the FIFA 11+ programme and exercises for core stability or balance training. All these interventions proved to have a successful effect on prevention of hamstring injuries.

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Lewis, Michael. "Individual Team Incentives and Managing Competitive Balance in Sports Leagues: An Empirical Analysis of Major League Baseball." Journal of Marketing Research 45, no. 5 (October 2008): 535–49. http://dx.doi.org/10.1509/jmkr.45.5.535.

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Major League Baseball and other professional sports leagues have long been concerned with competitive imbalances caused by differences in local revenues. The fear is that in the absence of salary caps or other regulatory mechanisms, smaller-market teams will be unable to remain competitive. This research uses a structural dynamic programming model to analyze ownership's payroll investment decisions. This model estimates the relationship between optimal payrolls and local-market populations and the influence of long-term customer equity dynamics on payroll investments. In addition, the author analyzes the impact of a recent policy intervention that implemented revenue transfers from high-local-revenue markets to low-local-revenue markets. The statistical results indicate that market population has a significant impact on the value of a team's payroll investments. For example, optimal payrolls double as the population increases from 2.5 million to 7.5 million. Furthermore, rather than improving competitive balance, the adoption of revenue sharing has decreased the incentives for small-market teams to remain competitive. The author uses the estimation results to evaluate alternative approaches to managing competitive balance. Specifically, the results suggest that basing revenue-sharing payments on local-market population and (higher) attendance rates reduces payroll dispersion.

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Tungaraza, Tongeji E., Wakil Ahmed, Chinonyelum Chira, Erin Turner, Susan Mayaki, Harpal Singh Nandhra, Tom Edwards, and Saeed Farooq. "Prescribing pattern of clozapine and other antipsychotics for patients with first-episode psychosis: a cross-sectional survey of early intervention teams." Therapeutic Advances in Psychopharmacology 7, no. 3 (December 15, 2016): 103–11. http://dx.doi.org/10.1177/2045125316683151.

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Objective: To describe the pattern of antipsychotic drug prescribing in patients with first episode psychosis, with more emphasis in the use of clozapine in this group of patients. Method: A cross-sectional survey involving six early intervention service (EIS) teams in the West Midlands was conducted. Data was extracted from case notes and electronic records by clinicians working in each participating team. The pattern of antipsychotic prescribing and the changes that took place after being accepted in EIS, including the use of clozapine, was established. Clinicians involved in the treatment of patients in each team rated the overall clinical response to treatment based on the presence or absence of positive psychotic symptoms. Result: 431 patients with FEP were included in the final analysis. Low antipsychotic discontinuation rate was observed, with the majority (88.2%) still being prescribed antipsychotics. Most (77.3%) were prescribed second-generation antipsychotic drugs, with olanzapine (21.8%) and aripiprazole (19.7%) being the most frequently prescribed antipsychotics. There was low rate use of antipsychotic combinations (7.4%), high dose antipsychotic regime (3.9%), low depot antipsychotic prescribing (9.3%), and clozapine use was low (9.7%). On average, three antipsychotics were tried before clozapine was initiated and it took on average 19.5 months from being accepted into EIS to clozapine being initiated. Conclusion: The majority of patients were prescribed antipsychotics within the guidelines. EIS was associated with an overall low antipsychotic discontinuation. There was also a short waiting time before clozapine was initiated following patients being accepted into EIS.

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Gomes, Grace Angélica de Oliveira, Eduardo Kokubun, Grégore Iven Mieke, Luiz Roberto Ramos, Michael Pratt, Diana C. Parra, Eduardo Simões, et al. "Characteristics of physical activity programs in the Brazilian primary health care system." Cadernos de Saúde Pública 30, no. 10 (October 2014): 2155–68. http://dx.doi.org/10.1590/0102-311x00085713.

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The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.

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Chin, A., L. Heywood, P. Iu, A. M. Pelecanos, and M. J. Barrington. "The Effectiveness of Regional Anaesthesia before and after the Introduction of a Dedicated Regional Anaesthesia Service Incorporating a Block Room." Anaesthesia and Intensive Care 45, no. 6 (November 2017): 714–19. http://dx.doi.org/10.1177/0310057x1704500611.

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Dedicated regional anaesthesia services incorporating block rooms and/or block teams may facilitate theatre efficiency and improve training in regional anaesthesia. Currently, it is unknown if a dedicated regional anaesthesia service improves the effectiveness of regional anaesthesia. In November 2013, the Royal Brisbane and Women's Hospital established a dedicated regional anaesthesia service comprising a block team and a block room. Pre-intervention (conventional model of care) registry data was retrospectively compared with post-intervention (dedicated regional anaesthesia service) audit data, with regard to pain and opioid requirement in the post-anaesthesia care unit (PACU). The primary outcome was inadequate analgesia, defined as a numerical rating scale (NRS; 0, no pain; 10, worst pain imaginable) for pain >5 in the PACU. Pre- and post-intervention, 43.7% and 27.7% of patients respectively reported a NRS >5 (P <0.001). A difference in the type of blocks and surgery performed may have accounted for the improved outcome seen post-intervention. After adjustment for American Society of Anesthesiologists physical status, block type and surgery type, the odds ratio of having inadequate analgesia (NRS >5) was 0.54 (95% confidence interval 0.39 to 0.76) for post-intervention compared to pre-intervention. Secondary outcomes examined pre- and post-intervention were the absence of pain (39.3% and 55.1% of patients, respectively, P <0.001), systemic opioid analgesia requirement (48.6% and 30.5% of patients respectively, P <0.001) and median maximum NRS (4 [interquartile range (IQR) 0 to 8] and 0 [IQR 0 to 6] respectively, P <0.001). A dedicated regional anaesthesia service was associated with improved effectiveness of regional anaesthesia.

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Jones, Julie, Lyndsay Alexander, Elizabeth Hancock, and Kay Cooper. "A collaborative approach to exercise provision for people with Parkinson’s – a feasibility and acceptability study of the PDConnect programme." AMRC Open Research 2 (December 10, 2020): 29. http://dx.doi.org/10.12688/amrcopenres.12936.1.

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Background: Exercise has been shown to be beneficial for people with Parkinson’s (PwP), limiting the rate of decline of motor and non-motor symptoms, with emerging evidence associating exercise with a neuroprotective effect. Current exercise provision is time-limited, and delivered in the absence of strategies to support long-term adherence to exercise. With a growing Parkinson’s population, there is a need to develop long-term sustainable approaches to exercise delivery. The primary aim of this study is to assess the feasibility and acceptability of a multicomponent intervention (PDConnect) aimed at promoting physical activity, and self-management for PwP. Methods: A convergent fixed parallel mixed methods design study will be undertaken. The study aims to recruit 30 PwP, who will be randomly allocated into two groups: (i) the usual care group will receive physiotherapy once a week for six weeks delivered via Microsoft Teams. (ii) The PDConnect group will receive physiotherapy once a week for six weeks which combines exercise, education and behaviour change interventions delivered by NHS Parkinson’s specialist physiotherapists via Microsoft Teams. This will be followed by 12 weekly sessions of group exercise delivered on Microsoft Teams by fitness instructors specially trained in Parkinson’s. Participants will be then contacted by the fitness instructors once per month for three months by video conferencing to support exercise engagement. Primary feasibility data will be collected during the study, with acceptability assessed via semi-structured interviews at the end. Secondary outcomes encompassing motor, non-motor and health and well-being measures will be assessed at baseline, at six, 18, and 30 weeks. Discussion: This pilot study will establish whether PDConnect is feasible and acceptable to PwP. This will provide a platform for a larger evaluation to assess the effectiveness of PDConnect at increasing exercise participation and self-management within the Parkinson’s Community. Trial registration: Registered on ISRCTN (ISRCTN11672329, 4th June 2020).

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Jones, Julie, Lyndsay Alexander, Elizabeth Hancock, and Kay Cooper. "A collaborative approach to exercise provision for people with Parkinson’s – a feasibility and acceptability study of the PDConnect programme." AMRC Open Research 2 (April 1, 2021): 29. http://dx.doi.org/10.12688/amrcopenres.12936.2.

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Background: Exercise has been shown to be beneficial for people with Parkinson’s (PwP), slowing the rate of decline of motor and non-motor symptoms, with emerging evidence associating exercise with a neuroprotective effect. Current exercise provision is time-limited, and delivered in the absence of strategies to support long-term adherence to exercise. With a growing Parkinson’s population, there is a need to develop long-term sustainable approaches to exercise delivery. The primary aim of this study is to assess the feasibility and acceptability of a multicomponent intervention (PDConnect) aimed at promoting physical activity, and self-management for PwP. Methods: A convergent fixed parallel mixed methods design study will be undertaken. The study aims to recruit 30 PwP, who will be randomly allocated into two groups: (i) the usual care group will receive physiotherapy once a week for six weeks delivered via Microsoft Teams. (ii) The PDConnect group will receive physiotherapy once a week for six weeks which combines exercise, education and behaviour change interventions delivered by NHS Parkinson’s specialist physiotherapists via Microsoft Teams. This will be followed by 12 weekly sessions of group exercise delivered on Microsoft Teams by fitness instructors specially trained in Parkinson’s. Participants will be then contacted by the fitness instructors once per month for three months by video conferencing to support exercise engagement. Primary feasibility data will be collected during the study, with acceptability assessed via semi-structured interviews at the end. Secondary outcomes encompassing motor, non-motor and health and well-being measures will be assessed at baseline, at six, 18, and 30 weeks. Discussion: This pilot study will establish whether PDConnect is feasible and acceptable to PwP. This will provide a platform for a larger evaluation to assess the effectiveness of PDConnect at increasing exercise participation and self-management within the Parkinson’s Community. Trial registration: Registered on ISRCTN (ISRCTN11672329, 4th June 2020).

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Gerrard, David, Jennifer Rhodes, Ruth Lee, and Jonathan Ling. "Using positive behavioural support (PBS) for STOMP medication challenge." Advances in Mental Health and Intellectual Disabilities 13, no. 3/4 (June 12, 2019): 102–12. http://dx.doi.org/10.1108/amhid-12-2018-0051.

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Purpose The purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a learning disability, autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge, (NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication. Design/methodology/approach A two-group, experimental design was utilised. Both groups were considered for medication reduction. The experimental group of 25 people received input from a specialist PBS team, while the control group of 29 people underwent unsupported medication challenge. Findings There was a significantly higher success rate for medication reduction and discontinuation when PBS assessment and intervention was provided as an alternative to medication. Practical implications This study indicates that providing PBS is associated with decreased medication and if replicated should be become standard practice for specialist teams. Originality/value This is the first study to investigate the effect of PBS on medication reduction in patients prescribed psychotropic medication for behaviour thought to be challenging.

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Salgia, Ravi, Leigh M. Boehmer, Catherine Celestin, Hong Yu, and David R. Spigel. "Improving Care for Patients With Stage III or IV NSCLC: Learnings for Multidisciplinary Teams From the ACCC National Quality Survey." JCO Oncology Practice 17, no. 8 (August 2021): e1120-e1130. http://dx.doi.org/10.1200/op.20.00899.

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PURPOSE: Insufficient characterization of the optimal multidisciplinary team and lack of understanding of barriers to quality care are unmet needs in the management of stage III or IV non–small-cell lung cancer (NSCLC). A national survey was conducted to inform the design and execution of process improvement plans and address identified barriers. METHODS: A steering committee of multidisciplinary specialists and representation from patient advocacy collaborated for a comprehensive, double-blind, web-based survey (January-April 2019) to obtain insights on care delivery for patients with advanced NSCLC in a diverse set of US community cancer programs. RESULTS: Overall, 639 responses (160 unique cancer programs across 44 US states) were included; 41% (n = 261) of respondents indicated an absence of a thoracic multidisciplinary clinic in their cancer program. Engagement in shared decision making was significantly associated with the presence of navigation and radiation oncology disciplines ( P ≤ .04); 19.2% and 33.3% of respondents belonged to cancer programs with no lung cancer screening and no protocol for biomarker testing, respectively. The frequency of tumor board meetings negatively correlated with time to complete disease staging ( P = .03); the average time to first therapeutic intervention in newly diagnosed patients was 4 weeks. The most challenging barriers to quality care included insufficient quantity of biopsy material for biomarker testing, lack of primary care provider referrals, and diagnostic costs. CONCLUSION: Improving the quality of advanced NSCLC care, including optimization of a multidisciplinary team framework, may surmount barriers to care coordination, diagnosis and staging, and treatment planning, consequently improving adherence to evolving standards of care.

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Matter, Dean, and Linke Potgieter. "Allocating epidemic response teams and vaccine deliveries by drone in generic network structures, according to expected prevented exposures." PLOS ONE 16, no. 3 (March 5, 2021): e0248053. http://dx.doi.org/10.1371/journal.pone.0248053.

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The tumultuous inception of an epidemic is usually accompanied by difficulty in determining how to respond best. In developing nations, this can be compounded by logistical challenges, such as vaccine shortages and poor road infrastructure. To provide guidance towards improved epidemic response, various resource allocation models, in conjunction with a network-based SEIRVD epidemic model, are proposed in this article. Further, the feasibility of using drones for vaccine delivery is evaluated, and assorted relevant parameters are discussed. For the sake of generality, these results are presented for multiple network structures, representing interconnected populations—upon which repeated epidemic simulations are performed. The resource allocation models formulated maximise expected prevented exposures on each day of a simulated epidemic, by allocating response teams and vaccine deliveries according to the solutions of two respective integer programming problems—thereby influencing the simulated epidemic through the SEIRVD model. These models, when compared with a range of alternative resource allocation strategies, were found to reduce both the number of cases per epidemic, and the number of vaccines required. Consequently, the recommendation is made that such models be used as decision support tools in epidemic response. In the absence thereof, prioritizing locations for vaccinations according to susceptible population, rather than total population or number of infections, is most effective for the majority of network types. In other results, fixed-wing drones are demonstrated to be a viable delivery method for vaccines in the context of an epidemic, if sufficient drones can be promptly procured; the detrimental effect of intervention delay was discovered to be significant. In addition, the importance of well-documented routine vaccination activities is highlighted, due to the benefits of increased pre-epidemic immunity rates, and targeted vaccination.

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Nambiar, Bejoy, James Shaw, Dougal S. Hargreaves, Tim Colbourn, Ann McKillop, Nicolette Sheridan, Carolyn Steele Gray, et al. "AbstractsUnderstanding the impact of a QI intervention on newborn mortality in 3 central districts in Malawi: a post-hoc theory-based evaluationAdvancing Implementation Science for Quality and Safety in Primary Health Care: The Integrated Care for Older Adults with Complex Health Needs Study (iCOACH)." BMJ Quality & Safety 26, no. 5 (April 18, 2017): 430–32. http://dx.doi.org/10.1136/bmjqs-2017-006696.

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IntroductionA recent WHO multi-country study on maternal and newborn health concluded that there was no evidence of an association between high coverage with essential interventions and reduced mortality in health care facilities, or improvement in other outcomes.1 According to Horton the missing ingredient in this relation is quality of care.2 Quality improvement in healthcare has adopted techniques mainly from industries such as manufacturing and has been used widely in Europe and US. However, evidence of success of these techniques in healthcare is not very conclusive, especially in low and middle-income countries. There have been limited efforts to critically analyse the techniques used in quality improvement interventions. One of the main challenges in evaluating quality improvement is the complexity of the interventions themselves and the complex nature of the systems in which they are implemented. Robust evidence regarding quality improvement interventions for resource poor settings is generally lacking.The MaiKhanda trial looked at the effect of QI interventions and community women's groups on maternal and newborn mortality in 3 central districts in Malawi.3 The impact evaluation measuring effect on newborn mortality for the QI interventions, using a cluster RCT approach, remained inconclusive. We use a Theory-Based Evaluation (TBE) approach to understand why improvement interventions undertaken by MaiKhanda for new-born care did not show an effect. Absence of effect could be attributed to a failure of theory, a failure of implementation, an evaluation failure or a combination of these.Our primary objective was to understand the mechanisms by which the QI interventions worked (or not) and explore the interaction between the various factors that mediated the lack of effect on neonatal mortality that was observed in the cluster randomized control trial.MethodsOur research strategy consisted of developing a post-hoc Theory of Change, consolidating and synthesizing all the available evidence using an appropriate framework, and analysing the program and implementation theory using theory based approaches to evaluation.Data synthesis was conducted using the Consolidate Framework for Implementation Research (CFIR).4 The synthesis takes into consideration the various reports and documents accumulated through the life of the project and complements the process evaluation studies conducted during the same period. In doing so, it draws a picture of the intervention with a multi-dimensional perspective, which provides insights into the evolution of the project. The framework is very comprehensive covering 5 major domains and a range of constructs, not all of which were included in our study. As this was post-hoc analysis, the choice of constructs was based on the availability of data rather than prioritizing the key constructs to consider.CFIR helps to produce structured and comprehensive data that is then used for analysing the program theory in relation to the intervention outcome. The program theory thus generated for the MaiKhanda intervention is compared with the program theories of the Michigan Keystone Project, which used similar collaborative methods to successfully reduce their central venous line blood stream infections in 106 participating ICUs.5 The rationale for such a comparison is that while the interventions per se are very unique and specific to their context, the program theories underlying the use of collaborative methods in both the interventions is the same and therefore comparable. Theories offer a higher level of abstraction that can be comparable across different settings.6 ResultsThe key finding from analysis of the program theory is that similar intervention strategies that triggered successful mechanisms for improvement in the Keystone Project failed to generate such mechanisms in MaiKhanda project.The Model for Improvement used in MaiKhanda was built around Deming's improvement theory7 and Roger's diffusion of innovation theory.8 The former theory considers improvement as a product of subject matter knowledge and profound knowledge. Subject matter knowledge on essential and emergency newborn care was generally lacking among health care providers in Malawi. Similarly, understanding variations within the health systems is an acquired skill. While the implementing partners, provided ample opportunities for the Malawian health system to learn the Institute for Healthcare Improvement (IHI) model for improvement, in general, QI teams lacked capacity to collate data and analyse the variations between the health facilities. QI was a fairly new concept in Malawi and MaiKhanda's attempts to embed it within existing health system was limited by challenges of the health systems context, MaiKhanda's own organizational transition and QI and clinical capacity of health care providers.The main challenge for MaiKhanda was to simultaneously implement and sustain the various change packages it had introduced in the different facilities. While there were isolated instances of successful intervention activities within MaiKhanda, it did not build enough momentum to generate mechanisms across a critical mass of the facilities that would eventually result in improved newborn outcomes. This can be attributed to the implementation strength, context and complexity of MaiKhanda's interventions. This is explored further using the implementation theory.Implementation was based on diffusion theories where better performing facilities were to act as role models for other facilities to emulate. The cRCT design for measuring impact evaluation required a random allocation of the improvement facilities and this conflicted with innovation diffusion theories, which prescribed a gradual organic spread of the interventions by strategically engaging the innovators and early adapters.Limitations of the evaluation design notwithstanding, the implementation strength characterized by the dose, duration, intensity and specificity of the intervention was sub-optimal.Implementation strength is not the only factor triggering an intervention mechanism and cannot be measured independent of the intervention complexity or the intervention context. For example, MaiKhanda struggled to show an effect of its interventions, despite having a long pre-intervention period to refine its interventions, while the Michigan study produced results within 18 month period. This could be because of other factors related to intervention complexity such as the long implementation chain for intervention delivery, the subjective perception of the agency (QI teams) regarding QI and contextual factors such as organizational readiness, the health systems context, QI team capacity to deliver QI interventions and MaiKhanda's own internal capacity.Human agency is at the heart of implementation and the intervention required a continuous and prolonged time and effort, than was anticipated, to engage and train the health facility QI teams on the improvement model.One of the key factors affecting the uptake of strategies was MaiKhanda's positioning within the health system and the degree of influence it could exert on other actors. This factor has a significant role to play in country where projects are donor supported and perhaps also donor driven. The period of the intervention also saw MaiKhanda going through a period of rapid organizational transition, which affected intervention implementation on the ground. Furthermore, MaiKhanda's own understanding of QI concepts was evolving gradually and this coupled with its long implementation chain, influenced the subjective understanding of the QI teams regarding QI concepts. Health facility staff also lacked the necessary skills and knowledge related to management of newborn health.Limited resources within the health facilities meant that gains achieved in some aspects of the intervention could not be sustained in the long run. External contextual factors such as fuel shortages contributed to poor implementation. Changes in policy such as government ban on TBAs, affected intervention uptake and resulted in an increase in health facility deliveries, overwhelming the already under-resourced staff capacity in the health facilities. It is conceivable that quality improvement was not on top of their priority list. But, ‘motivation’ to be involved in QI Collaboratives remained high. In resource constrained settings, ‘motivation’ can be influenced by the lure of personal incentives (such as per diems for attending workshops and meetings) as much as individual's commitment to broader social gains (ie reduction in newborn case fatality rates in their facility). The improvement model was competing against other existing models and it was difficult to get enough stakeholder commitment to the prescribed model as there were huge expectations fuelled by the poverty and poor governance structures and a culture of “perdiemitis” was prevalent in Malawian health care system.9 DiscussionAs is evident from the study, a single research method will not be able to provide justice to evaluation of a complex set of factors that influence newborn outcomes. We propose a research strategy that includes developing a Theory of Change, followed by evaluation of the program theory, measuring implementation strength, analysing implementation theory and comparing this in relation to the outcomes of the intervention observed through the impact evaluation. The results arising from such a comprehensive evaluation will contribute to the growth of improvement science with the accumulation of knowledge and explanation rather than being just a bedrock of observational facts.More generally, we propose that design, implementation and evaluation of QI activities, particularly in resource-poor settings, should consider five key principles i.e it should include whole systems thinking, accountability, participatory approach, should be evidence-based and adapt innovative methods.10

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Cauterman, M., S. Woynar, and S. Vergnaud. "Quality Improvement in Ambulatory Mental Health Settings." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71103-4.

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Eight ambulatory Mental Health Settings have been commited in a national pilot intervention aiming at improving the quality of the service they deliver from April 2006 to december 2007. This twenty months intervention allowed teams to set operational bjectives, to describe their organization, to implement an actions’plan and to evaluate their results.The main operational objectives they chose were the following:•Delay for an initial appointment.•Delay for an appointment following a discharge from hospitalization.•Rate of non attendance.The framework to analyse their organisation included a focus on Human ressources, on Operations, on Strategy and on Information Sharing.The main findings were awide variations in performance from a setting to one another (median delay for a first appointment with a psychiatrist ranging from one to seven weeks, paid psychiatrist working time for a single appointment ranging from 0.6 to 2.5 hours...), lack of formalisation of processes (including major processes as intake, discharge from hospital...), the absence of objectives set by the managemers.Actions’plans included very basical actions as setting dashboards and objectives, setting strategy to decrease non attendance, sharing diaries, reorganising meetings, mapping patient’ pathway.Finally, some results were obtained as:•reduction of delays for first appointments (4 settings amongs 8);•reduction of delays for a appointment after hospital discharge (1 amongst 8).Furthermore, this pilot intervention allowed to create and develop tools, method and experience for accompaining other settings. Ten new volunteers are involved since july 2008.

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Alex Viehman, J., Gordon Scott, Eli S. Goshorn, Peter Volpe, Rachel V. Marini, Erin K. McCreary, and Minh-Hong Nguyen. "1042. Antibiotic Stewardship Program (ASP) Implementation of Short-course Antimicrobials for Low-Risk Enterobacteriaceae Blood Stream Infection (EBSI) at a Tertiary Care Center." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S367. http://dx.doi.org/10.1093/ofid/ofz360.906.

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Abstract Background Literature demonstrates short course (e.g., 7 days) of antibiotic therapy for EBSI is appropriate in low-risk patients. Real-world experience with the implementation of this approach is not known. Methods In January 2019, a prospective ASP pathway was implemented to review all ESBI. The ASP contacted treatment teams of patients (patients) with low-risk ESBI between day 4–6 of antibiotic therapy to recommend short-course antimicrobial therapy (SC, ≤10 days). Low-risk ESBI was defined as: (1) venous catheter-associated infection (with removal), or an uncomplicated urinary tract infection (UTI), and 2) absence of: organ transplant, polymicrobial or persistent bacteremia ( ≥3d), or lack of improvement at 72h. Controls were pre-intervention patients with low-risk EBSI between July 2016-December 2017. Carbapenem-resistant isolates were excluded; multi-drug-resistant (MDR, ≥3 class acquired resistance) and extended-spectrum β-lactamase (ESBL) bacteria were included. Results Pre-intervention, 107 patients met low-risk ESBI criteria. In the intervention period, 15 patients had low-risk ESBI. The ASP pathway was executed in 13/15 patients (87%) with an 85% success rate. Charlson Comorbidity Index scores and Pitt Bacteremia Scores were similar pre- and post-intervention. The post-intervention group was older (median 71y vs. 63y, P = 0.02). Otherwise, clinical characteristics did not differ pre- and post-intervention: cirrhosis (8 vs. 13%), renal failure (4% vs. 0%), ICU admission (29% vs. 33%) and BSI with ESBL or MDR bacteria (8% vs. 7%) and (21% vs. 20%). UTI was the most common source pre- and post-intervention (61% and 73%) Time to active therapy did not differ (median 0.15d vs. 0.12d). The median duration of active therapy for ESBI was 15d pre-intervention and 8d post-intervention (P < 0.001). SC rate improved from 11% to 67% post-intervention. There was no significant difference in recurrence (2% vs. 0%), mortality (2% vs. 0%) or readmission rates (25% vs. 20%) at 30d. Conclusion A multidisciplinary ASP pathway for low-risk ESBI resulted in the decreased duration of antimicrobial therapy without increased rates of recurrence, readmission, or morality at 30d. SC therapy was also effective for BSI due to MDR or ESBL producing bacteria. Disclosures All authors: No reported disclosures.

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Jahoda, Andrew, Richard Hastings, Chris Hatton, Sally-Ann Cooper, Nicola McMeekin, Dave Dagnan, Kim Appleton, et al. "Behavioural activation versus guided self-help for depression in adults with learning disabilities: the BeatIt RCT." Health Technology Assessment 22, no. 53 (September 2018): 1–130. http://dx.doi.org/10.3310/hta22530.

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Background Depression is the most prevalent mental health problem among people with learning disabilities. Objective The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. Design A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation. There was a nested qualitative study. Setting Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. Participants Participants were aged ≥ 18 years, with clinically significant depression, assessed using the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities. Participants had to be able to give informed consent and a supporter could accompany them to therapy. Interventions BeatIt was a manualised behavioural activation intervention, adapted for people with learning disabilities and depression. StepUp was an adapted guided self-help intervention. Main outcome measures The primary outcome measure was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD). Secondary outcomes included carer ratings of depressive symptoms and aggressiveness, self-reporting of anxiety symptoms, social support, activity and adaptive behaviour, relationships, quality of life (QoL) and life events, and resource and medication use. Results There were 161 participants randomised (BeatIt, n = 84; StepUp, n = 77). Participant retention was strong, with 141 completing the trial. Most completed therapy (BeatIt: 86%; StepUp: 82%). At baseline, 63% of BeatIt participants and 66% of StepUp participants were prescribed antidepressants. There was no statistically significant difference in GDS-LD scores between the StepUp (12.94 points) and BeatIt (11.91 points) groups at the 12-month primary outcome point. However, both groups improved during the trial. Other psychological and QoL outcomes followed a similar pattern. There were no treatment group differences, but there was improvement in both groups. There was no economic evidence suggesting that BeatIt may be more cost-effective than StepUp. However, treatment costs for both groups were approximately only 4–6.5% of the total support costs. Results of the qualitative research with participants, supporters and therapists were in concert with the quantitative findings. Both treatments were perceived as active interventions and were valued in terms of their structure, content and perceived impact. Limitations A significant limitation was the absence of a treatment-as-usual (TAU) comparison. Conclusions Primary and secondary outcomes, economic data and qualitative results all clearly demonstrate that there was no evidence for BeatIt being more effective than StepUp. Future work Comparisons against TAU are required to determine whether or not these interventions had any effect. Trial registration Current Controlled Trials ISRCTN09753005. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 53. See the NIHR Journals Library website for further project information.

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Hanson, Heather M., Tova Léveillé, Mollie Cole, Lesley JJ Soril, Fiona Clement, Adrian Wagg, and James Silvius. "Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care." BMJ Open Quality 10, no. 2 (April 2021): e001211. http://dx.doi.org/10.1136/bmjoq-2020-001211.

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BackgroundAntipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta.MethodsWe conducted a multimethod evaluation of the provincial implementation of the project in 170 LTC sites over a 3-year project period incorporating a quasi-experimental before–after design. Using a three-component intervention of education and audit and feedback delivered in a learning workshop innovation collaborative format, local LTC teams were supported to reduce the number of residents receiving antipsychotic medications in the absence of a documented indication. Project resources were preferentially allocated to supporting sites with the highest baseline antipsychotic medication use. Changes in antipsychotic medication use, associated clinical and economic outcomes, and the effects of the project on LTC staff, physicians, leaders and administrators, and family members of LTC residents were assessed at the conclusion of the implementation phase.ResultsThe province-wide initiative was delivered with a 75% implementation fidelity. Inappropriate antipsychotic medication use declined from 26.8% to 21.1%. The decrease was achieved without unintended consequences in other outcomes including physical restraint use or aggressive behaviours. The project was more expensive but resulted in less inappropriate use of antipsychotics than the pre-project period (incremental cost per inappropriate antipsychotic avoided of $5 678.71). Accounts from family, organisational leaders, and LTC staff were supportive of the project activities and outcomes.ConclusionThis quality improvement initiative was successfully delivered across an entire delivery arm of the continuing care sector. Quality of care in LTC was improved.

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Pariha, Sheri, Sana Saeed, Sonia Qureshi, and Sadaf Altaf. "Implementation of a low-cost standardized handoff system (IPASS) in a pediatric hematology/oncology unit: Lessons from a low-middle income country." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 278. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.278.

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278 Background: Communication failure is the most common preventable cause of medical adverse event, and almost half of all sentinel events involve handoff failure. Inefficient handoff is labor intensive and time consuming, impacting the quality of patient care provided. A safe and efficient means of exchange of medical information between care teams via a standardized handoff system is essential, especially in high intensity fields such as Pediatric Hematology/Oncology. Methods: Pre-intervention, handoff entailed the physical handover of handwritten notes, carbon copied for various team members. A standardized electronic handoff tool (IPASS) was identified, and significantly modified to fit our needs, since we do not have a complete electronic medical record (EMR). Microsoft Sharepoint (Microsoft, Redmond, WA) was used to develop a tabulated online portal incorporating patient demographic, clinical and laboratory details with physician remarks. This allowed remote access, multiple simultaneous inputs, authenticated use and user-specific access control. Implementation included sensitizing residents to the IPASS template, hands-on training, weekly feedback from the residents, directly observed hand-off by the chief and/or senior resident. Following a four-week pilot this was expanded to other sub specialties, and a pre and post intervention survey was conducted to assess its impact. Results: Pre-implementation survey revealed 74% resident and 87% faculty dissatisfaction with the current handoff process. Weekly compliance audits after initial pilot demonstrated a 100% compliance. Post-Implementation results showed that the resident dissatisfaction has gone down to less than 5%. Conclusions: Implementation of an electronic handoff tool in the absence of an EMR with minimal resources is a major breakthrough and can be replicated in other low-resource settings. We successfully implemented IPASS without any added infrastructure cost. In the next phase of our project we will be measuring trends in reduction in medical errors since implementation.

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Anderson, Jane, and Petia Sice. "Evaluating the possibilities and actualities of the learning process." Learning Organization 23, no. 2/3 (April 11, 2016): 94–120. http://dx.doi.org/10.1108/tlo-02-2014-0004.

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Purpose This paper aims to reflect on the opportunities and challenges of the learning process in practice and explores the case of a local authority school Pilot Wellbeing Programme (PWP) intervention. The aim of the PWP was to create the best workplace conditions and circumstances for people to flourish and mature, both individually and collectively. Findings show that the socio-physical environment plays a significant and leading role in supporting this work, as does the consistent modelling of higher level behaviours including integrity, respect and acceptance by intervention managers and school leadership teams. It was also important that the change processes were continually tailored and nuanced to meet the evolving needs of the staff and organisation throughout the intervention. Emphasis was also placed on encouraging individual involvement and commitment by implementing inclusive measures that fostered trust and openness. Design/methodology/approach The intervention worked to the organisational learning process model. Findings Headteachers (HT) are still playing a key role as caregivers to their staff. Wellbeing is something people in school generally expect to be “done” to them. Personal accountability for one’s own health and wellbeing is still a growth area in schools. Any change processes implemented to support this process need to be continually tailored and respectfully nuanced to meet the evolving needs of the staff and organisation throughout the intervention. Accruing quantitative evidence to support the effects of wellbeing work in schools is painstaking and challenging. Practical implications HT have traditionally taken the role of school staff “caregiver”, overseeing staff wellbeing often to the detriment of their own wellbeing. This situation is becoming unsustainable as HT’ capacity for this kind of work is diminishing. School staff need to accept an increasing role in the maintenance of their own personal–professional wellbeing. Social implications School staff who do not mind their own wellbeing act as a poor model to their pupils who may ultimately emulate their behaviour. Additionally, as staff sickness absence due either directly or indirectly to stress becomes a growing issue in schools, educational standards will be increasingly difficult to attain and maintain. Wellbeing mechanisms need to be put in place now to stem this possibility. Originality/value The intervention is unique in as much as it took a deliberately holistic approach to school staff wellbeing by including all school staff in the change programme. Previous similar programmes have targeted professional staff only, excluding non-teaching classroom staff and school support and maintenance staff.

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Chen, Dafna, Elizabeth Temkin, Ester Solter, Amir Nutman, Yehuda Carmeli, Mitchell Schwaber, and Debby Ben-David. "A National Intervention to Reduce Undesirable Urinary Tract Events in Internal Medicine Wards." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s98. http://dx.doi.org/10.1017/ice.2020.598.

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Background: Catheter-associated urinary tract infection (CAUTI) is considered a preventable healthcare-associated infection. Many local and national interventions using multimodal prevention measures have targeted CAUTI incidence as the primary outcome. Other undesirable events related to urinary catheters and infections such as overuse of urine culturing and antimicrobial prescribing for asymptomatic bacteriuria, are not captured by CAUTI surveillance, and may not be the targets of such interventions. The aim of this study was to assess the impact of expanded national surveillance targeting various aspects of urinary tract infections, culturing and treatment practices, and catheter use in internal medicine wards. Methods: The Israeli National Center for Infection Control (NCIC) issued CAUTI prevention guidelines and initiated in 2016 a urinary tract event surveillance system that targets the incidence of CAUTI, urinary catheter utilization ratio, and the proportion of urine cultures sent and patients treated in the absence of symptoms. The surveillance is conducted for 1 month 3 times per year. Hospitals are required to report all positive urine cultures (>100,000 CFU) collected in internal medicine wards, along with the following data: admission date, symptoms of infection, dates of urinary catheter use, and antibiotic treatment. These data enable the NCIC to validate hospital classifications of each event. In addition, during each surveillance month, hospitals conduct point-prevalence surveys of compliance with CAUTI prevention measures. An electronic data collection form with built-in algorithms supports the local teams during the surveillance process. Results: Between 2016 and 2019, a total of 3,028 positive urine cultures not present on admission were reported by internal medicine wards in 30 hospitals. A significant decrease was observed in the incidence of CAUTI (from 4.7 to 2.9; P < .001) and in the proportion of asymptomatic bacteriuria treated with antibiotics (from 31% to 20%; P = .02) (Table 1). The catheter utilization ratio decreased from 0.25 to 0.23 (P < .001). The rate of cultures sent from asymptomatic patients decreased from 1.5 to 1.1 (P < .01). Point-prevalence surveys in internal medicine wards detected a significant increase in the use of closed urinary drainage systems (from 79% to 97% in 2018, P < .001) and documentation of a daily nurse assessment of the need for a catheter (from 74% to 81%, P < .001). Conclusions: National surveillance of undesirable urinary tract events resulted in a significant reduction in CAUTI, antibiotic treatment for ASB, and the rate of cultures sent from asymptomatic patients. A small decrease was observed in catheter utilization ratio. CAUTI surveillance programs should include other undesirable urinary tract events.Funding: NoneDisclosures: None

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Oliveira, W. S., J. R. Soares Júnior, S. R. O. Maier, C. A. S. Flores, G. A. S. Moser, D. C. M. Aguiar, and G. A. Sudré. "Perspective of nursing professionals on the discharge of patients suffering from recurrent myocardial infarction." Scientific Electronic Archives 13, no. 11 (October 29, 2020): 69. http://dx.doi.org/10.36560/131120201138.

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the present study aims to understand how nursing professionals develop their care activities in face of the victim of recurrent acute myocardial infarction in the discharge process from the specialized intensive care unit. It is a research with a qualitative approach anchored in the methodological precepts of Convergent Care Research (PCA), articulating intervention and assistance, divided into two complementary phases, with five professionals working in the coronary intensive care unit of a hospital in the south of Mato Grosso . The data were collected through interviews with the use of a semi-structured script prepared by the authors. From the transcription of the interviews, categories of analysis emerged: “The development of technical knowledge and the execution of routine” and “Praxis and the need for advances in scientific nursing knowledge”. In addition to the assistance aspect, it was possible to understand, through the statements made explicit throughout the study, the absence of the professional nurse in the care process, since they were mentioned in a correlated way with the institutional routines and not as the main agents that propagate health care. care and guidance, especially at discharge from the unit. Thus, it is suggested the planning of the discharge process of the unit, with proper structuring capable of showing the interprofessionality between the care teams working in the unit, and in the context of nursing, its technical-scientific role.

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Hill, Edward M., Benjamin D. Atkins, Matt J. Keeling, Louise Dyson, and Michael J. Tildesley. "A network modelling approach to assess non-pharmaceutical disease controls in a worker population: An application to SARS-CoV-2." PLOS Computational Biology 17, no. 6 (June 16, 2021): e1009058. http://dx.doi.org/10.1371/journal.pcbi.1009058.

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As part of a concerted pandemic response to protect public health, businesses can enact non-pharmaceutical controls to minimise exposure to pathogens in workplaces and premises open to the public. Amendments to working practices can lead to the amount, duration and/or proximity of interactions being changed, ultimately altering the dynamics of disease spread. These modifications could be specific to the type of business being operated. We use a data-driven approach to parameterise an individual-based network model for transmission of SARS-CoV-2 amongst the working population, stratified into work sectors. The network is comprised of layered contacts to consider the risk of spread in multiple encounter settings (workplaces, households, social and other). We analyse several interventions targeted towards working practices: mandating a fraction of the population to work from home; using temporally asynchronous work patterns; and introducing measures to create ‘COVID-secure’ workplaces. We also assess the general role of adherence to (or effectiveness of) isolation and test and trace measures and demonstrate the impact of all these interventions across a variety of relevant metrics. The progress of the epidemic can be significantly hindered by instructing a significant proportion of the workforce to work from home. Furthermore, if required to be present at the workplace, asynchronous work patterns can help to reduce infections when compared with scenarios where all workers work on the same days, particularly for longer working weeks. When assessing COVID-secure workplace measures, we found that smaller work teams and a greater reduction in transmission risk reduced the probability of large, prolonged outbreaks. Finally, following isolation guidance and engaging with contact tracing without other measures is an effective tool to curb transmission, but is highly sensitive to adherence levels. In the absence of sufficient adherence to non-pharmaceutical interventions, our results indicate a high likelihood of SARS-CoV-2 spreading widely throughout a worker population. Given the heterogeneity of demographic attributes across worker roles, in addition to the individual nature of controls such as contact tracing, we demonstrate the utility of a network model approach to investigate workplace-targeted intervention strategies and the role of test, trace and isolation in tackling disease spread.

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Quinn, Robert R., Farah Mohamed, Robert Pauly, Tracy Schwartz, Nairne Scott-Douglas, Louise Morrin, Anita Kozinski, et al. "Starting Dialysis on Time, At Home on the Right Therapy (START): Description of an Intervention to Increase the Safe and Effective Use of Peritoneal Dialysis." Canadian Journal of Kidney Health and Disease 8 (January 2021): 205435812110037. http://dx.doi.org/10.1177/20543581211003764.

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Background: Most of the patients with end-stage kidney failure are treated with dialysis. Jurisdictions around the world are actively promoting peritoneal dialysis (PD) because it is equivalent to hemodialysis in terms of clinical outcomes, but is less costly. Unfortunately, PD penetration remains low. Objectives: The Starting dialysis on Time, At Home, on the Right Therapy (START) Project had 2 overarching goals: (1) to provide information that would help programs increase the safe and effective use of PD, and (2) to reduce inappropriate, early initiation of dialysis in patients with kidney failure. In this article, we focus on the first objective and describe the rationale for START and the methods employed. Design: The START Project was a comprehensive, province-wide quality improvement intervention. Setting: The START project was implemented in both Alberta Kidney Care (AKC)-South and AKC-North, including all 7 renal programs in the province. Patients: The project included all patients who commenced maintenance dialysis between October 1, 2015, and March 31, 2018, in Alberta, Canada who met our inclusion criteria. Measurements: We reported baseline characteristics of incident dialysis patients overall, and by site. Our key performance indicator was the proportion of patients who received PD for any period of time within 180 days of the first dialysis treatment. Reports also included detailed metrics pertaining to the 6 steps in the process of modality selection and we had the capacity to provide more granular data on an as-needed basis. To understand loss of PD patients, we reported the numbers of incident patients who recovered kidney function, experienced technique failure, received a transplant, were lost to follow-up, transferred to another program, or died. Methods: START provided dialysis programs with a conceptual framework for understanding the drivers of PD utilization. High-quality, detailed data were collected using a tool that was custom-built for this purpose, and were mapped to steps in the process of care that drove the outcomes of interest. This allowed sites to identify gaps in care, develop action plans, and implement local interventions to address them. The process was supported by an Innovation Learning Collaborative consisting of 3 learning sessions that brought frontline staff together from across the province to share strategies and learnings. Ongoing data collection allowed teams to determine whether their interventions were effective at each subsequent learning session, and to revisit their interventions if required (the “Plan-Do-Study-Act Cycle”). Results: Future work will report on the impact of the START project on incident PD utilization at a provincial and regional level. Limitations: The time required to design and implement interventions in practice, as well as the need for multiple PDSA (Plan-Do-Study-Act) cycles to see results, meant that the true potential may not be realized during a relatively short intervention period. Change required buy-in and support from local and provincial leadership and frontline staff. In the absence of accountability for local performance, we relied on the goodwill of participating programs to use the information and resources provided to effect change. Finally, the burden of documentation and data collection for frontline staff was high at baseline. We anticipated that adding supplemental data collection would be difficult. Conclusions: The START project was a comprehensive, province-wide initiative to maximize the safe and effective use of PD in Alberta, Canada. It standardized the management of incident dialysis patients, leveraged high-quality data to facilitate the reporting of metrics mapped to steps in the process of care that drove incident PD utilization, and helped programs to identify gaps in care and target them for improvement. Future work will report on the impact of the program on incident utilization at the provincial and regional level.

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McNamara, Rachel, Elizabeth Randell, David Gillespie, Fiona Wood, David Felce, Renee Romeo, Lianna Angel, et al. "A pilot randomised controlled trial of community-led ANtipsychotic Drug REduction for Adults with Learning Disabilities." Health Technology Assessment 21, no. 47 (August 2017): 1–92. http://dx.doi.org/10.3310/hta21470.

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Background Data suggest that approximately 50,000 adults with learning disabilities (LDs) in England and Wales are currently prescribed antipsychotic medication. Illness in this population is common, including significant rates of challenging behaviour and mental illness, but there is particular concern over the use of antipsychotics prescribed for reasons other than the treatment of psychosis. Control of challenging behaviour is the primary reason why such medications are prescribed despite the absence of good evidence for any therapeutic effect for this purpose. Objectives To assess the feasibility of recruitment and retention and to explore non-efficacy-based barriers to a blinded antipsychotic medication withdrawal programme for adults with LDs without psychosis compared with treatment as usual. A secondary objective was to compare trial arms regarding clinical outcomes. Design A two-arm individually randomised double-blind placebo-controlled drug reduction trial. Setting Recruitment was through community learning disability teams (CLDTs) in south Wales and south-west England. Participants Adults with LDs who are prescribed risperidone for treatment of challenging behaviour with no known current psychosis or previous recurrence of psychosis following prior drug reduction. Intervention A double-blind drug reduction programme leading to full withdrawal within 6 months. Treatment in the intervention group was gradually reduced over a 6-month period and then maintained at the same level for a further 3 months, still under blind conditions. In the control group, the baseline level of medication was maintained throughout the 9-month period. The blind was broken at 9 months, following final data collection. Main outcome measures Feasibility outcomes were (1) the number and proportion of general practices/CLDTs that progressed from initial approach to recruitment of participants and (2) the number and proportion of recruited participants who progressed through the various stages of the study. Trial arms were also compared regarding clinical outcomes, the Modified Overt Aggression Scale, the Aberrant Behaviour Checklist, the Psychiatric Assessment Schedule for Adults with Developmental Disability checklist, the Antipsychotic Side-effect Checklist, the Dyskinesia Identification System Condensed User Scale, the Client Service Receipt Inventory, use of other interventions to manage challenging behaviour, use of as-required (pro re nata) medication and level of psychotropic medication use. Results Of the 22 participants randomised (intervention, n = 11; control, n = 11), 13 (59%) achieved progression through all four stages of reduction. Follow-up data at 6 and 9 months were obtained for 17 participants (intervention, n = 10; and control, n = 7; 77% of those randomised). There were no clinically important changes in participants’ levels of aggression or challenging behaviour at the end of the study. There were no expedited safety reports. Four adverse events and one serious adverse event were reported during the trial. Limitations Recruitment was challenging, which was largely a result of difficulty in identifying appropriate persons to consent and carer concerns regarding re-emergence of challenging behaviour. Reduced recruitment meant that the full trial became an exploratory pilot study. Conclusions The results indicate that drug reduction is possible and safe. However, concerns about taking part were probably exacerbated by limited availability of alternative (behavioural) interventions to manage behaviour; therefore, focused support and alternative interventions are required. The results of the qualitative study provide important insights into the experiences of people taking part in drug reduction studies that should influence future trial development. Future work We recommend that further work focuses on support for practitioners, carers and patients in reducing antipsychotic medication. Trial registration Current Controlled Trials ISRCTN38126962. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 47. See the NIHR Journals Library website for further project information.

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Akerstrom, M., J. Severin, H. Imberg, I. H. Jonsdottir, L. Björk, and L. Corin. "Methodological approach for measuring the effects of organisational-level interventions on employee withdrawal behaviour." International Archives of Occupational and Environmental Health 94, no. 7 (March 26, 2021): 1671–86. http://dx.doi.org/10.1007/s00420-021-01686-y.

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Abstract Background Theoretical frameworks have recommended organisational-level interventions to decrease employee withdrawal behaviours such as sickness absence and employee turnover. However, evaluation of such interventions has produced inconclusive results. The aim of this study was to investigate if mixed-effects models in combination with time series analysis, process evaluation, and reference group comparisons could be used for evaluating the effects of an organisational-level intervention on employee withdrawal behaviour. Methods Monthly data on employee withdrawal behaviours (sickness absence, employee turnover, employment rate, and unpaid leave) were collected for 58 consecutive months (before and after the intervention) for intervention and reference groups. In total, eight intervention groups with a total of 1600 employees participated in the intervention. Process evaluation data were collected by process facilitators from the intervention team. Overall intervention effects were assessed using mixed-effects models with an AR (1) covariance structure for the repeated measurements and time as fixed effect. Intervention effects for each intervention group were assessed using time series analysis. Finally, results were compared descriptively with data from process evaluation and reference groups to disentangle the organisational-level intervention effects from other simultaneous effects. Results All measures of employee withdrawal behaviour indicated statistically significant time trends and seasonal variability. Applying these methods to an organisational-level intervention resulted in an overall decrease in employee withdrawal behaviour. Meanwhile, the intervention effects varied greatly between intervention groups, highlighting the need to perform analyses at multiple levels to obtain a full understanding. Results also indicated that possible delayed intervention effects must be considered and that data from process evaluation and reference group comparisons were vital for disentangling the intervention effects from other simultaneous effects. Conclusions When analysing the effects of an intervention, time trends, seasonal variability, and other changes in the work environment must be considered. The use of mixed-effects models in combination with time series analysis, process evaluation, and reference groups is a promising way to improve the evaluation of organisational-level interventions that can easily be adopted by others.

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Svaldi, Jennifer, Florian Schmitz, Julia Baur, Andrea S. Hartmann, Tanja Legenbauer, Charlotte Thaler, Jörn von Wietersheim, Martina de Zwaan, and Brunna Tuschen-Caffier. "Efficacy of psychotherapies and pharmacotherapies for Bulimia nervosa." Psychological Medicine 49, no. 6 (December 5, 2018): 898–910. http://dx.doi.org/10.1017/s0033291718003525.

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AbstractBackgroundBulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological, nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the efficacy of these interventions in up to 19 different interventions.MethodsDatabase search terms were combined for BN and RCTs from database inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome variables. Retrieved RCTs were meta-analyzed using fixed and random effects models.ResultsRCT (79 trials; 5775 participants) effects post-treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help, pharmacotherapy, and combined therapies.ConclusionsMost psychological and pharmacological interventions revealed to be effective in BN treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration, CBT can be recommended as the best intervention for the initial treatment of BN.

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Munoz, Diego F., and Sylvia K. Plevritis. "Estimating Breast Cancer Survival by Molecular Subtype in the Absence of Screening and Adjuvant Treatment." Medical Decision Making 38, no. 1_suppl (March 19, 2018): 32S—43S. http://dx.doi.org/10.1177/0272989x17743236.

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Background. As molecular subtyping of breast cancer influences clinical management, the evaluation of screening and adjuvant treatment interventions at the population level needs to account for molecular subtyping. Performing such analyses are challenging because molecular subtype-specific, long-term outcomes are not readily accessible; these markers were not historically recorded in tumor registries. We present a modeling approach to estimate historical survival outcomes by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status. Method. Our approach leverages a simulation model of breast cancer outcomes and integrates data from two sources: the Surveillance Epidemiology and End Results (SEER) databases and the Breast Cancer Surveillance Consortium (BCSC). We not only produce ER- and HER2-specific estimates of breast cancer survival in the absence of screening and adjuvant treatment but we also estimate mean tumor volume doubling time (TVDT) and mean mammographic detection threshold by ER/HER2-status. Results. In general, we found that tumors with ER-negative and HER2-positive status are associated with more aggressive growth, have lower TVDTs, are harder to detect by mammography, and have worse survival outcomes in the absence of screening and adjuvant treatment. Our estimates have been used as inputs into model-based analyses that evaluate the effects of screening and adjuvant treatment interventions on population outcomes by ER and HER2 status developed by the Cancer Intervention and Surveillance Modeling Network (CISNET) Breast Cancer Working Group. In addition, our estimates enable a re-assessment of historical trends in breast cancer incidence and mortality in terms of contemporary molecular tumor characteristics. Conclusion. Our approach can be generalized beyond breast cancer and to more complex molecular profiles.

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Korshunov, V. F., and M. A. Skvortsova. "OPERATIVNOE LEChENIE BOKOVOY NESTABIL'NOSTI PYaSTNO-FALANGOVOGO SUSTAVAI PAL'TsA KISTI." N.N. Priorov Journal of Traumatology and Orthopedics 10, no. 1 (March 15, 2003): 50–53. http://dx.doi.org/10.17816/vto200310150-53.

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Examination and treatment results of 27 patients with lateral instability of metacarpal-phalanx thumb joint were presented. The indication to operation and technique of surgical intervention in dependence on the terms from injury moment, presence or absence of instability, value of passive lateral deviation angle were detected. Surgical technique for the treatment of complete tears of collateral ligaments of metacarpal-phalanx thumb joint was perfected. In 22 patients follow up period ranged from 6 to 12 months. Excellent results were achieved in 13 (59%), good - in 7(32%), satisfactory - in 2 (9%) patients.

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Oliveira, Edmundo C., Marco A. G. Moura, José A. Almeida, Antonio L. P. Ribeiro, and Bruno R. Nascimento. "Percutaneous closure of ostium secundum atrial septal defect using left internal jugular vein access in a child with situs inversus and absence of inferior caval vein." Cardiology in the Young 29, no. 10 (September 2, 2019): 1310–12. http://dx.doi.org/10.1017/s1047951119002099.

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AbstractFemoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.

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Baghdady, Nour, Daniel Voit, Anne M. McDonell, and David W. Kubiak. "Effect of Pharmacists’ Interventions on the Appropriateness of Empiric Vancomycin Therapy in Oncology Patients with Febrile Neutropenia." Journal of King Abdulaziz University - Medical Sciences 26, no. 2 (December 31, 2019): 53–59. http://dx.doi.org/10.4197/med.26-2.6.

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The purpose of this observational study is to evaluate the effect of an active pharmacy intervention to facilitate timely discontinuation of empiric vancomycin therapy in oncology patients with febrile neutropenia who lack objective evidence of a Gram-positive infection. This was a two-phase study. Vancomycin use was evaluated retrospectively on all oncology patients with febrile neutropenia over four weeks (phase I). In a parallel four weeks a year later, vancomycin use in this patient population was evaluated prospectively (phase II). In the absence of evidence of Gram-positive infection after 72 hours of treatment initiation, the team was contacted by a pharmacist to encourage discontinuation. Usage was compared between both phases. Forty-three patients in phase I and 25 patients in phase II were treated with vancomycin with no evidence for Gram-positive infections. Pharmacists’ interventions were documented on 18 patients in phase II. Of these, 56% of interventions to discontinue vancomycin were accepted, but only 33.3% of patients had treatment stopped within 72 hours of initiation. Although not significant, a trend in more appropriate use of vancomycin in oncology patients with febrile neutropenia was observed. Pharmacist’s interventions might have played a role in this observation.

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Cherkasov, M. A., R. M. Tikhilov, I. I. Shubnyakov, A. N. Kovalenko, and Z. A. Mugutdinov. "PATIENT SATISFACTION FOLLOWING TOTAL HIP REPLACEMENT: PREDICTORS OF SUCCESS." Traumatology and Orthopedics of Russia 24, no. 3 (October 7, 2018): 45–54. http://dx.doi.org/10.21823/2311-2905-2018-24-3-45-54.

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Background.Total hip arthroplasty (THA) is reliable and successful intervention in terms of relieving pain andimproving joint function. Between 7% and 16% of patients are dissatisfied after THA. To assess predictors and postoperative determinants of satisfaction 3 and 12 months after THA. Material and Methods.During our research from 2015 to 2017 prospectively 1015 patients were interviewedusing patient related outcome measures (a questionnaire of functional outcome (Oxford Hip Score, Harris Hip Score), health-related quality of life (EQ-5D)) preoperatively, 3 and 12 months postoperatively. Satisfaction was assessed using Visual Analogue Scale (VAS). Also Univariate and multivariate analyses were performed. Results.A female gender, absence of interventions on the operated joint in history were preoperative predictorsof satisfaction. The main postoperative determinant of satisfaction was the fulfillment of patient’s expectations, improve physical function, quality of life, relief of pain. Conclusion.To improve patient satisfaction after THA, patients’ expectations and their fulfillment need to becarefully addressed. Patients with a history of interventions on the operated joint with low physical function or quality of life, high level of pain should be identified and specifically informed on expected surgical outcome

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Monroy, Carlota, Dulce Maria Bustamante, Sandy Pineda, Antonieta Rodas, Xochitl Castro, Virgilio Ayala, Javier Quiñónes, and Bárbara Moguel. "House improvements and community participation in the control of Triatoma dimidiata re-infestation in Jutiapa, Guatemala." Cadernos de Saúde Pública 25, suppl 1 (2009): S168—S178. http://dx.doi.org/10.1590/s0102-311x2009001300016.

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The deterioration or absence of plaster walls in houses and poor hygienic conditions are the most important risk factors for indoor Triatoma dimidiata infestation in Guatemala. A cross-disciplinary study was conducted addressing T. dimidiata infestation, household hygiene, and housing construction. The study focused on local materials and cultural aspects (including gender roles) that could lead to long-term improvements in wall construction. A new plaster mix for walls was developed on the basis of laboratory studies on construction materials recommended by local villagers. Four villages with persistent (post-spraying) T. dimidiata infestation were studied. In two villages, an ecosystem approach was implemented, and the homeowners conducted wall improvements and household sanitation with the support of the interdisciplinary team (the ecosystem intervention). In the other two villages, a vector control approach based on insecticide spraying was adopted (traditional intervention). Both interventions were associated with a reduction in T. dimidiata infestation, but only the ecosystem approach produced important housing improvements (sanitation and wall construction) capable of preventing T. dimidiata re-infestation in the long term.

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Zettler, Marjorie E., Ethan Basch, and Chadi Nabhan. "Patient-Reported Outcome Labeling for Malignant Hematology Drugs Approved in the United States: 2011-2017." Blood 132, Supplement 1 (November 29, 2018): 2292. http://dx.doi.org/10.1182/blood-2018-99-116404.

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Abstract Introduction: Patient-reported outcomes (PROs), defined as any report on the status of a patient's health condition that comes directly from the patient without interpretation by anyone else, play an increasingly important role in drug development. In 2009 the FDA issued final guidance on using PRO measures to support labeling claims, to incorporate the patient perspective into the drug approval process. The 21st Century Cures Act emphasizes PROs as a differentiating element in the FDA approval process of new drugs, beyond traditional clinical outcome measures. Further, recent data has shown that intervention based on PROs can improve survival in metastatic cancers (Basch et al; 2017). The incorporation of PROs into the labeling of new drugs for malignant hematology disorders has not been studied and is the subject of this investigation. Methods: We reviewed the FDA's Novel New Drug Summaries (2011-2017) to identify drugs approved for malignant hematology indications. Drug approval packages and product labeling were accessed via the Drugs@FDA database and analyzed for PRO endpoints, measures, and labeling claims. Clinical trial designs and published study results were retrieved via the ClinicalTrials.gov website and PubMed. Results: Of 250 novel drugs approved by the FDA between 2011 and 2017, 22 (8.8%) were approved for malignant hematology indications. Interestingly, only 1 had PRO-based claims in their labeling, even though 13 of the 22 drugs (59%) collected PRO data in pivotal trials that led to their approval. Notably, the proportion of malignant hematology trials assessing PROs has increased over time, with 4 of the 5 drugs approved in 2017 for malignant hematology indications evaluating PROs in their development programs, compared with 9 of the 17 drugs approved in the preceding 6 years (80% vs. 53%). PROs evaluated included generic instruments such as the EQ-5D, and disease-specific instruments such as the EORTC QLQ-C30 (see table). Reasons cited for rejection of PRO data inclusion in drug labeling were single arm trial design, excessive missing data, statistical issues, and use of an inappropriate PRO instrument. Conclusions: While the FDA encourages PRO data submission as part of the new drug approval process, and although more than half of all malignant hematology drugs approved in the past 7 years assessed PROs during development, only 1 was able to successfully acquire labeling claims. Whether this is due to lack of PRO expertise on clinical development teams or absence of strong regulatory guidance on how best to implement PROs remains unknown and requires further research. Designing strategies to develop, validate and report PROs effectively is needed to meet regulatory requirements and enhance patients' voices in their own care. Table. Table. Disclosures Nabhan: Cardinal Health: Employment, Equity Ownership.

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Preston, Robyn, Hilary Waugh, Sarah Larkins, and Judy Taylor. "Community participation in rural primary health care: intervention or approach?" Australian Journal of Primary Health 16, no. 1 (2010): 4. http://dx.doi.org/10.1071/py09053.

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Community participation is considered important in primary health care development and there is some evidence to suggest it results in positive health outcomes. Through a process of synthesising existing evidence for the effectiveness of community participation in terms of health outcomes we identified several conceptual areas of confusion. This paper builds on earlier work to disentangle the conceptual gaps in this area, and clarify our common understanding of community participation. We conducted a research synthesis of 689 empirical studies in the literature linking rural community participation and health outcomes. The 37 final papers were grouped and analysed according to: contextual factors; the conceptual approach to community participation (using a modification of an existing typology); community participation process; level of evidence; and outcomes reported. Although there is some evidence of benefit of community participation in terms of health outcomes, we found only a few studies demonstrating higher levels of evidence. However, it is clear that absence of evidence of effect is not necessarily the same as absence of an effect. We focus on areas of debate and lack of clarity in the literature. Improving our understanding of community participation and its role in rural primary health care service design and delivery will increase the likelihood of genuine community–health sector partnerships and more responsive health services for rural communities.

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Aktas, Aynur, Lenna Finch, Danielle Boselli, Declan Walsh, Kunal C. Kadakia, Lauren Dennis Giamberardino, Beth York, Sally Trufan, and Rupali Bose. "The effect of quality improvement interventions on inpatient cancer malnutrition documentation and coding in an academic medical center." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 38. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.38.

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38 Background: Malnutrition (MN) is common yet underdiagnosed in hospitalized cancer patients. Effective assessments can identify those who need nutritional care and help plan intervention. We examined the effect of quality improvement (QI) interventions on the dietitian documented MN (DDMN) and physician coded malnutrition (PCMN). We also determined if the registered dietitian (RD) and physician assessments of MN agreed. Methods: Electronic medical records (EMR) were reviewed for a consecutive cohort of inpatients with a solid tumor diagnosis staged I-IV and admitted to Atrium Health’s Carolinas Medical Center at least once between 1/1/2016 to 5/31/2019. Data were collected from the first admission EMR encounter closest to the cancer diagnosis date. RD assessments were reviewed for DDMN. PCMN diagnosis was based on MN ICD-10 codes in the discharge summary. MN was graded as mild, moderate, and severe. Two QI interventions were implemented during the study period: 1) 8/2016: RD message via EMR to query MD approval for MN diagnosis; 2) 4/2018: Clinical Documentation Integrity Team query MD by sending ASPEN criteria via an alert integrated into MD workflow. Agreement in MN identification was defined as the absence or presence of both DDMN and PCMN; agreement in severity was defined as the absence of DDMN and PCMN or the agreement in presence and severity of DDMN and PCMN. Cochran-Armitage tests for trend assessed prevalence and agreement across the three periods (N1=652; N2=2858; N3=1622) defined by the two sequential QI interventions. Results: N=5143; 52% males. Median age 63 (range 18-102) years. 70% White; 24% Black, 3% Latino. Commonest cancer diagnostic groups: Upper Gastrointestinal 22%, Thoracic (19%), Genitourinary 18%. 28% had stage IV disease. 11% (N=557) met criteria for DDMN and/or PCMN. Of the 557, 40% (N=223) met criteria for both DDMN and PCMN. DDMN (N=420) was mild 2%, moderate 19%, and severe 79%. On discharge, PCMN (N=360) was mild in 10%, moderate in 21%, and severe in 69%. The RD and MD agreed on the presence or absence (94%) and severity (93%) of MN. Significant trends were observed as DDMN prevalence increased from 3.1%, 8.1%, to 10.3% (p<.001), and PCMN prevalence from 0.5%, 7.8%, to 8.2% (p<.001). While rates of mild, moderate, and severe MN varied across the periods, statistically significant change in these distributions was not identified in DDMN (p=0.62) or PCMN (p=0.20) after the second QI intervention. Conclusions: MN was under-diagnosed compared to nutrition intervention studies. When MN was identified, it was moderate or severe in the majority. Evaluations by RD and MD were highly congruent for MN prevalence and severity. Implementation of nutrition-focused QI interventions improved documentation and coding of MN. Improved communication between the RD and the MD could improve the recognition and diagnosis of MN.

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Arruzza, Elio, and Minh Chau. "The effectiveness of cultural competence education in enhancing knowledge acquisition, performance, attitudes, and student satisfaction among undergraduate health science students: a scoping review." Journal of Educational Evaluation for Health Professions 18 (February 24, 2021): 3. http://dx.doi.org/10.3352/jeehp.2021.18.3.

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Purpose: Cultural competence in healthcare assists in the delivery of culturally sensitive and high-quality services. This scoping review aims to provide an overview of the available evidence and to examine the effectiveness of classroom-based intervention strategies used to enhance the cultural competence of undergraduate health science students.Methods: A comprehensive and systematic literature search was undertaken in databases, including Cochrane Library, Medline, and Emcare. Articles were eligible if they employed an experimental study design to assess classroom-based cultural competency education for university students across the health science disciplines. Two reviewers independently screened and extracted relevant data pertaining to study and participant characteristics using a charting table. The outcomes included knowledge, attitudes, skills, and perceived benefits.Results: Ten studies were analysed. Diverse approaches to cultural education exist in terms of the mode, frequency, and duration of interventions. For the knowledge outcome, students who experienced cultural education interventions yielded higher post-test scores than their baseline cultural knowledge, but without a significant difference from the scores of students who did not receive interventions. Data relating to the skills domain demonstrated positive effects for students after experiencing interventions. Overall, students were satisfied with their experiences and demonstrated improvements in confidence and attitudes towards culturally competent practice.Conclusion: Across health science disciplines, cultural competency interventions were shown to be effective in enhancing knowledge acquisition, performance of skills, attitudes, and student satisfaction. Future research is necessary to address the significant absence of control arms in the current literature, and to assess long-term effects and patient-related outcomes.

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Ropponen, Annina, Marja Känsälä, Johanna Rantanen, and Sally Toppinen-Tanner. "Organizational Initiatives for Promoting Employee Work-Life Reconciliation Over the Life Course. A Systematic Review of Intervention Studies." Nordic Journal of Working Life Studies 6, no. 3 (October 1, 2016): 79. http://dx.doi.org/10.19154/njwls.v6i3.5529.

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This review aimed to explore the initiatives, interventions, and experiments implemented by employing organizations and designed to support the work-life reconciliation at workplaces, and the effects of these actions on employees’ well-being at work. A systematic literature review was conducted on the basis of a search in PsycInfo, ERIC, and the ISI Web of Science database of Social Sciences between January 2000 and May 2015. Those studies were included in which either organizational or individual-level initiatives, interventions, or experiments were implemented by employers at workplaces in order to promote the work-life reconciliation of their employees. Work-life reconciliation was considered to encompass all life domains and all career stages from early to the end of working career. The content analysis of 11 studies showed that effective employer actions focused on working time, care arrangements, and training for supervisors and employees. Flexibility, in terms of both working time and other arrangements provided for employees, and support from supervisors decreased work-family conflict, improved physical health and job satisfaction, and also reduced the number of absence days and turnover intentions. Overall, very few intervention studies exist investigating the effects of employer-induced work-life initiatives. One should particularly note the conditions under which interventions are most successful, since many contextual and individual-level factors influence the effects of organizational initiatives on employee and organizational outcomes.

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Starfield, Barbara. "Guest Editorial: What can we learn from equity research and interventions?" Australian Journal of Primary Health 10, no. 3 (2004): 7. http://dx.doi.org/10.1071/py04039.

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Equity in health has been defined, in terms to facilitate its assessment and achievement, as the absence of systematic and potentially remediable differences in one or more aspects of health across population groups defined socially, geographically, or demographically (International Society for Equity in Health, 2004). Thus, the key to success in equity research and interventions is to understand those factors that influence the distribution of health in populations.

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Kenning, Cassandra, Karina Lovell, Mark Hann, Raymond Agius, Penny E. Bee, Carolyn Chew-Graham, Peter A. Coventry, et al. "Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial." Public Health Research 6, no. 2 (January 2018): 1–76. http://dx.doi.org/10.3310/phr06020.

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BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.

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Senent-Capuz, Nuria, Inmaculada Baixauli-Fortea, and Carmen Moret-Tatay. "Parent-Implemented Hanen Program It Takes Two to Talk®: An Exploratory Study in Spain." International Journal of Environmental Research and Public Health 18, no. 15 (August 3, 2021): 8214. http://dx.doi.org/10.3390/ijerph18158214.

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Parent-implemented interventions are a highly common approach for enhancing communication and linguistic abilities of late talkers, involving a population that shows a small expressive vocabulary in the absence of other deficits that could explain it. This study aimed to compare the outcomes of a parent-implemented language intervention, It Takes Two to Talk®—The Hanen Program® for Parents (ITTT), to a clinician-directed therapy. Participants were 17 families and their late-talking children: 10 families took part in ITTT and 7 in the clinician-directed modality. The outcomes in the social communication domain were more favorable for the ITTT group, but there were no significant differences between groups as regards vocabulary and syntax. In terms of parents, the research focused on examining if there were significant changes in parents’ stress and their perceptions of their children’s communication abilities. No differences were observed in the level of stress. In contrast, the group that received the ITTT program significantly altered their perceptions of their children’s communication difficulties in comparison with the clinician-directed therapy. These results have implications in the clinical management of late-talking children, and they are discussed in terms of evidence-based practice.

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Blazinska, Lucia, Martin Rusnak, and Margareta Kacmarikova. "Legislation impact on sick leave in Slovakia." International Journal of Workplace Health Management 10, no. 3 (June 5, 2017): 182–91. http://dx.doi.org/10.1108/ijwhm-11-2016-0085.

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Purpose Sickness absence is a major public health and economic problem. The purpose of this paper is to evaluate the effects of a legislative intervention that concerns reduction of compensation levels in sickness absence in the Slovak Republic. In addition, the study encompasses appraisal of effects reflected by related indicators. Design/methodology/approach The paper describes an evaluation study, based on national statistics from relevant sources. Numeric data were used for characterizing the dynamics of sickness absence in Slovakia in the years 1997-2013. Statistical programmes join-point and R-environment were used for analytical purposes in terms of Wilcoxon test and linear regression. Findings The results suggest that following the implementation of the Act No. 462/2003 Coll. the number of new cases as well as the proportion of sickness absence among insured persons decreased by 50 per cent (from 2003 – 60/100 to 2004 – 30,8/100). Average duration of inability to work increased to 6.5 days and there were more women compared to men on sick leave. The most frequent causes of sickness absence were respiratory diseases, muscular-skeletal diseases and injuries outside the workplace. Research limitations/implications The trend of sickness absence can be influenced by many others factors, but the research is mainly focussed on legislative impact. Originality/value The research indicates an effect of legislative intervention at national level.

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Hosokawa, Takahiro, Yoshitake Yamada, Yutaka Tanami, Yumiko Sato, Mayumi Hosokawa, and Eiji Oguma. "Predictors of prognosis in children with portal venous gas detected by ultrasound." Medical Ultrasonography 21, no. 1 (February 17, 2019): 30. http://dx.doi.org/10.11152/mu-1727.

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Aims: To evaluate ultrasound findings in order to determine potential predictors of prognosis in pediatric patients with portal venous gas (PVG) detected by ultrasound.Materials and methods: Thirty-nine children were included and divided into two groups: benign PVG (n=24) and life-threatening PVG (n=15; 6 surgical interventions and 9 deaths). Possible predictors, i.e., the location of PVG in the liver, the distribution of intestinal pneumatosis, ascites and free air were compared between the two groups.Results: A significant difference was noted between the two groups in terms of the distribution of intestinal pneumatosis (limited to the large bowel, benign vs life-threatening = 60.9% (14/23):21.4% (3/14), p=0.040), the absence of ascites (benign vs life-threatening = 79.1% (19/24):40.0% (6/15), p=0.019) and patient age (benign vs life-threatening = 52.5±65.3 months vs 19.7±44.0 months, p=0.019). No significant difference was observed in the location of PVG in the liver, the presence of free air, and sex between the two groups.Conclusions: In pediatric patients with PVG, including various ages and underlying diseases, intestinal pneumatosis limited to the large bowel and absence of ascites were predictors of a benign prognosis. However, despite the presence of these predictors, some patients with PVG required surgical intervention, therebysuggesting that the cause of PVG, such as necrotizing enterocolitis, volvulus, or pancreatitis, must be also carefully evaluated.

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Huang, Derek, Huanyu Tao, Qilong Wu, Sheng-You Huang, and Yi Xiao. "Modeling of the Long-Term Epidemic Dynamics of COVID-19 in the United States." International Journal of Environmental Research and Public Health 18, no. 14 (July 16, 2021): 7594. http://dx.doi.org/10.3390/ijerph18147594.

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Coronavirus 2019 (COVID-19) is causing a severe pandemic that has resulted in millions of confirmed cases and deaths around the world. In the absence of effective drugs for treatment, non-pharmaceutical interventions are the most effective approaches to control the disease. Although some countries have the pandemic under control, all countries around the world, including the United States (US), are still in the process of controlling COVID-19, which calls for an effective epidemic model to describe the transmission dynamics of COVID-19. Meeting this need, we have extensively investigated the transmission dynamics of COVID-19 from 22 January 2020 to 14 February 2021 for the 50 states of the United States, which revealed the general principles underlying the spread of the virus in terms of intervention measures and demographic properties. We further proposed a time-dependent epidemic model, named T-SIR, to model the long-term transmission dynamics of COVID-19 in the US. It was shown in this paper that our T-SIR model could effectively model the epidemic dynamics of COVID-19 for all 50 states, which provided insights into the transmission dynamics of COVID-19 in the US. The present study will be valuable to help understand the epidemic dynamics of COVID-19 and thus help governments determine and implement effective intervention measures or vaccine prioritization to control the pandemic.

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Indregard, Anne-Marthe R., Stein Knardahl, Jan Shahid Emberland, Øivind Skare, and Håkon A. Johannessen. "Effectiveness of the Labour Inspection Authority’s regulatory tools for work environment and employee health: study protocol for a cluster-randomised controlled trial among Norwegian home-care workers." BMJ Open 9, no. 11 (November 2019): e031226. http://dx.doi.org/10.1136/bmjopen-2019-031226.

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IntroductionThere is a need to evaluate whether, and to what degree, labour inspections or other regulatory tools have the desired effects on psychosocial, organisational and mechanical work environment, and employee health. The Norwegian Labour Inspection Authority (NLIA) uses different tools and strategies to enforce compliance with occupational safety and health (OSH) legislation. The aim of the present study is to evaluate the effects of labour inspections and other regulatory tools employed by the NLIA. The home-care service is one of the fastest growing occupations and a prioritised area for the NLIA, hence the present study will investigate regulatory tools in this sector.Methods and analysisThe research project has been designed as a longitudinal, cluster-randomised, controlled trial and will be conducted among Norwegian home-care workers. The objective of the research project is to evaluate the effects of the NLIA’s regulatory tools (inspection and guidance) on: (1) compliance with OSH legislation and regulation; (2) psychosocial, organisational and mechanical work environment; (3) employee health in terms of musculoskeletal and mental health complaints; and (4) sickness absence. Public home-care services have been randomised to three intervention groups and one control group. Home-care services in the intervention groups will receive one of three intervention activities from the NLIA: (1) inspection from the Labour Inspection Authority; (2) guidance through an online interactive risk-assessment tool; and (3) guidance on psychosocial, organisational and mechanical work environment through workshops. The interventions will be performed at the organisational level (home-care service), and the effects of the interventions on the working environment and health complaints will be measured at the individual level (home-care employees).Ethics and disseminationThis project has been approved by the Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East) (2018/2003/REK sør-øst C), the Norwegian Center for Research Data (566128), and will be conducted in accordance with the World Medical Association Declaration of Helsinki. The results will be reported in international peer-reviewed journals.Trial registration numberNCT03855163.

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Birkun, A. A. "On the Question Concerning the Creation of Unified Accounting Data Form “The Protocol of Cardiopulmonary Resuscitation” for Mobile Teams of Emergency Medical Services." Russian Sklifosovsky Journal "Emergency Medical Care" 8, no. 4 (January 17, 2020): 379–83. http://dx.doi.org/10.23934/2223-9022-2019-8-4-379-383.

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Significant decrease in death rates from out-of-hospital cardiac arrest (OHCA) can be achieved by developing and implementing an integrated program of administrative interventions focused on improvements in the provision of the first aid and emergency medical care. However, both identification of the foreground and reasonable components of the program, and evaluation of its efficiency are impossible in the absence of reliable tools for collecting and analyzing data on epidemiology of OHCA and performance of the prehospital care system. This paper discusses the development of unified form for collecting data on cases of OHCA with attempted cardiopulmonary resuscitation (CPR), addresses the promising data form “The protocol of CPR” that is recommended by the Specialized Board on Emergency Medical Care of the Ministry of Health of Russia, and offers a set of proposals for optimizing the form with consideration for the international guidelines for uniform reporting of data from OHCA.Author declare lack of the conflicts of interests.

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Țolescu, Cosmin, Abigaela Rus, Monica Chitu, Mihaela Ratiu, and Imre Benedek. "Congenital Absence of Left Main Trunk – CCTA Evaluation of a Patient with Ischemic Heart Disease." Journal of Interdisciplinary Medicine 6, no. 2 (June 1, 2021): 123–25. http://dx.doi.org/10.2478/jim-2020-0028.

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Abstract Coronary artery anomalies represent a heterogeneous group of congenital diseases with various clinical presentations. Over time, the subject of coronary anomalies has been constantly changing in terms of definition, morphology, clinical manifestations, prognosis, and treatment. We present the case of a male patient, aged 53, with coronary artery disease and a medical history of high blood pressure and diabetes mellitus, who had undergone a coronary computed tomography angiography during the one-year follow-up after a percutaneous coronary intervention with drug-eluting stent implantation for a critical stenosis in the middle segment of the left anterior descending artery. Axial images revealed a separate origin of the left anterior descending and circumflex arteries from the left aortic coronary sinus, with the absence of the left main coronary artery.

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Jones, Rebecca J., Uwe Napiersky, and Joanne Lyubovnikova. "Conceptualizing the distinctiveness of team coaching." Journal of Managerial Psychology 34, no. 2 (March 11, 2019): 62–78. http://dx.doi.org/10.1108/jmp-07-2018-0326.

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Purpose Team coaching (TC) is a popular new addition to the team learning and development toolkit. However, the conceptualization of TC and the distinction between TC, team training, team development and team building interventions remains unclear. The paper aims to discuss these issues. Design/methodology/approach The authors address this significant gap by abductively exploring how TC is conceptualised in practice (n=410). The authors survey practitioners engaged in delivering TC to ask how they would define TC and distinguish it from other team interventions. Findings A thematic analysis of the data reveals eight themes, which can be used to define TC and illustrate areas of overlap and distinctiveness with other team interventions. Research limitations/implications The absence of a clearly defined construct is hindering the development of a rigorous theory of TC. The contribution of the paper is, therefore, a clear and comprehensive definition of TC, which can be used by researchers and practitioners alike when working within the domain of TC. Originality/value The paper provides the first systematic exploration of a definition of TC in relation to alternative team interventions. By utilising an abductive approach in the research, the authors are able to capitalise on practitioner experience in this practice-led field.

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Patmore, Russell, Alexandra Smith, Burton Cathy, Eve Roman, and Simon Crouch. "Predicting Time to Treatment in Follicular Lymphoma Using Population-Based Data." Blood 126, no. 23 (December 3, 2015): 3912. http://dx.doi.org/10.1182/blood.v126.23.3912.3912.

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Abstract Introduction Patients diagnosed with Follicular Lymphoma (FL) either require immediate immuno-chemotherapy or, may simply be observed until the development of symptoms suggests that treatment should be initiated. Although there is no evidence to indicate that early intervention in asymptomatic, stage II - IV disease improves outcomes, both doctors and patients find "watch and wait" (W+W) strategies difficult to accept as it leaves considerable uncertainty as to the future. The ability to predict the likely time to treatment (TTT) being required would be helpful, both to give reassurance in cases where the likelihood of therapy in the near future is low and to identify higher risk cases where close observation or early intervention might be justified. Prognostic indices are usually derived using data from clinical trials or institutional datasets where patients who do not require treatment tend to be underrepresented; accordingly we constructed an improved prognostic index for TTT for those patients initially on a W+W strategy in an unselected, population-based cohort. Methods This study was based on an established population-based cohort, which since 2004 has tracked all patients newly diagnosed with a haematological malignancy in a representative UK population of nearly 4 million people (www.hmrn.org). All diagnoses, including disease progressions and transformations, are made by a single specialist haematopathology laboratory (www.hmds.info), and clinical teams work to UK guidelines (www.bcshguidlines.com). Clinical and treatment information is systematically collected for all patients and survival data is acquired through links with national data sources. All 296 out of 741 patients newly diagnosed with FL from 2004-2011 initially managed by a W+W approach were included in the analyses and these patients were followed up to February 2015. Prognostic indices for TTT were constructed using the components of the Follicular Lymphoma International Prognostic Index (FLIPI) and other routinely measured clinical variables. Modern machine learning techniques were used, in particular the LASSO applied to semiparametric survival regression, using bootstrapped model selection to confirm Lasso variable selection. The appropriate functional forms for individual variables were chosen on the basis of the Akaike Information Criterion. Predictive performance was measured using area under the ROC curve (AUC) and the concordance index (C). Results With a median age of 65.4 years (range 21-95), 42% of patients were male, 16% had B-symptoms and 37% had stage IV disease at presentation. Median follow-up was 6.4 years; 83 patients were subsequently treated for FL, a further 34 patients transformed to diffuse large B-cell lymphoma and 9 others died from disease progression prior to receiving chemotherapy for FL; median time to these events was 1.4 years. Whilst the FLIPI score for patients initially managed on W+W was predictive for TTT (Figure 1) - achieving an AUC=0.64 and C=0.61, as a result of the model building process a proposed new index for TTT achieved AUC=0.75 and C=0.70 retaining blood albumin, haemoglobin, presence/absence of bulky disease (1/0 respectively) and a score based on the number of nodal sites in the prognostic model (Risk_Score = Albumin (g/dL) x 0.0412 + 0.719 * bulky_disease - 0.102 x Hb (g/dL) + 0.159 x nodal_score). The relation between index value and expected time-to-event for TTT is shown in Figure 2. Conclusion Our population-based data demonstrates that the FLIPI can be used to predict TTT in patients diagnosed with FL and put onto a W+W strategy. By utilising all of the information contained in the components of the FLIPI and by adding additional routine clinical factors we show that the accuracy of prediction of TTT can be improved leading to the production of an accurate and simple TTT curve that can be used in routine clinical practice. Figure 1. Time-to-treatment stratified by FLIPI (p = 0.0004 log-rank test) Figure 1. Time-to-treatment stratified by FLIPI (p = 0.0004 log-rank test) Figure 2. Expected Probability of Not Having Received Chemotherapy at 5 years After Diagnosis by Time-to-Treatment Risk Score Figure 2. Expected Probability of Not Having Received Chemotherapy at 5 years After Diagnosis by Time-to-Treatment Risk Score Disclosures Patmore: Gilead: Honoraria; Janssen: Honoraria.

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Chernyak, M. M., and О. О. Korchynska. "Modern views on endometriosis surgery. Literature review." Reproductive Endocrinology, no. 58 (May 27, 2021): 45–52. http://dx.doi.org/10.18370/2309-4117.2021.58.45-52.

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Endometriosis is a disease associated with the presence of tissue morphologically similar to the endometrium outside the uterine cavity and it is an important medical and social problem. Statistical analysis of the endometriosis prevalence is complicated by polymorphism of manifestations a gradual increase of symptoms and a long period of time from the first symptoms to diagnosis. Manifestations of endometriosis are chronic pain, algodismenorea, dyspareunia, decreased fertility. All these manifestations worsen the quality of life and do not allow a woman to realize her reproductive potential. The most common forms of endometriosis are superficial peritoneal endometriosis, endometrioid ovarian cysts and deep infiltrative endometriosis. Treatment tactics depends on the form and stage of disease, woman's age, presence or absence of reproductive plans, previous treatment. It is possible to use both medical and surgical methods of treatment. Surgical methods can be organ-preserving and radical. The optimal surgical approach should weigh the risks of the surgery itself and the likelihood of recurrence in the radicalism absence. Modern techniques of surgical intervention are considered as one of the main methods of endometriosis treatment. Severe forms of endometriosis are a serious challenge for the surgical team, as chronic inflammation and adhesions alter the normal pelvis anatomy. Such operations often require the involvement of surgeons, urologists and other specialists, and the decision about final operation scope is made during the operation. Endometriosis surgery aims at the maximum possible in each case, the removal of pathological foci, which leads to relief of pain and increase the likelihood of reproductive plans. This article describes the rational scope of surgical interventions and optimal strategies for the management of patients with various forms of endometriosis. The data of international researches of efficiency of various methods of surgical interventions, influence of degree of radicalism on a disease course, probability of recurrence and quality of patient’s life are resulted.

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Lee, Sang Moo, Gaeun Kim, Jeonghoon Ahn, Hae Sun Suh, and Dae Seog Heo. "FACTORS INFLUENCING DECISION MAKING ON THERAPEUTIC INTERVENTIONS." International Journal of Technology Assessment in Health Care 29, no. 3 (July 2013): 331–35. http://dx.doi.org/10.1017/s0266462313000214.

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Objectives: The aim of this study was to explore factors that influenced decision making in the assessment of new health technology in Korea.Methods: We analyzed the decision-making results of the Committee for New Health Technology Assessment (CnHTA) on fifty-three new nondrug health technologies in Korea from July 2007 to December 2010. The scope of the committee was mainly limited to safety and efficacy/effectiveness, and every decision was based on a systematic review of the literature. The committee was composed of healthcare professionals, policy makers, lawyers, and representatives from nongovernmental organizations. Decisions made on therapeutic interventions were included, while those on diagnostic procedures were excluded.Results: Factors that positively influenced decisions were lower complication rate than existing technology, similar or greater effectiveness compared with existing technology, ability to save critical organs, absence of alternative intervention, decreased invasiveness, expansion of patient's set of choices, and similarity to the mechanism of existing technology. Factors that negatively influenced decisions were higher complication rates than existing technology, lower effectiveness than comparable technology, low levels of evidence, unknown mechanisms of intervention, inconsistency, lack of long-term outcomes, lack of comparative data, nonstandardized technology, heterogeneity between control and treatment, excessively diverse indications, and nongeneralizability.Conclusions: This qualitative analysis of past decision-making results provided us with clues on the values that decision makers on the Korean CnHTA considered in terms of safety and effectiveness. These findings will help us develop appraisal guidelines and enhance the objectivity of decision-making processes in Korea.

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Journal articles on the topic 'Absence Intervention Teams'

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