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Frias, Patricio A., Matthew Oster, Patricia A. Daley, and Jeffrey R. Boris. "Outpatient echocardiography in the evaluation of innocent murmurs in children: utilisation benchmarking." Cardiology in the Young 26, no. 3 (April 23, 2015): 499–505. http://dx.doi.org/10.1017/s1047951115000517.
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AbstractObjectivesWe sought to benchmark the utilisation of echocardiography in the outpatient evaluation of heart murmurs by evaluating two large paediatric cardiology centres.BackgroundAlthough criteria exist for appropriate use of echocardiography, there are no benchmarking data demonstrating its utilisation.MethodsWe performed a retrospective cohort study of outpatients aged between 0 and 18 years at the Sibley Heart Center Cardiology and the Children’s Hospital of Philadelphia Division of Cardiology, given a sole diagnosis of “innocent murmur” from 1 July, 2007 to 31 October, 2010. Using internal claims data, we compared the utilisation of echocardiography according to centre, patient age, and physician years of service.ResultsOf 23,114 eligible patients (Sibley Heart Center Cardiology: 12,815, Children’s Hospital of Philadelphia Division of Cardiology: 10,299), 43.1% (Sibley Heart Center Cardiology: 45.2%, Children’s Hospital of Philadelphia Division of Cardiology: 40.4%; p<0.001) underwent echocardiography. There was wide variability in the utilisation of echocardiography by individual physicians at both centres (Sibley Heart Center Cardiology 18.3–85.5%, median 45.4%; Children’s Hospital of Philadelphia Division of Cardiology 13.9–81.8%, median 34.7%, p=0.45). Children in their first month of life represented the group with highest utilisation of echocardiography (62.3%), whereas children aged >1–5 years had the lowest utilisation (32.7%).ConclusionsIn two large paediatric cardiology practices, the overall utilisation of echocardiography by physicians with a sole diagnosis of innocent murmur was similar. There was significant and similar variability in utilisation by provider at both centres. Although these data serve as initial benchmarking, the variability in utilisation highlights the importance of appropriate use criteria.
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Modi, Yogesh, Alka Suri, Pallavi Gupta, and Ravi Karan Sahu. "Utilisation of Scholarly Communication through DRDO E-journal Consortium during 2012-2017." DESIDOC Journal of Library & Information Technology 38, no. 6 (November 2, 2018): 423. http://dx.doi.org/10.14429/djlit.38.6.12991.
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<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>Timely, speedy dissemination of latest information is the benchmark of any information and documentation </span><span>center, but utilisation of e-journals is an important factor for its significance and cost effectiveness. However, in R&D community especially for defence R&D, where scientists are involved in core technology areas, value of information is more important instead of its utilisation. The aim of the study is to find out the utilisation of e-journals with cost effectiveness under Consortium, which was established in the year 2009 for resource sharing among DRDO labs with least expenses. The data was analysed for the period 2011-2017 to know the current trends of utilisation under Consortium. Feedbacks and suggestions were collected from all DRDO users to evaluate the importance of information and its effectiveness. The study shows that productivity of DRDO scientists in publications were increased in high </span><span>impact factor journal and majority of scientists preferred e-journals instead of print subscriptions. </span></p></div></div></div>
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Bytyqi, Hasime Qorraj, Rexhep Hoxha, Elton Bahtiri, Valon Krasniqi, and Shaip Krasniqi. "Antibiotic Utilization in Pediatric Hospitalized Patients – A Single Center Study." Open Access Macedonian Journal of Medical Sciences 5, no. 2 (March 24, 2017): 256–60. http://dx.doi.org/10.3889/oamjms.2017.045.
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BACKGROUND: Antibiotics are among the most commonly prescribed drugs in paediatrics. In most cases, antibiotics are started on an empirical basis, without proof of a bacterial infection, either before the start of therapy or afterwards.AIM: The main objective of this study was to analyse the consumption of antibiotics in hospitalised paediatric patients.MATERIAL AND METHODS: This retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical/DDD index) in Pulmonology, Gastroenterology and Nephrology Departments at Pediatric Clinic of the tertiary hospital. The data on the consumption of antimicrobials were collected for five years by using properly designed form. The consumption was related to days of hospital care.RESULTS: The most utilised antibiotics group in all three departments Pulmonology, Gastroenterology and Nephrology Departments were penicillins. Cephalosporins were mostly used in Pulmonology department. Metronidazole and Chloramphenicol were used in minimal quantities in all three departments.CONCLUSION: This study demonstrates that surveillance programs on antibiotic resistance should be established and accompanied by analyses of drug utilisation data which can aid in the creation of valid cross-national studies on antibiotic usage and resistance, to motivate improvements in prescribing and guideline-directed antibiotic prescribing.
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Sori, Demisew Amenu, Gurmesa Tura Debelew, Lema Seboka Degefa, and Zerihun Asefa. "Continuous quality improvement strategy for increasing immediate postpartum long-acting reversible contraceptive use at Jimma University Medical Center, Jimma, Ethiopia." BMJ Open Quality 12, no. 1 (February 2023): e002051. http://dx.doi.org/10.1136/bmjoq-2022-002051.
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BackgroundEven though the immediate postpartum period is a golden time and a great opportunity to provide long-acting reversible contraceptives to prevent unintended pregnancy, its utilisation is very low in Ethiopia. Quality of care in postpartum long-acting reversible contraceptive provision is thought to be an issue for this low utilisation. Thus, continuous quality improvement intervention is necessary to increase the use of postpartum long-acting reversible contraceptives at Jimma University Medical Center.MethodA quality improvement intervention to offer long-acting reversible contraceptive methods to immediate postpartum women at Jimma University Medical Center was initiated in June 2019. To study the baseline prevalence of long-acting reversible contraceptive use at Jimma Medical Centre over 8 weeks, we reviewed postpartum family planning registration logbooks and patients’ charts. Based on the baseline data, the quality gaps were identified, prioritised and change ideas were generated and tested over another 8 weeks towards achieving the immediate postpartum long-acting reversible contraceptive prevalence target set.ResultThis new intervention resulted in an average increase in immediate postpartum long-acting reversible contraceptive methods use from 6.9% to 25.4% by the end of the project intervention. The major barriers to low long-acting reversible contraceptive use were lack of attention from hospital administrative staff and quality improvement teams on the provision of long-acting reversible contraceptives, lack of training of healthcare providers on postpartum contraception and unavailability of contraception commodities at each postpartum service delivery points.Conclusion and recommendationsThe immediate postpartum long-acting reversible contraceptive use at Jimma Medical Centre was increased by training of healthcare providers, availing contraception commodities through administrative staff involvement, weekly audit and feedback on contraception use. Thus, training of the newly hired healthcare providers on postpartum contraception, involvement of hospital administrative staff, regular audits and feedback on contraception use is necessary to increase postpartum long-acting reversible contraception uptake.
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Szigethy, Eva, Francis Solano, Meredith Wallace, Dina L. Perry, Lauren Morrell, Kathryn Scott, Megan Jones Bell, and Megan Oser. "A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive–behavioural programme with integrated coaching for anxious adults in primary care." BMJ Open 8, no. 1 (January 2018): e019108. http://dx.doi.org/10.1136/bmjopen-2017-019108.
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IntroductionGeneralised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive–behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings.Methods and analysisThis pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive– behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app.Ethics and disseminationEthics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences.Trial registration numberNCT03035019.
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Brauer, Ruth, Ian Chi Kei Wong, Kenneth KC Man, Nicole L. Pratt, Rae Woong Park, Soo-Yeon Cho, Yu-Chuan (Jack) Li, Usman Iqbal, Phung-Anh Alex Nguyen, and Martijn Schuemie. "Application of a Common Data Model (CDM) to rank the paediatric user and prescription prevalence of 15 different drug classes in South Korea, Hong Kong, Taiwan, Japan and Australia: an observational, descriptive study." BMJ Open 10, no. 1 (January 2020): e032426. http://dx.doi.org/10.1136/bmjopen-2019-032426.
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ObjectiveTo measure the paediatric user and prescription prevalence in inpatient and ambulatory settings in South Korea, Hong Kong, Taiwan, Japan and Australia by age and gender. A further objective was to list the most commonly used drugs per drug class, per country.Design and settingHospital inpatient and insurance paediatric healthcare data from the following databases were used to conduct this descriptive drug utilisation study: (i) the South Korean Ajou University School of Medicine database; (ii) the Hong Kong Clinical Data Analysis and Reporting System; (iii) the Japan Medical Data Center; (iv) Taiwan’s National Health Insurance Research Database and (v) the Australian Pharmaceutical Benefits Scheme. Country-specific data were transformed into the Observational Medical Outcomes Partnership Common Data Model.PatientsChildren (≤18 years) with at least 1 day of observation in any of the respective databases from January 2009 until December 2013 were included.Main outcome measuresFor each drug class, we assessed the per-protocol overall user and prescription prevalence rates (per 1000 persons) per country and setting.ResultsOur study population comprised 1 574 524 children (52.9% male). The highest proportion of dispensings was recorded in the youngest age category (<2 years) for inpatients (45.1%) with a relatively high user prevalence of analgesics and antibiotics. Adrenergics, antihistamines, mucolytics and corticosteroids were used in 10%–15% of patients. For ambulatory patients, the highest proportion of dispensings was recorded in the middle age category (2–11 years, 67.1%) with antibiotics the most dispensed drug overall.ConclusionsCountry-specific paediatric drug utilisation patterns were described, ranked and compared between four East Asian countries and Australia. The widespread use of mucolytics in East Asia warrants further investigation.
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J Kibesa, Saraphina, Yona W Kitua, and Daniel W Kitua. "Determinants of Antenatal Healthcare Services Utilisation: A Case of Dodoma, Tanzania." East African Health Research Journal 6, no. 2 (December 15, 2022): 155–61. http://dx.doi.org/10.24248/eahrj.v6i2.701.
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Background: Antenatal Care (ANC) coverage is a key determinant of maternal and perinatal morbidity and mortality. Low utilization of ANC services and high Maternal Mortality Ratio (MMR) have been reported in the East African Region. Due to the paucity of information on the determinants of ANC utilization in this region, we conducted the study aiming at exploring factors influencing the utilization of ANC services. We further sought opinions that will aid the improvement of utilization of ANC services. Methods: A triangulation mixed-method study was conducted in August 2021 among forty-five women and ten healthcare providers in a selected health center located in Dodoma Urban District, Tanzania. Information was gathered using semi-structured questionnaires and in-depth interviews. Quantitative data were analysed using IBM SPSS Statistics. The relationship between the outcome variable and the predictor variables was assessed by either the Chi-square test or Fisher’s exact test and a p value<.05 was considered statistically significant. Manual thematic analysis was used for qualitative data after thorough transcript and documentary reviews. Results: Almost half (48.9%) of the interviewed women attended ANC services at least once during their last pregnancy. Women who reported having a low income and those who spent more than an hour reaching the health facility had poor ANC attendance (p value<.05). The main themed factors that negatively impacted ANC utilization included cultural practices and gender norms, poor communication between partners, and long waiting time at the ANC clinics. Conclusion: Utilization of ANC services was found to be low among women living in Dodoma Urban District. ANC attendance varied with the level of income and the time women spent reachingt the health facility. Cultural practices and gender norms, communication between spouses, and service waiting time were mentioned to influence ANC attendance. Recommendations: Public and private sectors should invest in maternal health, provide affordable services and formulate strategies to improve the accessibility of ANC services. Interventions should target women of low socio-economic class and those living in remote areas. Moreover, schemes to address the sociocultural barriers to ANC utilization need to be formulated.
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Tanaka, Eiichi, Eisuke Inoue, Ayako Shoji, Jonas Nilsson, Christos Papagiannopoulos, Devender Dhanda, Yuri Yoshizawa, et al. "Cost-consequence of abatacept as first-line therapy in Japanese rheumatoid arthritis patients using IORRA real-world data." PLOS ONE 17, no. 11 (November 16, 2022): e0277566. http://dx.doi.org/10.1371/journal.pone.0277566.
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Objectives To investigate the cost-effectiveness of abatacept (ABA) as first-line (1L) therapy in Japanese rheumatoid arthritis (RA) patients using data from the Institute of Rheumatology, Rheumatoid Arthritis database. Methods A decision-analytic model was used to estimate the cost per American College of Rheumatology response of at least 50% improvement (ACR50) responder and per patient in Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) remission from a Japanese healthcare payers’ perspective over a 2-year time horizon. Clinical characteristics of patients on ABA-1L were matched with those of patients on ABA second or later line (2L+) or tumour necrosis factor inhibitor (TNFi)-1L directly or using propensity scores. Resource utilisation and medical costs were calculated from the Japan Medical Data Center claims database. Parameter uncertainty was addressed by sensitivity and subgroup analyses (age, treatment duration, Japanese version of Health Assessment Questionnaire [J-HAQ] score). Results Incremental costs per member per month (ΔPMPM) for ABA-1L versus TNFi-1L and ABA-2L+ were -1,571 Japanese Yen (JPY) and 81 JPY, respectively. For ABA-1L versus TNFi-1L, ΔPMPM by ACR50 response was -11,715 JPY and by CDAI and SDAI remission 11,602 JPY and 47,003 JPY, respectively. Corresponding costs for ABA-1L were lower for all outcome parameters versus those for ABA-2L+. Scenario analyses showed that ABA-1L was cost-effective over TNFi-1L in patients <65 years for any outcome. Furthermore, ABA-1L was cost-effective over ABA-2L+ for all outcomes in patients with age <65 years, disease duration <5 years and J-HAQ ≥1.5. Conclusions ABA-1L demonstrated a favourable cost-effectiveness profile in RA patients, accruing savings for the Japanese healthcare payers.
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Philippi, Luiz S., Rejane H. R. da Costa, and Pablo H. Sezerino. "Domestic Effluent Treatment through Integrated System of Septic Tank and Root Zone." Water Science and Technology 40, no. 3 (August 1, 1999): 125–31. http://dx.doi.org/10.2166/wst.1999.0152.
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According to national statistical data, only 10% of the Brazilian urban population have their sewage treated. In the rural areas, where people usually treat sewage trough septic tank systems, this value is not greater than 5%. This situation, therefore, depicts a lack of basic sanitation in Brazil, which, in turn, is responsible for the utilisation of individual systems for the treatment of sewage by more than 100 million people. Generally, soils and water rivers are, no longer, the last fate for the discharged effluents. Wetland system for the treatment of domestic sewage have been employed in different situations and arrangements (combined system) always showing outstanding performances. The reasons which qualify this system for the treatment of effluents have been attributed to its low cost, easy maintenance and operation. The experiment was carried out in the Agriculture Secretary's Training Center, Santa Catarina State, responsible for servicing approximately 66 people daily, and was fed with local effluent. This work assesses the efficacy of such a kind of system, which is composed of a septic tank followed by the root zone, in the treatment of liquid effluents.
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Ng, Ivy, Michelle Lai, Jessie Ng, Richerlyn Quindara Beltran, Kie Yin Teng, Wei Wei, Chia Ching Lee, et al. "Reducing same-day cancellations of precious CT simulation slots: A quality improvement project." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 301. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.301.
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301 Background: CT simulation (CTsim) is a prerequisite step in radiotherapy treatment. Each successfully completed CTsim brings a patient a step closer to receiving their radiotherapy. A non-attempt or unsuccessful attempt (both reflected as cancellations) also delays radiotherapy for another patient. Baseline data revealed that 33% of CTsim appointments were cancelled, of which 47% occurred on the same day. Cancellations made on the same day provides little reaction time for slots to be allocated to another patient and leads to inefficiency in resource utilisation. This project aims to reduce the cancellations occurring on the same day from 15.5% to 10% within 6 months at National University Cancer Institute radiotherapy center at Tan Tock Seng Hospital. Methods: A cause-and-effect diagram was constructed to identify reasons attributing to existing same-day cancellations. Multi-voting and Pareto analysis were conducted to identify 3 main root causes. Interventions were introduced and then tested using the Plan-Do-Study-Act approach. Run chart was used to monitor the proportion of same-day cancellations over the total number of CTsim appointments. Results: Three root causes identified were 1) no workflow to check on patient’s adequacy of preparation leading up to CTsim 2) no workflow to identify potential non-attendance 3) no take-home information detailing CTsim process. Interventions introduced included establishing workflow to assess adequacy of patients’ preparation required for successful CTsim and integrating a screening phone call to confirm patient’s attendance two days prior to CTsim appointment day and handing out information sheet detailing instructions for CTsim respectively. We achieved our target in our fourth month and sustained the results for 2 further months. Mean was 5% in the last three months. This reduction of same-day cancellation improves efficiency in resource utilisation and reduces delay in access to radiotherapy. Conclusions: Using quality improvement tools, we have successfully reduced the same-day cancellations of our precious CT simulation slots from 15.5% to 5%.
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Poprawski, Dagmara Magdalena. "Budget poor, but outcomes rich: How to set up tele-assisted systems in a regional and rural cancer center." Journal of Global Oncology 5, suppl (October 7, 2019): 4. http://dx.doi.org/10.1200/jgo.2019.5.suppl.4.
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4 Background: Tyranny of distance in Australia has motivated oncologists to try innovations in oncology care to improve cost efficiency, access, and compliance. This is often done with little budget availability as health funds are metrocentric. The aim is to bring novel approaches to utilisation of oncology care and show its applicability to most countries even with financial constraints. Methods: Mt Gambier Hospital is a regional hospital in South Eastern South Australia (SE SA). The data collected from clinics was commenced in January 2016, to gain knowledge of epidemiology of cancer in the region, and numbers of patients seen. Despite gold standard cancer care being performed in consultations which are face-to-face, we rolled out telemedicine consultations. We also, implemented a Survivorship Care Model, and entered into a Teletrials Project which sets up a regional trials centre with support from a tertiary hospital, Flinders Medical Centre. Results: Telemedicine has been made in Mt Gambier Hospital’s cancer service a part of every day practice to save patients from unnecessary travel. From January 2016, until May 2019, there were 812 consultations with nurse practitioner, 2542 consultations with consultant in clinic, and 246 telemedicine consultations. Survivorship clinic has been implemented according to South Australian Framework for Survivorship with no extra funding. Since 2017, 49 patients were seen with curative therapy. A re-alignment of appointment scheduling will see 6 patients in the next 2 months, thus increasing clinic potential. Teletrials Project was born from collaboration with Flinders Medical Centre, and gained funding by Beat Cancer South Australia. We are now entering into final stages of Governance agreement for our 1st trial, 18 months from commencing the project. Since then, we also got 2 more collaboration grants from Beat Cancer SA. Conclusions: With limited resources, regional cancer centres are able to maximise their patient outcomes by applying novel strategies. These novel ways of doing things, may be able to be implemented on either existing budgets or through collaboration with metropolitan cancer centres to attract financial grants to improve patient outcomes.
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David, Nicole, Sophia Dückert, Petia Gewohn, Hannah König, Pascal Rahlff, Frank Erik, Kai Vogeley, et al. "Mixed-methods investigation of barriers and needs in mental healthcare of adults with autism and recommendations for future care (BarrierfreeASD): study protocol." BMJ Open 12, no. 8 (August 2022): e061773. http://dx.doi.org/10.1136/bmjopen-2022-061773.
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IntroductionAutism refers to an early-onset neurodevelopmental condition with characteristic impairments and difficulties in practical living skills, which persist across the lifespan such that adults with autism often require substantial support and comprehensive care. Yet, mental health and other services are frequently unavailable for adults with autism despite considerable need for mental healthcare and individual, familial and socioeconomic burdens. This study will (1) examine current needs, barriers and burdens related to ineffective healthcare of adults with autism in Germany, (2) develop specific recommendations for a need-oriented mental healthcare model and (3) evaluate its future implementation.Methods and analysisA mixed-methods design with three phases will be conducted. In phase 1, current mental healthcare for adults with autism will be assessed at three levels (individual, structural and professional) and from three perspectives (adults with autism, relatives and healthcare providers) using (1) focus groups/interviews (qualitative data) and (2) large-scale online surveys (quantitative data). Furthermore, service utilisation and related costs will be estimated. In phase 2, recommendations for a future healthcare model will be derived based on phase 1, considering the heterogeneous and complex needs within the autism spectrum and specifying indications for recommended services. In phase 3, these will again be evaluated by the three stakeholder groups using mixed-methods and analysed regarding feasibility of implementation and cost-effectiveness. Our study will, thus, contribute to a better translation of recommendations into practice to reduce disability, burden and costs related to ineffective healthcare and improve mental health outcomes for adults with autism and those who support them.Ethics and disseminationThis study was approved by the Local Psychological Ethics Commission of the Center for Psychosocial Medicine at the University Medical Center Hamburg-Eppendorf (LPEK-0227). Findings will be disseminated via scientific meetings and peer-reviewed journals. Cooperating partners and associations will be informed about the study’s course and findings by regular newsletters and meetings.Trial registration numberThis study protocol was preregistered at the Open Science Framework (osf.io/5x8pg).
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Xu, Xiaomin, Yujian Ye, Xuyi Wang, Jiajun Xu, Chuanwei Li, Gang Wang, Youwei Zhu, Haifeng Jiang, and Na Zhong. "Effectiveness and utility of an electronic intervention for appropriate benzodiazepine and Z-drugs prescription in psychiatric clinics: protocol for a multicentric, real-world randomised controlled trial in China." BMJ Open 12, no. 4 (April 2022): e055341. http://dx.doi.org/10.1136/bmjopen-2021-055341.
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IntroductionBenzodiazepine receptor agonists (BZRAs), which include benzodiazepines and Z-drugs, are the most commonly prescribed psychotropic drugs worldwide, and their inappropriate use places a significant burden on public health. Given the widespread use of BZRAs in psychiatric settings, this condition may result from doctors’ improper prescribing. Researchers have developed an electronic intervention system to assist psychiatrists in prescribing BZRAs appropriately. This study aims to determine the efficacy and utility of electronic intervention in reducing improper BZRAs prescriptions in real-world psychiatric outpatient settings.Methods and analysisA multicentre randomised controlled research study will be conducted in real-world settings with licensed psychiatrists with prescription qualifications from five of Chinese most significant regional hospitals that provide high-quality mental healthcare. Participants will be 1:1 randomly assigned to receive a 3-month electronic intervention (11 related information pushing and 3 online lectures) or be placed on a waiting list. The primary outcome is the change in the proportion of inappropriate BZRAs prescriptions between the baseline period (3 months before the intervention) and 3 months after the intervention. Secondary outcomes will be examined at baseline, the third month and the sixth month. The secondary outcomes include psychiatrists’ knowledge and attitudes about appropriate BZRAs prescription, the associated side effects of BZRAs among patients and self-efficacy. To measure the utility, intervention assessment and system utilisation data from the intervention group were collected.Ethics and disseminationThe institutional review board and ethics committees of Shanghai Mental Health Center, Second Xiangya Hospital, West China Hospital, Guangji Hospital and Wuhan Mental Health Center approved the study. After the study is completed, the results will be published in peer-reviewed journals or presented at conferences. If the educational materials are effective, they are available to the general public.Trial registration numberNCT03724669; Pre-results.
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Van Decker, Stephanie Grana, Nicholas Bosch, and Jaime Murphy. "Catheter-associated urinary tract infection reduction in critical care units: a bundled care model." BMJ Open Quality 10, no. 4 (December 2021): e001534. http://dx.doi.org/10.1136/bmjoq-2021-001534.
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Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%–70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical Center (BMC) began an initiative to decrease CAUTI rates within its intensive care units (ICUs). A CAUTI taskforce convened and reviewed process maps and gap analyses. Based on Centers for Disease Control and Prevention (CDC) and Institute for Healthcare Improvement (IHI) guidelines, and delineated by the Healthcare Infection Control Practices Advisory Committee 2009 guidelines, all BMC ICUs sequentially implemented plan–do–study–act cycles based on which measures were most easily adaptable and believed to have the highest impact on CAUTI rates. Implementation of five care bundles spanned 5 years and included (1) processes for insertion and maintenance of foley catheters; (2) indications for indwelling foley catheters; (3) appropriate testing for CAUTIs; (4) alternatives to indwelling devices; and (5) sterilisation techniques. Daily rounds by unit nursing supervisors and inclusion of foley catheter necessity on daily ICU checklists held staff accountable on a daily basis. With these interventions, the total number of CAUTIs at BMC decreased from 53 in 2013 to 9 in 2017 (83% reduction) with a 33.8% reduction in indwelling foley catheter utilisation during the same time period. Adapted protocols showed success in decreasing the CAUTI rate and indwelling foley catheter usage in all of the BMC ICU’s. While all interventions had favourable and additive trends towards decreasing the CAUTI rate, the CAUTI awareness education, insertion and removal protocols and implementation of PureWick female incontinence devices had clear and significant effects on decreasing CAUTI rates. Our project provides a framework for improving HAIs using rapid cycle testing and U-chart data monitoring. Targeted education efforts and standardised checklists and protocols adapted sequentially are low-cost and high yield efforts that may decrease CAUTIs in ICU settings.
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Ng, Junice Yi Siu, Ivan John Clement, Cecilia Jimeno, Rosa Allyn Sy, Roberto Mirasol, Pepito De La Pena, Araceli Panelo, et al. "Estimating direct medical costs of type 2 diabetes mellitus in the Philippines: a protocol." BMJ Open 10, no. 7 (July 2020): e025696. http://dx.doi.org/10.1136/bmjopen-2018-025696.
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IntroductionDiabetes and its complications are a major cause of morbidity and mortality in the Philippines. The prevalence of diabetes in the Philippines has increased from 3.4 million in 2010 to 3.7 million in 2017. The government has formulated strategies to control this increase, for example, through its non-communicable disease prevention and control plan. However, there is scarce research on the financial burden of diabetes. Filling this gap may further help policymakers to make informed decisions while developing and implementing resource planning for relevant interventions. The primary objective of the current study is to estimate the direct medical costs associated with type 2 diabetes mellitus (T2DM).Methods and analysisThis is a 1-year retrospective cohort study of patients with T2DM in 2016. Data will be collected from: (1) hospital databases from public institutions to estimate the cost of diabetes treatment and (2) physician interviews to estimate the cost of management of diabetes in outpatient care. We will perform descriptive and comparative analyses on direct medical costs and healthcare resource utilisation, stratified by the presence of diabetes-associated complications.Ethics and disseminationResearch ethics board approval has been obtained from the Department of Health Single Joint Research Ethics Board and Cardinal Santos Medical Center Research Ethics Review Committee. Findings from the study will be reported in peer-reviewed scientific journals and local researcher meetings.
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Wilford, Katherine Fisher, Maria Jesus Mena-Iturriaga, Margaret Vugrin, Macarena Wainer, Phillip S. Sizer, and Gesine Hendrijke Seeber. "International perspective on healthcare provider gender bias in musculoskeletal pain management: a scoping review protocol." BMJ Open 12, no. 6 (June 2022): e059233. http://dx.doi.org/10.1136/bmjopen-2021-059233.
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IntroductionChronic pain affects millions of individuals worldwide. Healthcare provider gender bias in the management of these individuals has societal and individual ramifications. Yet, a thorough and comprehensive literature summary on this topic is lacking. Therefore, this study aims to systematically: (1) identify and map the available scientific and grey literature as it relates to healthcare provider gender bias in the assessment, diagnosis and management of (chronic) musculoskeletal pain and (2) identify current gaps that necessitate further research.Methods and analysisThis scoping review will be conducted in accordance with recent guidelines, and the results will be reported via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The following databases will be searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (Ebscohost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022. Additionally, relevant grey literature will be identified. All screening will be done by two independent reviewers during two stages: first title/abstract screening followed by full-text screening. Data will be extracted from the bibliometric, study characteristics, and pain science families of variables. Results will be descriptively mapped, and the frequency of concepts, population, characteristics and other details will be narratively reported. Additionally, results will be presented in tabular and graphical form.Ethics and disseminationAs this study will neither involve human subject participation nor utilisation of protected data, ethical approval is not required. This study’s methodological approach follows current recommendations. Study findings will be disseminated through conference presentations and international peer-review journal publication. In addition, infographics available in English, Spanish and German will be disseminated.Registration detailsThis project will be registered in Open Science Framework prior to data collection.
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Cunningham, Chinazo O., Joanna L. Starrels, Chenshu Zhang, Marcus A. Bachhuber, Nancy L. Sohler, Frances R. Levin, Haruka Minami, Deepika E. Slawek, and Julia H. Arnsten. "Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain." BMJ Open 10, no. 12 (December 2020): e043400. http://dx.doi.org/10.1136/bmjopen-2020-043400.
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IntroductionIn the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study’s overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events.Methods and analysesWe are conducting a cohort study of 250 adults with and without HIV infection with (a) severe or chronic pain, (b) current opioid use and (c) who are newly certified for medical cannabis in New York. Over 18 months, we collect data via in-person visits every 3 months and web-based questionnaires every 2 weeks. Data sources include: questionnaires; medical, pharmacy and Prescription Monitoring Program records; urine and blood samples; and physical function tests. Using marginal structural models and comparisons within participants’ 2-week time periods (unit of analysis), we will examine how medical cannabis use (primary exposure) affects (1) opioid analgesic use (primary outcome), (2) HIV outcomes (HIV viral load, CD4 count, antiretroviral adherence, HIV risk behaviours) and (3) adverse events (cannabis use disorder, illicit drug use, diversion, overdose/deaths, accidents/injuries, acute care utilisation).Ethics and disseminationThis study is approved by the Montefiore Medical Center/Albert Einstein College of Medicine institutional review board. Findings will be disseminated through conferences, peer-reviewed publications and meetings with medical cannabis stakeholders.Trial registration numberClinicalTrials.gov Registry (NCT03268551); Pre-results.
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Alkhawaldeh, Abdullah. "Factors associated with utilisation of university health centre services by students." International Journal Of Community Medicine And Public Health 4, no. 6 (May 22, 2017): 1858. http://dx.doi.org/10.18203/2394-6040.ijcmph20172145.
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Background: Little is known about the factors that are associated with students’ utilisation of university health centre services. The current study examines factors associated with utilisation of university health centre services by students.Methods: Data were collected from 440 university students using a cross-sectional study design and self-reported questionnaire.Results: University health centre services were utilised by 147 (39.5%) of the students in the past 6 months. Utilisation of university health centre services was associated with gender, faculty, tobacco use and chronic illnesses. The main predictor of university health centre services utilisation at 6 months was chronic illnesses (OR=4.205).Conclusions: Although several factors were associated with university health centre services utilisation, chronic illness was the most important predictor.
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van Doorn, Pieter F., Evelien I. T. de Schepper, Dieuwke Schiphof, Ramon P. G. Ottenheijm, Marloes Thoomes-de Graaf, Marc A. Koopmanschap, John M. van Ochten, et al. "Clinical and cost effectiveness of a corticosteroid injection versus exercise therapy for shoulder pain in general practice: protocol for a randomised controlled trial (SIX Study)." BMJ Open 11, no. 3 (March 2021): e050101. http://dx.doi.org/10.1136/bmjopen-2021-050101.
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IntroductionShoulder pain is common and the prognosis is often unfavourable. Dutch guidelines on the treatment of shoulder pain in primary care recommend a corticosteroid injection or a referral to exercise therapy, if initial pain management fails and pain persists. However, evidence of the effectiveness of a corticosteroid injection compared with exercise therapy, especially in the long term, is limited. This trial will assess the clinical effectiveness and cost effectiveness of a corticosteroid injection compared with physiotherapist-led exercise therapy over 12 months follow-up in patients with shoulder pain in primary care.Methods and analysisThe SIX Study is a multicentre, pragmatic randomised clinical trial in primary care. A total of 213 patients with shoulder pain, aged ≥18 years presenting in general practice will be included. Patients will be randomised (1:1) into two groups: a corticosteroid injection or 12 sessions of physiotherapist-led exercise therapy. The effect of the allocated treatment will be assessed through questionnaires at 6 weeks and after 3, 6, 9 and 12 months. The primary outcome is patient’s reported shoulder pain-intensity and function, measured with the Shoulder Pain and Disability Index, over 12 months follow-up. Secondary outcomes include cost effectiveness, pain-intensity, function, health-related quality of life, sleep quality, patient’s global perceived effect, work absence, healthcare utilisation and adverse events. Between group differences will be evaluated using a repeated measurements analysis with linear effects models. A cost-utility analysis will be performed to assess the cost effectiveness using quality-adjusted life years from a medical and societal perspective.Ethics and disseminationThis study was approved by the Medical Ethics Committee of Erasmus MC University Medical Center Rotterdam (MEC 2020-0300). All participants will give written informed consent prior to data collection. The results from this study will be disseminated in international journals and implemented in the primary care guidelines on shoulder pain.Trial registration numberDutch Trial Registry (NL8854).
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Harbola, S., and V. Coors. "SEASONALITY DEDUCTION PLATFORM: FOR PM<sub>10</sub>, PM<sub>2.5</sub>, NO, NO<sub>2</sub> AND O<sub>3</sub> IN RELATIONSHIP WITH WIND SPEED AND HUMIDITY." ISPRS Annals of Photogrammetry, Remote Sensing and Spatial Information Sciences VI-4/W2-2020 (September 15, 2020): 71–78. http://dx.doi.org/10.5194/isprs-annals-vi-4-w2-2020-71-2020.
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Abstract. Human and ecosystem health is affected by the risk of air pollution. A comprehensive understanding of the parameters generating pollution and governing their nature in time is essential to devise functional policies focusing on minimising the concentration of the pollutants. The effect of pollution parameters on meteorological data and existing in between relationships, have been the focus of the researcher’s planning of better city future. Thorough study of resources utilisation is required for contributing to framing effective, sustainable development, government policies management, and advance public services convenience. For protecting the environmental quality, renewable resources like solar and wind are more incorporated in techniques supporting better city planning. This paper considers the hourly time series Particular Matter (PM) PM2.5 and PM10, Nitrogen Oxide (NO), and Nitrogen Dioxide (NO2), and Ozone (O3) along with measured wind flow and humidity. This study’s objective is to assess the temporal seasonality patterns of these parameters in Stuttgart, Germany. The temporal variations over the city center in Stuttgart are analysed using unsupervised approach to perform seasonal hierarchical clustering on a series of parameters NO, NO2, O3, PM10, and PM2.5, wind speed and humidity. Furthermore, the correlations between meteorological and pollution parameters are analysed using the Spearman rank correlation method. Moreover, a dashboard is developed to provide the user desired time frame visualisation of these parameters. Proposed work would provide empirical meaning and seasonality comparison among the above mentioned parameters combined with interactive dashboard support. The analyses of the presented results clearly demonstrates the relationship between air pollutants, wind, humidity together in combine temporal activities frame. Thus, it would help city planner and policies maker with advanced knowledge of seasonality for meteorological and pollution parameters conditions.
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McNab, Duncan, Paul Bowie, Alastair Ross, Gordon MacWalter, Martin Ryan, and Jill Morrison. "Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge." BMJ Quality & Safety 27, no. 4 (December 16, 2017): 308–20. http://dx.doi.org/10.1136/bmjqs-2017-007087.
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BackgroundPharmacists’ completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload.MethodsThis is a systematic literature review and meta-analysis of extracted data. Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Allied and Complementary Medicine Database (AMED),Education Resources Information Center (ERIC), Scopus, NHS Evidence and the Cochrane databases were searched using a combination of medical subject heading terms and free-text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using the Critical Appraisal Skills Programme. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively.ResultsFourteen studies were included, comprising five randomised controlled trials, six cohort studies and three pre–post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload.ConclusionsPharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge, but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload.
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Smart, Dave, Wendy Moore, Susanne Munksted Fosvig, and Kenneth Joel Bloom. "A preliminary review of adoption of new HCPCS codes for NGS in CMS claims." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e13522-e13522. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e13522.
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e13522 Background: Adequate reimbursement is considered a prerequisite for adoption of new diagnostic technologies that facilitate patient access to better treatments. Detailed longitudinal investigation of the adoption of new HCPCS codes and the factors influencing it are scarce, although the availability of large-scale claims databases should facilitate such studies. We examined claims for three CPT codes used for next generation sequencing (NGS): 81445, 81450 and 81455 in a large database of claims data from CMS and attempted to correlate presumptive drivers of test adoption such as coverage decisions and payments with test volume. Methods: CMS claims data were accessed using CMS’ Virtual Research Data Center (VRDC) under data use agreement 50486. Any claim with a CPT code of 81445, 81450 or 81455 was extracted from the data and analysed using SAS Enterprise Guide with results summarised in Microsoft Excel. Data relating to national/local coverage determinations were located by internet searches. Results: Test volumes for all 3 codes showed significant variability, including a large decrease around Q1-2 of 2020, likely due to the COVID-19 pandemic. Utilization of the 3 CPT codes varied by patient diagnosis. Details of the top 5 diagnoses for each CPT are given in the Table. The top 30 diagnoses for each CPT code accounted for 80.33%-88.45% of patients. Conclusions: Utilisation of NGS testing from 2016-2021 was highly variable, confounding attempts to match potential drivers to changes in monthly test volumes. A relatively small number of conditions accounted for >80% test use. Increased use of 81445 and 81450 from 2019 onwards may be related to CMS LCD issued in March 2018, suggesting that it can take 8-9 months or more for a LCD to filter through to testing practice. Decreases in test volume around March 2020 coincide with decreased patient presentation and testing for cancer because of the COVID-19 pandemic indicating that factors beyond reimbursement can significantly affect test use. Changes in reimbursement or adoption of proprietary lab analysis (PLA) codes covering specific NGS tests may have caused the drop in test volumes in the latter half of 2021. This study demonstrates that determination of factors affecting adoption of a test technology can be problematic due to wide variation in claims over a relatively short space of time. However, determination of these factors is important as they ultimately affect patient access to testing and potentially to therapy. [Table: see text]
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Smart, Dave, Wendy Moore, Susanne Munksted Fosvig, and Kenneth Joel Bloom. "A preliminary review of adoption of new HCPCS codes for NGS in CMS claims." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e13522-e13522. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e13522.
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e13522 Background: Adequate reimbursement is considered a prerequisite for adoption of new diagnostic technologies that facilitate patient access to better treatments. Detailed longitudinal investigation of the adoption of new HCPCS codes and the factors influencing it are scarce, although the availability of large-scale claims databases should facilitate such studies. We examined claims for three CPT codes used for next generation sequencing (NGS): 81445, 81450 and 81455 in a large database of claims data from CMS and attempted to correlate presumptive drivers of test adoption such as coverage decisions and payments with test volume. Methods: CMS claims data were accessed using CMS’ Virtual Research Data Center (VRDC) under data use agreement 50486. Any claim with a CPT code of 81445, 81450 or 81455 was extracted from the data and analysed using SAS Enterprise Guide with results summarised in Microsoft Excel. Data relating to national/local coverage determinations were located by internet searches. Results: Test volumes for all 3 codes showed significant variability, including a large decrease around Q1-2 of 2020, likely due to the COVID-19 pandemic. Utilization of the 3 CPT codes varied by patient diagnosis. Details of the top 5 diagnoses for each CPT are given in the Table. The top 30 diagnoses for each CPT code accounted for 80.33%-88.45% of patients. Conclusions: Utilisation of NGS testing from 2016-2021 was highly variable, confounding attempts to match potential drivers to changes in monthly test volumes. A relatively small number of conditions accounted for >80% test use. Increased use of 81445 and 81450 from 2019 onwards may be related to CMS LCD issued in March 2018, suggesting that it can take 8-9 months or more for a LCD to filter through to testing practice. Decreases in test volume around March 2020 coincide with decreased patient presentation and testing for cancer because of the COVID-19 pandemic indicating that factors beyond reimbursement can significantly affect test use. Changes in reimbursement or adoption of proprietary lab analysis (PLA) codes covering specific NGS tests may have caused the drop in test volumes in the latter half of 2021. This study demonstrates that determination of factors affecting adoption of a test technology can be problematic due to wide variation in claims over a relatively short space of time. However, determination of these factors is important as they ultimately affect patient access to testing and potentially to therapy. [Table: see text]
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H. S., Madhusudhan, Satish Kumar T., Punit Gupta, and Gavin McArdle. "A Harris Hawk Optimisation system for energy and resource efficient virtual machine placement in cloud data centers." PLOS ONE 18, no. 8 (August 11, 2023): e0289156. http://dx.doi.org/10.1371/journal.pone.0289156.
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Virtualisation is a major technology in cloud computing for optimising the cloud data centre’s power usage. In the current scenario, most of the services are migrated to the cloud, putting more load on the cloud data centres. As a result, the data center’s size expands resulting in increased energy usage. To address this problem, a resource allocation optimisation method that is both efficient and effective is necessary. The optimal utilisation of cloud infrastructure and optimisation algorithms plays a vital role. The cloud resources rely on the allocation policy of the virtual machine on cloud resources. A virtual machine placement technique, based on the Harris Hawk Optimisation (HHO) model for the cloud data centre is presented in this paper. The proposed HHO model aims to find the best place for virtual machines on suitable hosts with the least load and power consumption. PlanetLab’s real-time workload traces are used for performance evaluation with existing PSO (Particle Swarm Optimisation) and PABFD (Best Fit Decreasing). The performance evaluation of the proposed method is done using power consumption, SLA, CPU utilisation, RAM utilisation, Execution time (ms) and the number of VM migrations. The performance evaluation is done using two simulation scenarios with scaling workload in scenario 1 and increasing resources for the virtual machine to study the performance in underloaded and overloaded conditions. Experimental results show that the proposed HHO algorithm improved execution time(ms) by 4%, had a 27% reduction in power consumption, a 16% reduction in SLA violation and an increase in resource utilisation by 17%. The HHO algorithm is also effective in handling dynamic and uncertain environments, making it suitable for real-world cloud infrastructures.
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Dissou, Florent Essin, Jacques Boco Adjakpa, and Peter D. M. Weesie. "Perceptions of local populations on the state of phytodiversity in the subwatershed of Kossi river in the municipalities of Dassa-Zoumé and Glazoué in the Center of Benin." International Journal of Biological and Chemical Sciences 14, no. 9 (March 25, 2021): 3200–3214. http://dx.doi.org/10.4314/ijbcs.v14i9.18.
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In Africa, since several decades a rarefaction of many plant species because of their daily use by people can be observed. This study which was conducted in the subwatershed of the Kossi River aims to collect peasant perceptions about the state of phytodiversity. The data were collected through an individual survey in 10 villages with 492 households. The software CAP version 2.15. and R version 3.3.3. were used for the statistical analysis. In total, 94 species belonging to 83 genera and 38 families were identified. The dominant genera are Ficus, Ocimum, Acacia and Blighia. Forty-six (46) species of the listed species (48.94%) are currently rare and 9 species (19.57%) of those rare species are threatened in Benin. Value of importance (IV) of activity and the consensus value (UCs) of the choice of activity show that logging, agriculture and breeding have greatest influence on species loss. This study gives information on the most used species by the populations and those we can select for reforestation campaigns. As a perspective, a work on the temporal dynamics of the land use units of this sub-basin will be done to better appreciate their evolution over time.
En Afrique, on assiste depuis plusieurs décennies à la raréfaction de plusieurs espèces végétales du fait de leur utilisation quotidienne par les populations. La présente étude conduite dans le sous-bassin versant de la rivière Kossi vise à recueillir les perceptions des populations locales sur l’état de la phytodiversité. Les données ont été collectées à travers une enquête individuelle dans 10 villages auprès de 492 ménages. Les logiciels CAP version 2.15. et R version 3.3.3. ont été utilisés pour les analyses statistiques. Au total, 94 espèces reparties en 83 genres et 38 familles ont été recensées. Les genres dominants sont Ficus, Ocimum, Acacia et Blighia et les familles les mieux représentées sont les Caesalpiniaceae, les Papilionaceae et les Combretaceae. Quarante-six des espèces recensées (48,94%) sont actuellement rares et 9 de ces espèces rares (19,57%) sont menacées au Bénin. La Valeur d’Importance (IV) de l’activité et la valeur consensuelle (UCs) du choix de l’activité ont révélé que l’exploitation forestière, l’agriculture et la transhumance sont les principaux facteurs responsables de cette raréfaction. Cette étude renseigne sur les espèces les plus utiles pour les populations et celles à apporter en cas d’enrichissement. Comme perspective, la dynamique temporelle des unités d’occupation du sol de ce sous-bassin sera abordée pour mieux apprécier leur évolution dans le temps.
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Marcotte, Nathalie, Marie-Claude Michel, Louise Deschenes, Nathalie Letarte, Daniel Froment, Emilie Lemieux-Blanchard, France Varin, et al. "Descriptive Analysis of Bortezomib Use in Multiple Myeloma in Four Adult University Teaching Hospitals in Quebec, Canada." Blood 126, no. 23 (December 3, 2015): 5573. http://dx.doi.org/10.1182/blood.v126.23.5573.5573.
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Abstract Background: Bortezomib, a reversible inhibitor of the 26S proteasome widely used in the treatment of multiple myeloma, is now being used in various other indications. Pharmacy directors gave the Therapeutic Drug Management Program (TDMP - www.pgtm.qc.ca) the mandate to evaluate bortezomib use in four University Hospitals in Quebec, Canada. Objectives: Describe bortezomib use for all indications in our hospitals and review its utilisation in the treatment of multiple myeloma. Methods: A review of pharmacy databases was performed to identify patients who received bortezomib between June1st 2012 and May 31st 2013. The pharmaceutical and medical records of every patient who received bortezomib were reviewed to assess the treatment, pathology and adverse events. Results: Two hundred and thirty two bortezomib regimens were administered to 227 different patients during the study period. Median age was 68. The most frequent indication (55%) was first-line treatment of multiple myeloma (n=128) followed by treatment of relapsed/refractory disease (31%) (n=73). Various other indications, including amyloidosis (n=17), lymphoplasmacytic lymphoma (n=12) and mantle cell lymphoma (n=2), represented 13% of the population. At the time of data analysis, 35% of patients were still treated with bortezomib, 25% had finished their planned treatment and 34% had discontinued treatment because of adverse events or disease progression. Fifteen patients (6%) died during the study period. Among the 45 patients eligible for autologous stem cell transplant (ASCT), the main regimen used was the association of bortezomib and dexamethasone (VelDex) (n=27), primarily using subcutaneous bortezomib (n=24) at 1.3 mg/m2 (n=30). Median treatment duration was four cycles. Twenty-eight patients have undergone ASCT and only two progressed. The association of bortezomib, melphalan and prednisone (VMP) (54.2%) followed by VelDex (29%) and the association of cyclophosphamide, bortezomib and dexamethasone (CyborD) (16.8%) were the regimens used in the population (n=83) not eligible to ASCT. Response rate using international uniform response criteria for multiple myeloma was 47.9% excluding patients still receiving treatment at the time of data collection. Seventy three patients received bortezomib for relapsed/refractory myeloma. Of these patients, thirty two (43.8%) discontinued therapy, nineteen due to disease progression, eight for the occurrence of side effects and five for other reasons. The initial dose was variable, from 1.0 to 1.6 mg/m2, and close to half of this patient population received CYBorD (49.4%), followed by VelDex (30.2%) and VMP protocols (15%). The number of cycles for patients who completed treatment (4 to 9) as well as the median exposure time (57 to 223 days) was also highly variable. Respectively 8.5% and 10.9% of the population treated with bortezomib for multiple myeloma were hospitalized (n=17) or had to discontinue treatment (n=22) because of adverse events (mostly hematologic toxicity, peripheral neuropathy or gastro-intestinal toxicity). Conclusions: Bortezomib is widely used in the treatment of multiple myeloma. Treatment algorithms should be developed and implemented to optimize the use of bortezomib, particularly in the relapsed/refractory setting. Standard regimens should also be implemented in each center. The utilisation of pre-printed orders for the prescription of chemotherapy regimens promotes uniform prescription. A review of the literature should be performed and recommendations should be made for the use of bortezomib in off-label indications like amyloidosis and lymphoplasmacytic lymphoma. Disclosures Off Label Use: bortezomib use in amyloidosis and lymphoplasmacitic lymphoma. Lemieux-Blanchard:celgene: Membership on an entity's Board of Directors or advisory committees; Amgen and Janssen: Other: preceptorship. Bérard:Janssen: Honoraria. Sebag:Janssen: Honoraria; Amgen: Honoraria; Celgene: Honoraria; Novartis: Honoraria.
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Lee, Bryanna, John Mafi, Maitraya K. Patel, Andrea Sorensen, Sitaram Vangala, Eric Wei, and Catherine Sarkisian. "Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system." BMJ Open Quality 10, no. 1 (February 2021): e001076. http://dx.doi.org/10.1136/bmjoq-2020-001076.
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ImportanceElectronic health record (EHR) clinical decision support (CDS) tools can provide evidence-based feedback at the point of care to reduce low-value imaging. Success of these tools has been limited partly due to lack of engagement by busy clinicians.ObjectiveMeasure the impact of a time-saving quality improvement intervention to increase engagement with a CDS tool for low back pain imaging ordering.Design, setting and participantsWe conducted a quasi-experimental difference-in-differences analysis at (BLINDED), examining back pain imaging orders from 29 May 2015 to 07 January 2016. The intervention site was (BLINDED) Emergency Medicine/Urgent Care Center (n=5736) and control sites included all other (BLINDED) hospitals and clinics (n=1621). In May 2015, the Department of Health Services installed a CDS tool that triggered a survey when clinicians ordered an imaging test, generating an ‘appropriateness score’ based on the American College of Radiology guidelines. Clinicians often bypassed the tool, resulting in ‘unscored’ tests.InterventionTo increase clinician engagement with the tool and decrease the rate of unscored imaging tests, a new policy was implemented at the intervention site on 15 August 2015. If clinicians completed the CDS survey and scored an appropriateness score >3, they could forego a previously mandatory telephone call for pre-imaging utilisation review with the radiology department.Main outcomes and measuresWe used EHR data to measure pre–post-intervention differences in: (1) percentage of unscored tests and (2) percentage of tests with high appropriateness scores (>7).ResultsPercentage of unscored tests decreased from 69.4% to 10.4% at the intervention site and from 50.6% to 34.8% at the control sites (between-group difference: −23.3%, p<0.001). Percentage of high scoring tests increased from 26.5% to 75.0% at the intervention site and from 17.2% to 22.7% at the control sites (between-group difference: 19%, p<0.001).ConclusionWorkflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.
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Cashen, Katherine, Tara L. Petersen, Cailyn Rood, Daniel Cater, Sheila F. Waslawski, James E. Slaven, and Christopher W. Mastropietro. "Emergency department utilisation and critical readmission in patients with Fontan circulation." Cardiology in the Young 30, no. 12 (October 30, 2020): 1902–9. http://dx.doi.org/10.1017/s1047951120003121.
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AbstractBackground:We aimed to conduct a multi-centre study characterising emergency department utilisation and critical readmissions experienced by children with Fontan circulation.Methods:We conducted a retrospective review of children who underwent the Fontan operation at three institutions (i.e., centres A, B, and C) between 2009 and 2014, with follow-up through December 2015. Multi-variable analyses were performed to determine factors associated for emergency department utilisation within 1 year of surgery, emergency department utilisation at any time following surgery, or critical readmission (defined as admission to ICU, operating room, or cardiac catheterisation).Results:We reviewed 297 patients, of which 147 patients (49%) had 607 emergency department encounters. Forty-six patients (15%) required 71 critical readmissions. Multi-variable analyses revealed centre C (p = 0.02) and post-operative hospitalisation ≥ 14 days (p = 0.03) to be significantly associated with emergency department utilisation within 1 year, whereas centre B (p < 0.001), post-operative hospitalisation ≥ 14 days (p = 0.002), and African-American/Black race (p = 0.04) were significantly associated with critical readmission.Conclusions:In this multi-centre study, nearly half of patients with Fontan circulation received emergency department care, often presenting with high disease acuity requiring readmission. Emergency department utilisation and need for critical readmission were independently influenced by the centre at which surgery was performed, prolonged post-operative hospitalisation, and racial background. These data could help guide quality improvement efforts aimed at reducing morbidity in this unique patient population.
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Vincent, Ann, Kelly M. Kruk, Stephen S. Cha, Brent A. Bauer, and David P. Martin. "Utilisation of Acupuncture at An Academic Medical Centre." Acupuncture in Medicine 28, no. 4 (December 2010): 189–90. http://dx.doi.org/10.1136/aim.2010.002568.
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Objective To provide information about the clinical use of acupuncture at an academic medical centre in the USA. Methods A retrospective review of 904 patients (receiving 6070 treatments) who were referred for acupuncture treatment at the Mayo Clinic (Rochester, Minnesota, USA) between 1 January 2004 and 31 December 2008. Data gathered included age, sex, primary diagnosis, number of treatments per diagnosis and health insurance carrier. Results The mean (SD) age of the patients was 53.4 (16.2) years; 73.8% were female and 26.2% were male. The three most common diagnostic categories for which acupuncture was used were spinal pain (33.4%), pain (other) (25.1%) and joint pain (12.3%). About 42% of visits were not covered by health insurance carriers and hence patients had to pay themselves. For the remaining 58% of visits, health insurance carriers picked up all or part of the cost of the acupuncture treatments. Conclusion The results indicate that pain is the most common reason for use of acupuncture in an academic medical centre and that women use acupuncture more than men. This is one of the few reports of clinical use of acupuncture at academic medical centres in the USA.
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Acevedo, Paloma, Sebastian Martinez, Leonardo Pinzon, Emmanuelle Sanchez-Monin, and Solis Winters. "Distance as a barrier to obstetric care among indigenous women in Panama: a cross-sectional study." BMJ Open 10, no. 3 (March 2020): e034763. http://dx.doi.org/10.1136/bmjopen-2019-034763.
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ObjectivesWe assess the relationship between distance to a woman’s assigned health clinic and obstetric care utilisation.DesignWe employ a cross-sectional study design using baseline data from the evaluation of a conditional cash transfer programme to promote greater utilisation of maternal and infant health services. Data were collected between December 2016 and January 2017.SettingThe study is conducted in Ngäbe Buglé, the largest of Panama’s three indigenous territories, where maternal mortality is three times the national average.ParticipantsWe analyse a representative sample of 1336 indigenous women with a birth in the 12 months prior to the survey.Primary and secondary outcome measuresPrimary outcomes include obstetric care utilisation measures for prenatal, childbirth and postpartum events. Secondary outcomes include reasons for not receiving prenatal care, alarming symptoms, child weight at birth and stillbirths or miscarriages.ResultsCompared with women in closest geographic proximity to a health centre (top quintile, Q1), women who lived farthest from a health centre (bottom quintile, Q5) had significantly lower obstetric care utilisation outcomes for critical prenatal, childbirth and postpartum events. Mothers in Q5 were 36 percentage points less likely to have had at least one prenatal care appointment in a hospital, health centre or clinic compared with mothers in Q1 (p<0.01), and 52 percentage points less likely to attend an institutional first appointment (p<0.01). The gap in institutional delivery and postnatal care between mothers in Q1 and Q5 was about 35 percentage points (p<0.01). All utilisation outcomes were negatively correlated with distance, and differences in obstetric care utilisation persisted even when controlling for household wealth, maternal age and maternal education.ConclusionDistance is an important barrier to obstetric care utilisation, with women in more distant locations suffering significantly lower use of prenatal, childbirth and postpartum care compared with women in closer vicinity to a health establishment. Expanding the supply of healthcare and implementing demand side incentives to promote the use of health services in remote communities are relevant policies to reduce disparities in obstetric care utilisation.Trial registration numberAEA Registry (RCT ID AEARCTR-0001751).
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Banu, D. Madhina, and S. Aranganathan. "Effective utilisation of cloud data centre and allocating user demands to virtual machines using LMRO algorithm." International Journal of Vehicle Information and Communication Systems 4, no. 4 (2019): 316. http://dx.doi.org/10.1504/ijvics.2019.10025631.
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Banu, D. Madhina, and S. Aranganathan. "Effective utilisation of cloud data centre and allocating user demands to virtual machines using LMRO algorithm." International Journal of Vehicle Information and Communication Systems 4, no. 4 (2019): 316. http://dx.doi.org/10.1504/ijvics.2019.103924.
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Anjum, Mohd, and Sana Shahab. "Emergency Vehicle Driving Assistance System Using Recurrent Neural Network with Navigational Data Processing Method." Sustainability 15, no. 4 (February 8, 2023): 3069. http://dx.doi.org/10.3390/su15043069.
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Emergency vehicle transportation is important for responding to and transporting individuals during emergencies. This type of transportation faces several issues, such as road safety, navigation and communication, time-critical operations, resource utilisation, traffic congestion, data processing and analysis, and individual safety. Vehicle navigation and coordination is a critical aspect of emergency response that involves guiding emergency vehicles, such as ambulances, to the location of an emergency or medical centre as quickly and safely as possible. Therefore, it requires additional effort to reduce driving risks. The roadside units support emergency vehicles and infrastructure to decrease collisions and enhance optimal navigation routes. However, during the emergency vehicle’s data communication and navigation process, communication is interrupted due to vehicle outages. Therefore, this study proposes the Navigation Data Processing for Assisted Driving (NDP-AD) method to address the problem. The proposed approach assimilates infrastructure and neighbouring location information during driving. The integrated information is processed for distance and traffic during the previous displacement interval. The NDP-AD method employs a recurrent neural network learning approach to analyse opposing vehicle distance and traffic to provide accurate, independent guidance. This effective learning-based guidance process minimises false navigations and deviation in displacement. System efficiency is evaluated based on processing latency, displacement error, data utilisation, false rate, and accuracy metrics.
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Areru, Hiwot Abera, Mesay Hailu Dangisso, and Bernt Lindtjørn. "Large local variations in the use of health services in rural southern Ethiopia: An ecological study." PLOS Global Public Health 2, no. 5 (May 25, 2022): e0000087. http://dx.doi.org/10.1371/journal.pgph.0000087.
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Ethiopia is behind schedule in assuring accessible, equitable and quality health services. Understanding the geographical variability of the health services and adjusting small-area level factors can help the decision-makers to prioritize interventions and allocate scarce resources. There is lack of information on the degree of variation of health service utilisation at micro-geographic area scale using robust statistical tools in Ethiopia. Therefore, the objective of this study was to assess the health service utilisation and identify factors that account for the variation in health service utilisation at kebele (the smallest administrative unit) level in the Dale and Wonsho districts of the Sidama region. An exploratory ecological study design was employed on the secondary patient data collected from 1 July 2017 to 30 June 2018 from 65 primary health care units of the fifty-four kebeles in Dale and Wonsho districts, in the Sidama region. ArcGIS software was used to visualise the distribution of health service utilisation. SaTScan analysis was performed to explore the unadjusted and covariate-adjusted spatial distribution of health service utilisation. Linear regression was applied to adjust the explanatory variables and control for confounding. A total of 67,678 patients in 54 kebeles were considered for spatial analysis. The distribution of the health service utilisation varied across the kebeles with a mean of 0.17 visits per person per year (Range: 0.01–1.19). Five kebeles with health centres had a higher utilisation rate than other rural kebeles without health centres. More than half (57.4%) of the kebeles were within a 10 km distance from health centres. The study found that distance to the health centre was associated with the low health care utilisation. Improving the accessibility of health services by upgrading the primary health care units could increase the service use.
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Beaugé, Yvonne, Manuela De Allegri, Samiratou Ouédraogo, Emmanuel Bonnet, Naasegnibe Kuunibe, and Valéry Ridde. "Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso." International Journal of Environmental Research and Public Health 17, no. 18 (September 8, 2020): 6543. http://dx.doi.org/10.3390/ijerph17186543.
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Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user fee exemption cards, and the effect of card possession on the utilisation of healthcare services. Methods: A panel data set of 1652 randomly selected ultra-poor individuals was used. Logistic regression was applied on the end line data to identify factors associated with the receipt of user fee exemption cards. Random-effects modelling was applied to the panel data to determine the effect of the card possession on healthcare service utilisation among those who reported an illness six months before the surveys. Results: Out of the ultra-poor surveyed in 2017, 75.51% received exemption cards. Basic literacy (p = 0.03), living within 5 km from a healthcare centre (p = 0.02) and being resident in Diébougou or Gourcy (p = 0.00) were positively associated with card possession. Card possession did not increase health service utilisation (β = −0.07; 95% CI = −0.45; 0.32; p = 0.73). Conclusion: A better intervention design and implementation is required. Complementing demand-side strategies could guide the ultra-poor in overcoming all barriers to healthcare access.
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Brennan, Aline, Mary Horgan, Arthur Jackson, John P. Browne, and Colm J. Bergin. "Utilisation patterns and cost of hospital care for people living with HIV in Ireland in 2012: a single-centre study." International Journal of STD & AIDS 28, no. 3 (July 10, 2016): 229–37. http://dx.doi.org/10.1177/0956462416640167.
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Data on the pattern and cost of health service use by HIV patients are required for evaluations of the cost-effectiveness of new drugs and technologies as well as being essential for service planning. The aim of this study was to identify the utilisation patterns and cost of hospital care for HIV patients in a single centre in Ireland in 2012. Data on the frequency and non-drug costs of all hospital resources used by HIV patients were extracted from a hospital activity-based costing system. Cost data were analysed using a generalised linear model. A total of 328 patients, 3672 patient months, were included in this study. Patients had a mean of 4.4 scheduled infectious disease outpatient appointments per patient year; 37% of patients also used another outpatient service, 15% in-patient services, 4% day-case service and 18% emergency department services in 2012. Patients with very advanced HIV disease continue to incur a disproportionate amount of the total cost of providing care. This study provides baseline utilisation and cost data for use of both infectious-disease and non-infectious disease hospital services and will be useful for service planning in light of the likely increases in resource demands.
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Aladul, Mohammed Ibrahim, Bharat Patel, and Stephen Robert Chapman. "Impact of the introduction of falls risk assessment toolkit on falls prevention and psychotropic medicines’ utilisation in Walsall: an interrupted time series analysis." BMJ Open 11, no. 8 (August 2021): e039649. http://dx.doi.org/10.1136/bmjopen-2020-039649.
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ObjectiveTo determine the impact of the introduction of a falls risk assessment toolkit (FRAT) in a UK medical centre on the number and cost of non-elective admissions for falls and psychotropic medication utilisation.DesignInterrupted time series analysis quantifying the number and cost of non-elective admissions for falls and primary care use data for Rushall Medical Centre before and after the implementation of FRAT at July 2017.SettingData on the monthly number and cost of non-elective admissions for falls and number of referrals and assessment to the falls service were provided by Walsall Clinical Commissioning Group. Primary care prescribing cost and volume data for Rushall Medical Centre was derived from the Openprescribing.net website for prescriptions dispensed between April 2015 and November 2018.Primary and secondary outcome measuresThe number and cost of non-elective admissions for falls and number of referrals and assessment to the falls service, and the volume of utilisation of psychotropic medicines.ResultsFollowing the implementation of FRAT at Rushall Medical Centre in July 2017, the number of non-elective admissions for falls decreased at a rate of 0.414 admissions per month (p<0.033, 95% CI –0.796 to –0.032). The utilisation of psychotropic medications (alimemazine, citalopram, escitalopram, fluoxetine, mirtazapine, olanzapine and risperidone) decreased. The expenditure on psychotropic medications prescribed/used at Rushall Medical Centre decreased by at least £986 per month (p<0.001, 95% CI –2067 to –986).ConclusionsThe implementation of FRAT at Rushall Medical Centre was associated with a reduction in the number of non-elective admissions for falls. Assessment of these patients together with deprescribing of psychotropic medications resulted in a reduction in the number of non-elective admissions for falls and associated costs.
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Lynch, Gerry, Margaret McKee, and Daniel M. Brennan. "Attendance at a psychiatric day centre." Irish Journal of Psychological Medicine 11, no. 4 (December 1994): 180–82. http://dx.doi.org/10.1017/s0790966700001774.
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AbstractObjective: To examine the service utilisation of a newly opened psychiatric day centre. We wished to determine if different diagnostic groups had different perspectives of the day centre, and to see if the drop-out rate differed among clients with neurotic or psychotic disorders.Method: Demographic and diagnostic data was gathered for all clients referred in the first year of operation of the day centre. Those who defaulted from attendance were visited at home and asked to detail reasons for non-attendance. Those who continued to attend 16 months after the centre opened completed a satisfaction survey.Results: The drop-out rate was high for both clients with neurotic and psychotic disorders. Clients who continued to attend were very positive about the day centre. Both client groups saw the benefits of attendance in social rather than therapeutic terms.Conclusions: Consumer opinion may have a valuable part to play in overall measure,measurement of service quality, particularly if it includes the opinion of those who no longer use that service.
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Darma, Azri, Hidayati Hidayati, and Fadil Oenzil. "Differences between dental health service quality and utilization of Community Health Centres in the City of Padang based on indicators of utilisation effectiveness." Padjadjaran Journal of Dentistry 30, no. 2 (July 31, 2018): 140. http://dx.doi.org/10.24198/pjd.vol30no2.18330.
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Introduction: The high prevalence of oral disease have not been followed by the availability of oral healthcare, especially at the community-based level. This study was aimed to determine the differences between dental health service quality and utilisation of community health centres in the city of Padang based on indicators of utilisation effectiveness. Methods: A cross-sectional survey was conducted towards two Community Health Services (Puskesmas) as the samples selected using random sampling technique. One Community Health Service was representing a rarely visited Community Health Service with ≤ 9 patients visit per day, and another Community Health Service was representing oppositely. As much as 131 respondents were included in this study, selected using the purposive sampling method. Dimensional satisfaction of service quality including tangibility, reliability, responsiveness, assurance, and empathy, were collected by interviewing the respondents based on a self-reported questionnaire. All data were analysed using the chi-square test. Results: The majority of respondents agreed that dimensional satisfaction such as tangibility, reliability, responsiveness, assurance, and empathy at both Community Health Services were at a good level. There was a significant relationship (p < 0.05) between several dimensional satisfaction of service quality variables (the wide and clean parking area; intense involvement of dentists on every oral examination; friendly service by the front-office; and empathetic affection of dentists towards the patient’s complain) and the utilisation of oral health services. Conclusion: No service differences found from relationship analysis between dental health service quality and utilisation of community health centres in the city of Padang based on indicators of utilisation effectiveness.Keywords: Service quality, dimensional satisfaction, oral health service, service utilisation, Community Health Centre.
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Lee, Sookyung, Jiyoon Yeo, Sook-Hyun Lee, Yoon Jae Lee, Sangkwan Lee, and In-Hyuk Ha. "Trends in healthcare utilisation of patients with migraine in South Korea: a retrospective observational study using Health Insurance Review and Assessment Service National Patient Sample data from 2010 to 2018." BMJ Open 13, no. 3 (March 2023): e059926. http://dx.doi.org/10.1136/bmjopen-2021-059926.
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ObjectiveThis study used 2010–2018 Health Insurance Review and Assessment Service National Patient Sample data to analyse the distribution and healthcare utilisation of patients with migraine in South Korea.DesignRetrospective, observational study using serial cross-sectional data.ParticipantsPatients with primary diagnosis of G43, a Korean Standard Classification of Diseases-10 code for migraine, were included in the analysis. The exclusion criteria were missing code information; code for dental, health centre or psychiatry; institution type specified as nursing hospital, psychiatric hospital, dental hospital, midwifery centre or health centre; blank entries for total cost or days of care. 453 246 records of patients and 117 157 patients corresponding to those records were identified.Outcome measuresPrimary outcome measures were medical service utilisation status, treatment methods and drug use status associated with migraine.ResultsCases and patients of migraine increased from 48 846 and 19 468 (2010) to 52 729 and 20 802 (2018), respectively, increases of 7.95% and 6.85%, respectively, compared with 2010. Total cost of care increased from $921 857.88 (2010) to $1 711 219.60 (2018). The most common age range of patients was 45–54 years, with 2.69 times more female than male patients. In Western medicine hospitals, subcutaneous or intramuscular injection therapy was used frequently, while in Korean medicine hospitals, acupuncture therapy was used. Among Western medicine outpatients, more than 50% of the therapeutics prescribed for acute migraine were simple analgesics or non-steroidal anti-inflammatory drugs. The number of prescriptions for the prevention of episodic migraine increased from 13 600 cases (2010) to 20 546 cases (2018), representing the steepest increase in drug utilisation.ConclusionsTreatments frequently used in Western and Korean medicine hospitals and their frequency of use and costs were identified. The findings of this study can be used as a basis for relevant health policy decisions.
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van den Belt, Angelique, Martin Prins, Alexander Gallus, Harry Büller, and Patrick Bossuyt. "Replacing Inpatient Care by Outpatient Care in the Treatment of Deep Venous Thrombosis – An Economic Evaluation." Thrombosis and Haemostasis 79, no. 02 (1998): 259–63. http://dx.doi.org/10.1055/s-0037-1614975.
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SummaryTwo clinical trials in patients with acute deep venous thrombosis have indicated that the outpatient management with fixed-dose, subcutaneous low-molecular-weight heparin is at least as effective and safe as inpatient treatment with unfractionated intravenous heparin with respect to recurrent venous thromboembolism and major bleeding. We performed an economic evaluation alongside one of these trials to assess the cost consequences of the outpatient management strategy. Data were collected through case record forms, complemented by a prospective questionnaire in 78 consecutive patients, interviews with health care providers, and hospital data bases. Our study demonstrated that seventy-five percent of patients allocated to low-molecular-weight heparin received treatment either entirely at home or after a brief hospital stay. Fifteen percent of these patients required professional domiciliary care. Within-centre comparisons of resource utilisation in terms of natural units showed that outpatient management with low-molecular-weight heparin reduced the average number of hospital days in the initial treatment period in nine centres by 59 percent (95% CI: 43 to 71 percent) accompanied by a limited increase in outpatient and professional domiciliary care. The average reduction in hospital days at the end of follow up was 40 percent (95% CI: 25 to 54 percent). A cost-minimisation analysis, focusing on resource utilisation directly related to the treatment of deep venous thrombosis and associated costs in one centre demonstrated a cost reduction of 64 percent (95% CI: 56 to 72 percent) with the outpatient management with low-molecular-weight heparin. These data suggest that outpatient management of patients with proximal venous thrombosis using low-molecular-weight heparin reduces resource utilisation and total treatment cost. Implementation should be preceded by a cautious evaluation of a potential cost shifting and organisational prerequisites.
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Idris, Suleiman, and Nafi'u Maharazu. "Information Needs and Resource Utilisation by Medical Doctors of Federal Medical Centre Katsina State, Nigeria." Asian Journal of Information Science and Technology 11, no. 2 (November 5, 2021): 12–17. http://dx.doi.org/10.51983/ajist-2021.11.2.2900.
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This study was carried out to find out the Information Needs and Resource Utilisation by Medical Doctors of Federal Medical Centre Katsina State. In order to achieve this objective, quantitative research method was adopted, whereas survey design was employed for the study. Data were collected from the respondents through the use of questionnaire. A total of seventy six (76) copies of questionnaire were administered to the respondents and seventy two (72) were returned and found useful. All data collected were categorized and presented in tabular forms. Analyses of categorized data were done through simple percentages. Ultimately, it was found that the main types of information sought by the respondents are information to satisfy curiosity and personal interest, information for formal course of study, information for research and business opportunities. Based on the findings of the research, it was recommended that management of the hospital should provide functional library within the hospital premises with adequate and relevant information resources. Secondly, more and reliable internet service should be provided in the hospital so that medical doctors can benefit from this information sources right from their various offices.
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Appiah, Francis. "Individual and community-level factors associated with early initiation of antenatal care: Multilevel modelling of 2018 Cameroon Demographic and Health Survey." PLOS ONE 17, no. 4 (April 6, 2022): e0266594. http://dx.doi.org/10.1371/journal.pone.0266594.
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Background Early initiation of antenatal care (ANC) provided by skilled personnel is essential as it enables pregnant women to receive comprehensive reproductive health services. Early ANC utilisation could prevent complications related to pregnancy and improve maternal and neonatal health outcomes. Regardless of this, only forty-one in every hundred women in Cameroon seek early ANC services. Studies on the uptake of antenatal care in Cameroon have not focused on individual and community-level factors that influence early initiation of ANC. This study aimed at investigating the association between individual and community-level factors and early ANC uptake in Cameroon. Methods This study was a cross-sectional survey design. Data was extracted from the women’s file of the 2018 Cameroon Demographic and Health Survey (CDHS). A sample of 4,183 women aged 15–49 who had complete information on variables of interest to the study was used. The outcome variable was early ANC (i.e. women whose first ANC occurred between 0–3 months of pregnancy). Eighteen explanatory variables consisting of fifteen individual-level variables and three community-level variables were selected for the study. At 95% confidence interval (95% CI), two-level multilevel models were built. The results for the fixed effects were presented in adjusted odds ratio (aOR) and the random effects were expressed in terms of Intra-Class Correlation (ICC) and Primary Sampling Units (PSUs) variance. Results Descriptively, 46% [CI = 45.0–48.0] of the women aged 15–49 attended ANC earlier. The median age at which women started utilising early ANC was 28 (15 to 48) years. For the fixed effects results, it was found that the odds of seeking early ANC increased among those aged 35–39 [aOR = 1.78, CI = 1.24–2.57], the richest [aOR = 2.43, CI = 1.63–3.64] and those with secondary/higher education [aOR = 1.38, CI = 1.05–1.82]. Muslims [aOR = 0.73, CI = 0.60–0.88] and women at parity four or more had lesser odds to seek early ANC [aOR = 0.63, CI = 0.49–0.82]. The study found that primary sampling unit (community/cluster) [σ2 = 0.53, CI = 0.40–0.72] and individual [σ2 = 0.16, CI = 0.09–0.29] level variations exist in early initiation of ANC. About 14% (intra-class correlation (ICC) = 0.14) and 5% (ICC = 0.05) variability in early initiation of ANC were attributable to variations in the primary sampling unit (community/cluster) and individual-level factors, respectively. Conclusion Individual-level factors (maternal age, wealth status, educational attainment and religious affiliation) were associated with early initiation of ANC whereas variations in cluster/community characteristics contributed to the variations in early initiation of ANC seeking. The Departments of Health Promotion, Health Information Center and eHealth under the Ministry of Public Health, Cameroon, have to strengthen mass sensitisation programs on early ANC uptake and such programs should consider individual differences such as age, wealth status, education, and religious affiliation in its program design.
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Jogia, Priyanka D., and Kaushik K. Lodhiya. "A cross sectional study for utilisation of antenatal care services and its association to birth weight of babies in a tertiary care centre in Western India." International Journal Of Community Medicine And Public Health 5, no. 8 (July 23, 2018): 3519. http://dx.doi.org/10.18203/2394-6040.ijcmph20183091.
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Background: Low birth weight is a major public health problem in India. Amongst several factors affecting birth weight, the two crucial factors are demographic characteristics of mothers and utilisation of antenatal care services. Identification of these bottlenecks will help in forming suitable strategies to mitigate the problem of low birth weight in developing countries.Methods: This was a cross-sectional study conducted in a medical college hospital of Gujarat. All the mothers admitted in maternity ward for delivery during July 2017 and had given informed consent, were involved in the study. Interview consisted of demographic characteristic of mothers, utilisation of antenatal services and records of pregnancy outcome. Data were entered in excel 2010 and analysed using Epi info 7.2. Strength of association between LBW and risk factors was obtained using odds ratio test.Results: Majority of the mothers had registered for antenatal care within the first trimester (78%) and had taken minimum of four ANC visits (93%). One fifth (18%) of the mothers had babies weighing less than 2.5 kgs. Lower education status of mothers, multigravida, and mothers with less than four ANC visits, preterm births and female foetus were significantly at higher risk of low birth weight as compared to their counterparts.Conclusions: The factors determining LBW were lower education status of mothers, multigravidity, inadequate ANC visits, preterm births and female sex of foetus. We recommend that increasing the education status of masses, particularly of females and ensuring adequate ANC utilisation will reduce the problem of LBW.
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Thomas, Susan, Sharmada Sivaram, Zubin Shroff, Ajay Mahal, and Sapna Desai. "‘We are the bridge’: an implementation research study of SEWA Shakti Kendras to improve community engagement in publicly funded health insurance in Gujarat, India." BMJ Global Health 7, Suppl 6 (September 2022): e008888. http://dx.doi.org/10.1136/bmjgh-2022-008888.
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IntroductionIndia’s efforts towards universal health coverage include a national health insurance scheme that aims to protect the most vulnerable from catastrophic health expenditure. However, emerging evidence on publicly funded health insurance, as well as experience from community-based schemes, indicates that women face specific barriers to access and utilisation. Community engagement interventions have been shown to improve equitable utilisation of public health services, but there is limited research specific to health insurance. We examined how existing community-based resource centres implemented by a women’s organisation could improve women’s access to, and utilisation of, health insurance.MethodsWe conducted an implementation research study in Gujarat, India to examine how SEWA Shakti Kendras, established by the Self-Employed Women’s Association, worked to improve community engagement in health insurance. SEWA organises women in the informal sector and provides social protection through health, insurance and childcare services. We examined administrative data, programme reports and conducted 30 in-depth qualitative interviews with users and staff. Data were analysed thematically to examine intervention content, context, and implementation processes and to identify enablers and barriers to improving women’s access to health insurance through SEWA’s community engagement approach.ResultsThe centres worked through multiple channels—doorstep services, centre-based support and health system navigation—to strengthen women’s capability to access health insurance. Each centre’s approach varied by contextual factors, such as women’s digital literacy levels and rural–urban settings. Effective community engagement required local leadership, strong government partnerships and the flexibility to address a range of public services, with implementation by trusted local health workers.ConclusionSEWA Shakti Kendras demonstrate how a local, flexible and community-based model can serve as a bridge to improve utilisation of health insurance, by engaging women and their households through multiple channels. Scaling up this approach will require investing in partnerships with community-based organisations as part of strategies towards universal health coverage.
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Khampuengson, Thakolpat, and Wenjia Wang. "Deep Reinforcement Learning Ensemble for Detecting Anomaly in Telemetry Water Level Data." Water 14, no. 16 (August 13, 2022): 2492. http://dx.doi.org/10.3390/w14162492.
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Water levels in rivers are measured by various devices installed mostly in remote locations along the rivers, and the collected data are then transmitted via telemetry systems to a data centre for further analysis and utilisation, including producing early warnings for risk situations. So, the data quality is essential. However, the devices in the telemetry station may malfunction and cause errors in the data, which can result in false alarms or missed true alarms. Finding these errors requires experienced humans with specialised knowledge, which is very time-consuming and also inconsistent. Thus, there is a need to develop an automated approach. In this paper, we firstly investigated the applicability of Deep Reinforcement Learning (DRL). The testing results show that whilst they are more accurate than some other machine learning models, particularly in identifying unknown anomalies, they lacked consistency. Therefore, we proposed an ensemble approach that combines DRL models to improve consistency and also accuracy. Compared with other models, including Multilayer Perceptrons (MLP) and Long Short-Term Memory (LSTM), our ensemble models are not only more accurate in most cases, but more importantly, more reliable.
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KHANNA, P. N., and R. R. KELKAR. "Temperature sounding of the atmosphere over the Indian region using satellite data." MAUSAM 44, no. 2 (January 1, 2022): 167–74. http://dx.doi.org/10.54302/mausam.v44i2.3815.
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Capability has been developed at the INSAT Meteorological Data Utilisation Centre (MDUC). New Delhi for making sounding retrievals using data from the U.S. Polar Orbiting Satellites; The International TOYS Processing Package (ITPP) developed by the University of Wisconsin, USA, was used for asking temperature soundings software for front-end processing and input of 1000 hPa analysis data Into the retrieval algorithm was developed at MDUC. In the physical retrieval method regression estimates generated listing stratospheric level HIRS channels and MSU channels were used as Initial guess. For the surface, two options were used, (i) climatological guess, and (ii) 1000 hPa analysis.
The paper discusses temperature retrievals over the Indian region made on 13 selected dates from different seasons in 1989-91. Results of comparison of satellite retrievals with colocated radiosonde data are presented. There is good agreement between the two from 700 hPa to 150 hPa levels, with RMSE with 3 C. The error is higher at 850 hPa and near the surface, when climatologic IS used as surface guess, but IS within 3°-4° C when the 1000 hPa analysis is used.
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Oliver, Scott W., Jacqueline Campbell, David B. Kingsmore, Ram Kasthuri, Wendy Metcalfe, Jamie P. Traynor, Denis Fischbacher-Smith, Alan G. Jardine, and Peter C. Thomson. "A national appraisal of haemodialysis vascular access provision in Scotland." Journal of Vascular Access 18, no. 2 (January 31, 2017): 126–31. http://dx.doi.org/10.5301/jva.5000651.
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Purpose Published registry data demonstrate longstanding variation in the utilisation of different vascular access (VA) modalities between Scottish renal units; this may reflect different clinical processes between centres. A comprehensive appraisal was undertaken to understand the processes underpinning VA creation and maintenance across Scotland. Methods A mixed methods approach was utilised. Fifty-two semi-structured interviews were conducted with patients and clinicians in all ten, adult and paediatric, Scottish renal units. Interview transcripts were subjected to thematic analysis. Clinical activity data were prospectively collected for six weeks, and correlated with registry data. Results VA accounts for a large clinical workload. There was significant inter-centre variation in the utilisation of different VA modalities, and patients described frustrating, dissatisfying experiences. VA creation and maintenance pathways functioned best when nephrologists, surgeons and radiologists were co-located on the same campus with close multi-disciplinary working, protected clinical time, and proactive VA maintenance. No unit routinely measured or discussed procedure outcomes or strategic aspects of their service. Conclusions Varied clinical outcomes reflected varied clinical processes. Optimised clinical pathways, staff education and measurement of clinical outcomes may improve VA service quality and facilitate safer, more effective, patient-centred care.
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Kuaban, Godlove Suila, Tülin Atmaca, Amira Kamli, Tadeusz Czachórski, and Piotr Czekalski. "Performance Analysis of Packet Aggregation Mechanisms and Their Applications in Access (e.g., IoT, 4G/5G), Core, and Data Centre Networks." Sensors 21, no. 11 (June 4, 2021): 3898. http://dx.doi.org/10.3390/s21113898.
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The transmission of massive amounts of small packets generated by access networks through high-speed Internet core networks to other access networks or cloud computing data centres has introduced several challenges such as poor throughput, underutilisation of network resources, and higher energy consumption. Therefore, it is essential to develop strategies to deal with these challenges. One of them is to aggregate smaller packets into a larger payload packet, and these groups of aggregated packets will share the same header, hence increasing throughput, improved resource utilisation, and reduction in energy consumption. This paper presents a review of packet aggregation applications in access networks (e.g., IoT and 4G/5G mobile networks), optical core networks, and cloud computing data centre networks. Then we propose new analytical models based on diffusion approximation for the evaluation of the performance of packet aggregation mechanisms. We demonstrate the use of measured traffic from real networks to evaluate the performance of packet aggregation mechanisms analytically. The use of diffusion approximation allows us to consider time-dependent queueing models with general interarrival and service time distributions. Therefore these models are more general than others presented till now.
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Mortimer, Craig, and Ann Ooms. "Students' experience and perceived value of a clinical simulation centre." Journal of Paramedic Practice 14, no. 6 (June 2, 2022): 250–58. http://dx.doi.org/10.12968/jpar.2022.14.6.250.
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Background: The emergence of new technology and innovation has seen dedicated simulation centres being designed and built to assist with the development of a range of professionals within the ever-changing healthcare setting. Focusing on the university environment, this study examined the extent to which paramedic students perceive these simulation centres as efficient and effective learning spaces. Methods: Using evaluation research, data were collected from 33 students studying paramedic science at a London university. An online questionnaire was used to measure student engagement, perceived value, impact and sustainability of a simulation centre. Findings: Participants primarily perceived the simulation centre as having high value and a good impact on their learning and development, although some concerns were raised regarding its utilisation and general usability. Conclusion: While large-scale simulation centres seem beneficial to learning, they need to be fully integrated into the curriculum to maximise their impact on preparing students for their forthcoming role.