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Journal articles on the topic "Outcome assessment (Medical care) Victoria"
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Klein, Harald. "Reforming Primary Care in Victoria: Will Primary Care Partnerships Do the Job?" Australian Journal of Primary Health 8, no. 1 (2002): 23. http://dx.doi.org/10.1071/py02004.
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Spiralling medical costs and escalating demand for health services are putting primary care reform firmly on the agenda for governments around the world. A more coordinated and prevention-oriented approach must be adopted now to avoid a looming crisis in health care. In Victoria, the Primary Care Partnership (PCP) Strategy aims to improve health outcomes and better manage the demand for services by functionally integrating health and community support services. This paper provides an overview of the key factors that have shaped primary care reform in the State of Victoria; the logic of the PCP Strategy; a summary of the results of the strategy after 18 months; and a critical assessment of the key challenges for the strategy in the future. The paper concludes that the strategy has already led to much stronger collaboration between agencies, more integrated service planning and emerging models for service coordination. For these achievements to translate to improved health outcomes, the systems changes being initiated by PCPs need to be translated into the way services are provided in the community. This cannot be achieved by collaboration between service providers alone. It is now time for all relevant parts of government to support PCP objectives and initiatives in the way they plan and fund services.
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Curtis, Kate, Margaret Fry, Sarah Kourouche, Belinda Kennedy, Julie Considine, Hatem Alkhouri, Mary Lam, et al. "Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial." BMJ Open 13, no. 1 (January 2023): e067022. http://dx.doi.org/10.1136/bmjopen-2022-067022.
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IntroductionPoor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID.Methods and analysisUsing an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites.Ethics and disseminationEthics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman’s Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, ‘business as usual’ ED training schedules and university curricula.Trial registration numberACTRN12621001456842.
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Bladin, Chris F., Kathleen L. Bagot, Michelle Vu, Joosup Kim, Stephen Bernard, Karen Smith, Grant Hocking, et al. "Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care." BMJ Open 12, no. 7 (July 2022): e052332. http://dx.doi.org/10.1136/bmjopen-2021-052332.
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ObjectivesTo determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI).DesignReal-world feasibility study, quasi-experimental design.SettingPrehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia.ParticipantsParamedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247).InterventionThe Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017–April 2018), with timelines compared between ‘Pulsara initiated’ (Pulsara) and ‘not initiated’ (no Pulsara).Primary outcome measureDoor-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes.ResultsStroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%–26%, p=0.15) and 90 min for STEMI (50%–78%, p=0.20).ConclusionsIn this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.
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Shafique, Muhammad Asim, Muhammad Amir Nadeem, and Muhammad Afzal. "Relationship of Timings and Outcome of Tracheostomy Among Patients Requiring Prolonged Mechanical Ventilation." Journal of Bahria University Medical and Dental College 10, no. 1 (December 5, 2019): 12–16. http://dx.doi.org/10.51985/jbumdc2019068.
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Objective: To assess the indications of tracheostomy among patients requiring prolonged mechanical ventilation and to observe the relationship of the timings and outcome of tracheostomy with age and gender. Study Design and Setting: It was a descriptive study conducted at intensive care unit (ICU) of Department of Otorhinolaryngology at Bahawal Victoria Hospital from January 2017 to December 2018. Methodology: Secondary data was collected with the help of charts of ICU patients in which elective tracheostomy was done to replace orotracheal intubation for mechanical ventilation. Inclusion and exclusion criteria were designed. Clinical record was reviewed for the assessment of indications of the procedure (medical or surgical) along with age and gender distribution. The timing of tracheostomy in these patients with its outcome in terms of decannulation and weaning were recorded. Proforma was used to enter the findings. Finally results were obtained and assessed on SPSS Version 23. Results: Out of total 551 tracheostomies 42(7.6%) were indicated for the patients of ICU requiring prolonged mechanical ventilation. From the 42 mechanical ventilated patients majority had Guillain-Barre syndrome (GBS) 20(47.6%). Twenty six patients were adults (61.9%) and sixteen were children (38%).Twenty four were male patients (57.1%) and eighteen were females (42.8%). The timing of tracheostomy among majority of the patients (40) was from 7-10 days, with mean of 9th day with good outcome. Only two patients who underwent tracheostomy after two weeks had to face poor outcome (failed decannulation, late weaning) (4.7%). Conclusion: Neuroparalytic lesions were the common indication among the patients requiring prolonged mechanical ventilation with tracheostomy. Tracheostomy if performed earlier in such patients carries good outcome
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Considine, Julie, Anastasia F. Hutchison, Helen Rawson, Alison M. Hutchinson, Tracey Bucknall, Trisha Dunning, Mari Botti, Maxine M. Duke, and Maryann Street. "Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services." Australian Health Review 42, no. 4 (2018): 412. http://dx.doi.org/10.1071/ah16265.
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Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.
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Oshovskyy, Victor. "The Results of a Prospective Cohort Study of the Effectiveness of the Algorithm for Monitoring Pregnancies in Patients from the Group of High Perinatal Risk to Reduce Perinatal Losses and Improve Neonatal Outcome." Family Medicine, no. 2-3 (July 30, 2021): 86–91. http://dx.doi.org/10.30841/2307-5112.2-3.2021.240773.
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Prenatal prognosis is an important part of obstetric care, which aims to reduce fetal and neonatal losses. A differentiated approach to the management of different risk groups allows you to optimize existing approaches. The objective: сomparison of pregnancy results in the high perinatal risk group using the proposed monitoring algorithms and the traditional method of management in a prospective cohort study. Materials and methods. The prospective cohort study was conducted from 2016 to 2018 on the basis of the medical center LLC «Uniclinica», Medical Genetics Center «Genome», Clinic of Reproductive Genetics «Victoria», Kyiv City Maternity Hospital №2. 580 women were included in the final analysis. Exclusion criteria were: low risk (0–2) according to the adapted antenatal risk scale (Alberta perinatal health program), multiple pregnancy, critical malformations and chromosomal abnormalities of the fetus, lack of complete information about the outcome of pregnancy, lack of results of all intermediate clinical and laboratory surveys. Results. The introduction of a comprehensive differentiated approach has improved the diagnosis of late forms of growth retardation (OR 4,14 [1.42–12.09]; p=0,009), reduced the frequency of urgent cesarean sections (OR 1,61 [1,03–2,49]; p=0,046) and reduced perinatal mortality [1,09–21,3]; р=0,041) due to reduction of antenatal losses (OR 2,2 [1,06–4,378]; р=0,045). There was a significant increase in the frequency of planned cesarean sections (p<0,0001, without affecting the total number of operative deliveries) and statistically insignificant, but tendentiously clear shifts to the increase in the frequency of preterm birth between 34–37 weeks of pregnancy and intensive care unit. The latter observation can be explained by better diagnosis of threatening fetal conditions and an increase in the frequency of active obstetric tactics, which in turn affects the number of premature infants, the involvement of the neonatal service, and thus the intensification of the load on intensive. Conclusions. Adequate enhanced monitoring should combine ultrasound, cardiotocography, actography and laboratory techniques, each of which will have a clearly defined purpose in a combined approach to fetal assessment.
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Langhorne, Peter, Olivia Wu, Helen Rodgers, Ann Ashburn, and Julie Bernhardt. "A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial." Health Technology Assessment 21, no. 54 (September 2017): 1–120. http://dx.doi.org/10.3310/hta21540.
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BackgroundMobilising patients early after stroke [early mobilisation (EM)] is thought to contribute to the beneficial effects of stroke unit care but it is poorly defined and lacks direct evidence of benefit.ObjectivesWe assessed the effectiveness of frequent higher dose very early mobilisation (VEM) after stroke.DesignWe conducted a parallel-group, single-blind, prospective randomised controlled trial with blinded end-point assessment using a web-based computer-generated stratified randomisation.SettingThe trial took place in 56 acute stroke units in five countries.ParticipantsWe included adult patients with a first or recurrent stroke who met physiological inclusion criteria.InterventionsPatients received either usual stroke unit care (UC) or UC plus VEM commencing within 24 hours of stroke.Main outcome measuresThe primary outcome was good recovery [modified Rankin scale (mRS) score of 0–2] 3 months after stroke. Secondary outcomes at 3 months were the mRS, time to achieve walking 50 m, serious adverse events, quality of life (QoL) and costs at 12 months. Tertiary outcomes included a dose–response analysis.Data sourcesPatients, outcome assessors and investigators involved in the trial were blinded to treatment allocation.ResultsWe recruited 2104 (UK,n = 610; Australasia,n = 1494) patients: 1054 allocated to VEM and 1050 to UC. Intervention protocol targets were achieved. Compared with UC, VEM patients mobilised 4.8 hours [95% confidence interval (CI) 4.1 to 5.7 hours;p < 0.0001] earlier, with an additional three (95% CI 3.0 to 3.5;p < 0.0001) mobilisation sessions per day. Fewer patients in the VEM group (n = 480, 46%) had a favourable outcome than in the UC group (n = 525, 50%) (adjusted odds ratio 0.73, 95% CI 0.59 to 0.90;p = 0.004). Results were consistent between Australasian and UK settings. There were no statistically significant differences in secondary outcomes at 3 months and QoL at 12 months. Dose–response analysis found a consistent pattern of an improved odds of efficacy and safety outcomes in association with increased daily frequency of out-of-bed sessions but a reduced odds with an increased amount of mobilisation (minutes per day).LimitationsUC clinicians started mobilisation earlier each year altering the context of the trial. Other potential confounding factors included staff patient interaction.ConclusionsPatients in the VEM group were mobilised earlier and with a higher dose of therapy than those in the UC group, which was already early. This VEM protocol was associated with reduced odds of favourable outcome at 3 months cautioning against very early high-dose mobilisation. At 12 months, health-related QoL was similar regardless of group. Shorter, more frequent mobilisation early after stroke may be associated with a more favourable outcome.Future workThese results informed a new trial proposal [A Very Early Rehabilitation Trial – DOSE (AVERT–DOSE)] aiming to determine the optimal frequency and dose of EM.Trial registrationThe trial is registered with the Australian New Zealand Clinical Trials Registry number ACTRN12606000185561, Current Controlled Trials ISRCTN98129255 and ISRCTN98129255.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 54. See the NIHR Journals Library website for further project information. Funding was also received from the National Health and Medical Research Council Australia, Singapore Health, Chest Heart and Stroke Scotland, Northern Ireland Chest Heart and Stroke, and the Stroke Association. In addition, National Health and Medical Research Council fellowship funding was provided to Julie Bernhardt (1058635), who also received fellowship funding from the Australia Research Council (0991086) and the National Heart Foundation (G04M1571). The Florey Institute of Neuroscience and Mental Health, which hosted the trial, acknowledges the support received from the Victorian Government via the Operational Infrastructure Support Scheme.
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Rosenberg, Ted, Patrick Montgomery, Vikki Hay, and Rory Lattimer. "Using frailty and quality of life measures in clinical care of the elderly in Canada to predict death, nursing home transfer and hospitalisation - the frailty and ageing cohort study." BMJ Open 9, no. 11 (November 2019): e032712. http://dx.doi.org/10.1136/bmjopen-2019-032712.
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ObjectiveTo assess the value of using frailty measures in primary care for predicting death, nursing home transfer (NHT) and hospital admission.DesignCohort study.Setting and participantsAll 380 people, mean age 88.4, living in the community and receiving home-based primary geriatric care from one practice in Victoria, Canada.Interventions/measurementsA 60 min baseline assessment which included: Clinical Frailty Scale (CFS), EuroQol EQ-5D-5L (EQ-5D), EuroQol Visual Analogue Scale (EQ-VAS) and Gait Speed (Gaitspeed).OutcomesDeath, NHT and hospital admission.ResultsDuring 18 months of follow-up, there were 39 (10.3%) deaths, 48 (12.6%) NHTs and 93 (24.5%) individuals admitted to hospital. All three outcomes were predicted by: CFS Level 6+7/4+5 (HR death 5.92, 95% CI 3.12 to 11.22, NHT 6.00, 95% CI 3.37 to 10.66 and hospital admission 2.92, 95% CI 1.93 to 4.40); EQ-5D Quintile 1/Quintile 5 (death 6.26, 95% CI 2.11 to 18.62; NHT 3.18, 95% CI 1.29 to 7.82 and hospital admission 2.94, 95% CI 1.47 to 5.87); EQ-VAS Q1/Q5 (death 7.0, 95% CI 2.34 to 20.93; NHT 3.38, 95% CI 1.22 to 9.35 and hospital admission 6.69, 95% CI 3.20 to 13.99) and Gaitspeed (death 5.87, 95% CI 1.78 to 19.34; NHT 8.51, 95% CI 3.18 to 22.79 and hospital admission 11.05, 95% CI 5.45 to 22.40). Medical diagnoses, multiple comorbidities and polypharmacy were weaker predictors of these outcomes. Cox regression analyses showed CFS (adjusted HR 2.88, 95% CI 1.23 to 6.68), EQ-VAS (0.96, 95% CI 0.93 to 0.98), estimated glomerular filtration rate (0.97, 95% CI 0.95 to 1.00) and haemoglobin (0.97, 95% CI 0.94 to 0.99) were independently associated with death. Gaitspeed (0.13, 95% CI 0.03 to 0.57), Geriatric Depression Scale (1.39, 95% CI 1.07 to 1.82) and dementia diagnosis (4.61, 95% CI 1.86 to 11.44) were associated with NHT. Only CFS (1.75, 95% CI 1.21 to 2.51) and EQ-VAS (0.98, 95% CI 0.96 to 0.99) were associated with hospital admission. No other diagnoses, polypharmacy nor multiple comorbidities predicted these outcomes.ConclusionsFor elderly people, standardised simple measures of frailty and health status were stronger predictors of death, NHT and hospital admission than medical diagnoses. Consideration should be given to adding these measures into usual medical care for this age group.
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Considine, Julie, Maryann Street, Mari Botti, Bev O'Connell, Bridie Kent, and Trisha Dunning. "Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care." Australian Health Review 39, no. 4 (2015): 387. http://dx.doi.org/10.1071/ah14106.
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Objective The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care. Methods Subacute care in-patients requiring unplanned transfer to an acute care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of subacute care admission. Results In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median subacute care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of subacute care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P < 0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P < 0.01) and the number of physiological abnormalities in the 24 h preceding transfer (OR 1.3, P < 0.01). Conclusions There is a high rate of unplanned transfers to acute care within 24 h of admission to subacute care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates. What is known about the topic? Subacute care is becoming a high acuity environment where many patients are at significant risk of clinical deterioration. Systems for recognising and responding to deteriorating patients are well developed in acute care, but still developing in subacute care. What does this paper add? This is the first Australian multisite study of clinical deterioration in patients situated in subacute care facilities. One-third of unplanned transfers occur within 24 h of admission to subacute care. Patients who require unplanned transfer from subacute to acute care have unexpectedly high hospital admission rates and high in-hospital mortality rates. The frequency and completeness of physiological monitoring preceding transfer was low. What are the implications for practitioners? Patients in subacute care require regular physiological assessment and early escalation of care if there are physiological abnormalities. Risk of clinical deterioration should be a factor in the decision to admit patients to subacute care after an acute illness or injury. There is a need to improve systems for recognising and responding to deteriorating patients in subacute care settings.
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Ryland, Georgina L., Lucy C. Fox, Ella Thompson, Graham John Lieschke, David Hughes, Francoise Marie Mechinaud, Anthea Louise Greenway, et al. "Providing Diagnoses in Bone Marrow Failure Syndromes through Multimodal Comprehensive Genomic Evaluation and Multidisciplinary Care: The Melbourne Genomics Health Alliance Bone Marrow Failure Flagship." Blood 132, Supplement 1 (November 29, 2018): 3867. http://dx.doi.org/10.1182/blood-2018-99-114410.
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Abstract Background and Aims The detection of sequence variants and copy number changes can improve diagnosis, inform prognosis and guide treatment in patients with bone marrow failure syndromes (BMFS). We aimed to establish and prospectively assess the impact of comprehensive genomic evaluation on diagnostic categorisation and clinical outcomes in patients with genomically uncharacterised BMFS. Methods Eligible patients were recruited from four participating institutions across Victoria, Australia. Inclusion criteria were (i) age >3 months (ii) clinicopathological diagnosis or suspicion of either acquired aplastic anaemia (AA), inherited BMFS, hypoplastic myelodysplastic syndrome (hMDS) or a BMFS with marrow hypoplasia/aplasia not able to be definitively categorised. Patients initially underwent 90-gene targeted sequencing (Peter MacCallum Cancer Centre PanHaem and Myeloid Amplicon next generation sequencing [NGS] panels) for rapid turnaround of accredited results for clinical decision-making. In addition, whole exome sequencing (WES), whole genome copy number analysis, NGS T-cell receptor β (TRB) repertoire assessment and longitudinal monitoring of selected mutations by digital droplet PCR (ddPCR) were performed. All patients received pre-test counselling and assessment. Genomic results were reviewed in centralised multidisciplinary case conferences including the treating clinician, molecular haematopathologists, medical scientists, clinical geneticists and genetic counsellors. Results 100 patients were enrolled. Median age was 25 years (range 3 months - 80 years); 39% were under 18 years. Detection of sequence variants or copy number abnormalities led to or confirmed a diagnosis of either an inherited or acquired BMFS in 36 patients. In 17 patients a diagnosis of an inherited BMFS was positively made by detection of pathogenic sequence variants or copy number changes in FANCA(1 patient [pt]), FANCM(1 pt), FANCI(1 pt), RAD51C(1 pt), HAX1(1 pt), SBDS(1 pt), DNAJC21(1 pt), RPS19(5 pts), RPL35A(1 pt), TERT(1 pt), TINF2(1 pt) and SAMD9L(1 pt). In five patients the clinical BMFS was considered undifferentiated without a clear candidate gene suspected on phenotypic features prior to genomic evaluation. Importantly, an established diagnosis of AA was altered to an inherited BMFS by genomic characterisation in two patients (SAMD9L, FANCA). In 19 patients pathogenic sequence variants or copy number changes were detected either leading to or confirming a diagnosis of an acquired BMFS (paroxysmal nocturnal haemoglobinuria, hMDS or AA). Pathogenic sequence variants were detected in TET2(n=5), RUNX1(n=4), ASXL1(n=3), PIGA(n=3), DNMT3A(n=3),CBL(n=2), and BCOR/IDH2/SF3B1/SRSF2/TP53/U2AF1(n=1 each). Sequencing-detected copy number abnormalities included loss of chromosome 7 (n=6), losses on chromosome 5q (n=2) and copy number loss of ETV6(n=2). Longitudinal monitoring of an acquired truncating RUNX1 mutation by ddPCR resulted in one patient undergoing allogeneic bone marrow transplant for a progressively rising allelic burden. There was a trend towards more restricted TRB diversity in patients with genomically-defined acquired BMFS versus inherited BMFS (normalised Shannon index ≤0.85, 36.4% vs 0%, p=0.09). Conclusion We have established and evaluated a model of comprehensive multimodal genomic characterisation and multidisciplinary care for 100 patients with BMFS. Our results demonstrate a significant contribution to diagnostic categorisation and patient care in this area of clinical need. Disclosures Lieschke: CSL Behring Australia: Consultancy. Tam:Janssen: Honoraria, Research Funding; Gilead: Honoraria; AbbVie: Honoraria, Research Funding; Pharmacyclics: Honoraria, Travel funding; Pharmacyclics: Honoraria; Beigene: Honoraria, Other: Travel funding; Roche: Honoraria; Beigene: Honoraria, Other: Travel funding; Gilead: Honoraria; Roche: Honoraria; AbbVie: Honoraria, Research Funding.
Dissertations / Theses on the topic "Outcome assessment (Medical care) Victoria"
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Fratila, Liana M. "Renal transplant outcome assessment /." free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p1421135.
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Che, Hamzah Jemaima. "Assessment of glaucoma : using patient-reported outcome measures in randomised controlled trials." Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=186205.
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Background: Glaucoma is a chronic, progressive eye disease and the second cause of blindness in the world. To measure the patients’ perspective in randomised controlled trials (RCTs), patient-reported outcome measures (PROMs) are increasingly being used. However, the use of PROMs in glaucoma trials is low suggesting there may be a reluctance to use PROMs. Objectives: To explore three methodological challenges of using PROMs in RCTs in glaucoma: 1) PROM selection; 2) characterising glaucoma severity; and 3) interpreting PROM scores in terms of minimal important difference (MID). Methods: Vision PROMs used in glaucoma studies were identified and content validated using a systematic review approach and categorised by a new PROM taxonomy. Existing visual field staging systems (VFSSs) based on standard automated perimetry were systematically identified and quality assessed with a new tool developed for this review using a consensus method. The performance of four high quality visual field staging systems were evaluated and referenced against an experienced ophthalmologist in a diagnostic test accuracy study. A pilot study using the social comparison approach was undertaken to test the feasibility of an anchor-based approach in determining the MID of a vision PROM in a glaucoma population. Results: Thirty-three vision PROMs were identified and categorised, according to content into impairment, disability, status and satisfaction measures. Twenty-three VFSSs were identified but evaluation of quality assessment, particularly performance, was affected by poor VFSS reporting. The diagnostic accuracy study demonstrated suboptimal performance of the four highest quality staging systems. The pilot study to determine the MID for a vision PROM found the social comparison method to be a feasible approach in a glaucoma population. Conclusion: This thesis demonstrated how to select a PROM and identified difficulties with characterising glaucoma severity. Future research needs include development of robust methods for characterising glaucoma severity and full scale evaluation of MIDs in PROMs in glaucoma.
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Hidalgo, Stevan. "Healthcare expenditure vs healthcare outcomes a comparison of 25 world health organization member countries /." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/SHidalgo2008.pdf.
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Liu, Pei, and 刘沛. "Endodontic treatment outcomes: patient based assessments." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B46288971.
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Muñoz, Jorge A. "What is the quality of care in a developing country? measuring physician practice and health outcomes /." Santa Monica, CA : RAND, 2002. http://books.google.com/books?id=7fDaAAAAMAAJ.
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Yung, Wing-yan Ada, and 楊穎欣. "Clinical outcome and prognosis of childhood epilepsy (1996-2006)." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45153322.
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Farquhar, Sara Jane. "Outcomes following unilateral total knee arthroplasty a longitudinal investigation /." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 228 p, 2008. http://proquest.umi.com/pqdweb?did=1605135911&sid=4&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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Tang, Yuen-ming Lewis. "Clinical outcomes for patients with traumatic brain injury in Kowloon Hospital." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B23295818.
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Schwenn, Heidi H. "The relationship between client-established goals and outcome in counseling /." free to MU campus, to others for purchase, 2002. http://wwwlib.umi.com/cr/mo/fullcit?p3052216.
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Lam, Lo-kuen Cindy. "Cross-cultural validation and norming of the MOS 36-item short-form health survey (SF-36) on Chinese adults in Hong Kong." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B3198180X.
Full textBooks on the topic "Outcome assessment (Medical care) Victoria"
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Rehabilitation outcome measures. Edinburgh: Churchill Livingstone, 2010.
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Stokes, Emma K. Rehabilitation outcome measures. Edinburgh: Churchill Livingstone, 2011.
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M, Kleinpell Ruth, ed. Outcome assessment in advanced practice nursing. New York: Springer, 2001.
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I, Iezzoni Lisa, ed. Risk adjustment for measuring health care outcomes. 3rd ed. Chicago, Ill: Health Administration Press, 2003.
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J, Lambert Michael, and Fields Scott A. 1972-, eds. Essentials of outcome assessment. New York: Wiley, 2002.
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1964-, IsHak Waguih William, Burt Tal 1960-, and Sederer Lloyd I, eds. Outcome measurement in psychiatry: A critical review. Washington, DC: American Psychiatric Pub., 2002.
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T, Rinke Lynn, Wilson Alexis A, and National League for Nursing, eds. Outcome measures in home care. New York: National League for Nursing, 1987.
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1945-, Pynsent P. B., Fairbank, J. C. T., 1948-, and Carr A, eds. Outcome measures in orthopaedics. Oxford: Butterworth-Heinemann, 1993.
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I, Pfeiffer Steven, ed. Outcome assessment in residential treatment. New York: Haworth Press, 1996.
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Outcomes in speech-language pathology. 2nd ed. New York: Thieme, 2013.
Find full textBook chapters on the topic "Outcome assessment (Medical care) Victoria"
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Marra, Annachiara, and Pratik P. Pandharipande. "Functional MRI in the Intensive Care Unit." In Functional MRI, edited by S. Kathleen Bandt and Dennis D. Spencer, 208–29. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190297763.003.0011.
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Magnetic resonance imaging (MRI) technology has revolutionized medical and scientific imaging, has had an important effect on research, and has become a great source of valuable information on the functioning of the major organs of the human body. The role of fMRI (functional MRI) in the intensive care unit is growing, and different fMRI techniques have been used to assess the brain, the lung, and the abdomen of patients. fMRI has been used to assess the brain of an acutely comatose or delirious patient and to detect subtle pathological changes in traumatic brain injury from the acute phase to the chronic phase. Pulmonary MRI is used for the assessment of regional functional changes (perfusion, ventilation, and oxygen diffusion) in patients with airway diseases and, due to better spatial and temporal resolution, for regional functional assessment and for evaluation of the possibility of morphologic changes in a single examination. Cardiac MRI has shown high reproducibility and accuracy, allowing detailed functional assessment and characterization of myocardial tissue and providing information on surrogate outcome measures and complications. Functional imaging techniques also have been applied to the study of the liver and the kidney.
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Bellini, Maria Irene, and Andre Kubler. "Health Literacy and Patient -Reported Outcomes." In Research Anthology on Improving Health Literacy Through Patient Communication and Mass Media, 203–17. IGI Global, 2022. http://dx.doi.org/10.4018/978-1-6684-2414-8.ch012.
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Modern healthcare needs to identify parameters for high-quality care. Quality improvement is the key for advancing in healthcare, and the new assessment tool shifts from a disease-centered outcome to a patient-centered outcome. Clinical outcome such as morbidity and mortality are directly connected and interdependent from patient-reported outcomes: well-informed patients who decide with their healthcare provider what treatment is best for them have better outcomes and higher patient satisfaction rates. These subjective data collected by rigorous, meaningful, and scientific methods and presented in a utilizable format can be used to create care objectives towards which both the surgeon and their patient can travel. Time has come to carry patient-centered outcomes from research into decision making and daily care plans. This chapter outlines a focus beyond life-prolonging therapy, aiming to minimize the negative effects of treatment, optimize quality of life, and align medical decisions with patient expectations.
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Bellini, Maria Irene, and Andre Kubler. "Health Literacy and Patient -Reported Outcomes." In Optimizing Health Literacy for Improved Clinical Practices, 109–23. IGI Global, 2018. http://dx.doi.org/10.4018/978-1-5225-4074-8.ch007.
Full textAbstract:
Modern healthcare needs to identify parameters for high-quality care. Quality improvement is the key for advancing in healthcare, and the new assessment tool shifts from a disease-centered outcome to a patient-centered outcome. Clinical outcome such as morbidity and mortality are directly connected and interdependent from patient-reported outcomes: well-informed patients who decide with their healthcare provider what treatment is best for them have better outcomes and higher patient satisfaction rates. These subjective data collected by rigorous, meaningful, and scientific methods and presented in a utilizable format can be used to create care objectives towards which both the surgeon and their patient can travel. Time has come to carry patient-centered outcomes from research into decision making and daily care plans. This chapter outlines a focus beyond life-prolonging therapy, aiming to minimize the negative effects of treatment, optimize quality of life, and align medical decisions with patient expectations.
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Saeed, Rabeeya, Salman Sharif, and Faridah Amin. "Unveiling the Uncertainty-Revolutionizing Medical Education in COVID-19 Era." In Psychosocial, Educational, and Economic Impacts of COVID-19 [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.103918.
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The beginning of the year 2020 marked the biggest pandemic of the twenty-first century. COVID-19 not only jeopardized the global health care system but also lead to unprecedented effects on every aspect of life. The tragedy evoked by the virus, resulted in disruption of face-to-face learning across the globe. The aftermath of this pandemic on medical education will be enormous and long-lasting. Therefore, it is of utmost importance to identify the challenges and threats facing medical education, both at undergraduate and postgraduate level. Comparative analysis of the innovative models adapted globally in post-COVID era will help countries learn from success stories. Amidst the uncertainty posed by the pandemic, there is a special prospect for medical education. Medical educationist and health policy makers may convert this crisis into opportunity through innovative strategies maximizing the outcome of e-learning. This is the time to relook medical curricula, redesign assessment, focus on standardization of e-learning and upgrade faculty development programs to produce doctors equipped and prepared to serve in the new era.
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"Neonatal medicine." In Paediatric Surgery, edited by Mark Davenport and Paolo De Coppi, 103–28. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198798699.003.0004.
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Paediatric surgeons are key members of a multidisciplinary team where neonates are concerned and pre- and postoperative care needs to be optimal to achieve the best outcome. This chapter provides a background for medical care of the surgical neonate and begins with infant statistics, including definitions in the field, current UK birth trends, and live birth and mortality rates. The assessment, diagnosis, and treatment of newborn respiratory distress and neonatal ventilation (including indications for extracorporeal membrane oxygenation (ECMO)) are covered. The range of infant formula milks and nutritional requirements are described. Use and indications for antibiotics are given with a standardized dosage chart designed specifically for neonates is tabulated.
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Kopp, Vincent J. "The pre-anaesthetic visit." In Handbook of Communication in Anaesthesia & Critical Care. Oxford University Press, 2010. http://dx.doi.org/10.1093/oso/9780199577286.003.0013.
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This chapter addresses deficiencies in pre-anaesthesia communication. Here, the use of medical narrative illustrates communication-enhancing techniques and attitudes that may help anaesthetists anticipate and respond to the biopsychosocial content, extant in the pre-anaesthesia assessment setting. By any measure, the pre-anaesthesia evaluation sets anaesthesia care in motion. Until now, little has been written about the development of a learnable framework for effective communication, in this or any other anaesthesia care setting. With respect to pre-anaesthesia communication, the need for heuristics or ‘rules of thumb’ is ever acute to improve rapport, elicit and respond to questions, manage ambiguity, as well as to obtain valid consent. Furthermore, anaesthetists have to communicate effectively with patients about conflicting advice, prior negative anaesthetic experiences and fears about awareness and intraoperative death. A 56-year-old man scheduled for an elective left inguinal herniorrhaphy meets his anaesthetist minutes before surgery is to begin. Three days before, the patient presented to hospital with his hernia incarcerated. It was easily reduced. A follow-up office visit with his surgeon preceded the surgery. The patient’s sole co-morbidity is benign prostatic hypertrophy. On the morning of surgery this otherwise healthy-appearing man, accompanied by his wife, meets the anaesthetist for the first time. After record review the patient is told three anaesthetic options exist—local anaesthesia with intravenous sedation, general anaesthesia and spinal anaesthesia — and that ‘spinal is the way to go’. Unquestioningly, the patient agrees to spinal anaesthesia. The spinal block is easy to place. The surgery is uneventful. Post-operatively, the patient cannot urinate. His discharge from the day-surgery unit is delayed by hours. He is told it is because of ‘the spinal’. Bladder catheterization ensues. The rest of his recuperation is uneventful, except for lingering feelings of betrayal, distrust and disappointment. He wonders why he was not told spinal anaesthesia might cause urinary retention. He becomes angry. He resolves never to use that anaesthetist’s or hospital’s services again. His wife even urges him to sue them both for pain and suffering. What could have been done to effect a more positive outcome for the patient, the anaesthetist and the hospital? The answer lies, at least in part, in improved communication.
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Scott, David L. "Clinical outcomes." In Oxford Textbook of Rheumatoid Arthritis, 507–18. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198831433.003.0042.
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The clinical outcomes measured in rheumatoid arthritis span three broad areas. Firstly, disease measures reflecting the presence and severity of joint inflammation. Secondly, end-organ damage particularly the extent and severity of joint damage. Thirdly, quality of life measures made by patients indicating the impact of their disease on their lives. Some are disease specific such as the Health Assessment Questionnaire (HAQ). Others are generic and applicable across all disease, such as the Short Form 36 (SF-36) and EuroQol. Several new patient-assessed outcome measures have been developed, such as the Patient-Reported Outcome Measurement Information System (PROMIS) and the Rheumatoid Arthritis Impact of Disease (RAID) score. Whether one of these new measures becomes dominant is currently uncertain. Clinical outcomes need to measure what is intended and have face, content, construct, and criterion validity. They also need to discriminate between states of interest reliably, exhibit sensitivity to change, and be easily measured and applied, given constraints of time, money, and interpretability. Different clinical outcomes are closely interrelated. Finally, clinical outcomes such as the EuroQol can be used to generate quality-adjusted life years (QALY), which are used in health economic studies. Measuring disease outcomes is essential for good medical care, which can only improve when clinicians know the results of their treatments and incorporate patients’ views.
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Ricci, Edmund M., Ernesto A. Pretto, and Knut Ole Sundnes. "Formulate Evaluation Questions (Step 2)." In Disaster Evaluation Research, edited by Edmund M. Ricci, Ernesto A. Pretto, and Knut Ole Sundnes, 73–80. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198796862.003.0006.
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In this chapter we define the five basic categories of evaluation, namely structure (resources), process (activities), outcomes, adequacy, and costs associated with the response(s). Structure refers to the equipment and personnel and the way in which these resources were organized for use in the medical response. Process refers to the activities carried out during the disaster response. Outcome assessment concerns the results of the care provided on the patients served, usually measured over time. Adequacy describes the extent to which the search-and-rescue, pre-hospital and hospital, and public health responses were able to meet the needs of the community during the disaster response. In general, these categories are consistent with the design of a typical logic model. Following the discussion of ‘evaluation categories’ we suggest questions that the evaluation team might consider for inclusion in the evaluation study. For each category we suggest questions which could be addressed in any disaster evaluation study which focuses on the medical and public health response. The stakeholder group should be fully involved in the selection of questions to be addressed by the evaluation team.
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Fadeeva, Tat'iana Sergeevna. "Connective tissue dysplasia: new horizons of the problem." In Дисплазия соединительной ткани: новые горизонты проблемы. Publishing house Sreda, 2019. http://dx.doi.org/10.31483/r-22132.
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The work raises questions of predicting the complications of pregnancy and childbirth and adverse conditions in the fetus in the presence of UCTD in the expectant mother, who also need to be studied, especially from the standpoint of mathematical modeling of the disease. It is also necessary to develop a common tactic for providing medical and social assistance and treatment and diagnostic services to pregnant women suffering from UCTD, which will make the outcome of childbirth more favorable and improve the subsequent prognosis for mother and newborn. In the literature there is practically no assessment of the course of pregnancy and the outcome of childbirth, depending on the severity of UCTD. Little is known about the role of a connective tissue metabolism marker - hydroxyproline, trace elements (magnesium) and vitamins (D3) in pregnant women suffering from UCTD, and the medical tactics regarding such patients are not clearly defined. Despite numerous successes in the study of the causes of complications during pregnancy and childbirth in women suffering from UCTD, a unified approach to their management during the prenatal stage has not yet been developed. Therefore, the search for possible predictors for the timely prediction of adverse pregnancy and childbirth outcome in such patients is becoming increasingly important. This will make it possible to develop an optimal organizational and methodological base and subsequently improve the prognosis for women and their offspring. Thus, in contrast to the existing standard approach, we have proposed a comprehensive management of patients suffering from UCTD, including the timely identification of patients from the risk group, clarification of their condition using such markers as magnesium and hydroxyproline, additional intake of magnesium and vitamin D preparations. Optimal plan managing the period of gestation, childbirth, and a pathogenetically reasoned set of treatment and preventive measures for women with UCTD, will not only improve the outcomes of pregnancy and childbirth, but also contribute to the health of the future generation. 1. UCTD affects the course of pregnancy, childbirth and the condition of the newborn. The degree of exposure is largely determined by the severity of the underlying disease. In severe UCTD, the prevalence of spontaneous miscarriage and preterm labor was significantly higher, and endometritis and severe anemia were more common in the postpartum period. Severe asphyxia on the Apgar scale at the 1st and 5th minutes, congenital heart defects, morphofunctional immaturity, conjugation jaundice and convulsive syndrome were more common in the fetus. 2. A low content of magnesium and hydroxyproline is associated with the occurrence of complications during childbirth and a decrease in the anthropometric characteristics of the newborn. Taking magnesium preparations reliably affects the concentration of this trace element and hydroxyproline in the blood of pregnant women suffering from UCTD. 3. Therapy with magnesium preparations is an effective tool in patients suffering from UCTD, as it helps to improve well-being during pregnancy, improves the course of the postpartum period and reduces the prevalence of chronic fetal hypoxia. 4. Vitamin D and magnesium supplements have a beneficial effect on pregnancy and the fetus, reducing the prevalence of pre-eclampsia and chronic intrauterine hypoxia of the fetus, reducing the incidence of morphofunctional immaturity and conjugation jaundice of the newborn. 5. The created computer program “STEP DST” can be applied in the clinical practice of obstetrician-gynecologists and health care organizers. The obtained individual forecast of the probability of development of complications of reproduction allows us to outline the optimal plan for managing the period of gestation, childbirth and the postpartum period, to prescribe a pathogenetically based set of therapeutic and preventive measures for women suffering from UCTD.
Conference papers on the topic "Outcome assessment (Medical care) Victoria"
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Zeljkovic, V., C. Druzgalski, and P. Mayorga. "Quantitative Outcome Assessment of Lower Rhytidectomy Surgery Images." In 2019 Global Medical Engineering Physics Exchanges/ Pan American Health Care Exchanges (GMEPE/PAHCE). IEEE, 2019. http://dx.doi.org/10.1109/gmepe-pahce.2019.8717348.
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Kalinin, Ruslan, and Evgeny Barinov. "Expert assessment of causal relationships with adverse outcomes of infection in clinical practice." In Issues of determining the severity of harm caused to human health as a result of the impact of a biological factor. ru: Publishing Center RIOR, 2020. http://dx.doi.org/10.29039/conferencearticle_5fdcb03a84e0b2.48443155.
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The article highlights the issues of establishing cause-and-effect relationships in cases of death and injury to human health in the provision of medical care. The theoretical foundations and practical problems of determining the severity of harm to the patient's health in severe infectious diseases and the development of complications caused by surgical infection are considered. The article presents a brief description of the main provisions of the legislation and methods of forensic medical expert assessment of infectious processes in the patient's body associated with both the disease and the consequences of medical interventions, including improper medical care. It is noted that the fact of occurrence of infectious complications cannot be regarded as harm to the patient's health in the absence of data confirming the presence of a direct cause-and-effect relationship between the admitted defects (shortcomings) of medical care and the adverse outcome of the disease or injury. An example from practice is given and a rare case of a combination of botulism with a brain infarction is analyzed. Simultaneous ischemic and toxic damage to the nervous system caused difficulties both in the clinical diagnosis during the patient's lifetime and in the process of expert evaluation of the medical care after his death. The authors of the article come to the conclusion that the procedure for establishing causal relationships and the severity of harm to human health caused during medical care needs to be further improved from the standpoint of legislation and methods of conducting forensic medical examination. Special attention should be paid to fatal cases of nosocomial infection, as well as infectious complications of surgical interventions. Determining the severity of a patient's health injury should be based on an analysis of the causal relationship between deficiencies in medical care and an adverse outcome.
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Skrinda, Ilona, Irēna Kokina, and Dzintra Iliško. "Assessment of a Professional Competence of Healthcare Personnel." In 15th International Scientific Conference "Rural Environment. Education. Personality. (REEP)". Latvia University of Life Sciences and Technologies. Faculty of Engineering. Institute of Education and Home Economics, 2022. http://dx.doi.org/10.22616/reep.2022.15.028.
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The role of health care personnel in any medical institution is particularly important. Staff as a resource is the most important and valuable capital that ensures the continuous and systemic functioning of the institution, its development in perspective. The competence and attitude of the employees determine the satisfaction of clients and patients and the outcome of treatment. Therefore, this is necessary for every medical institution to raise professional qualification and training of staff by raising their professional competence. High professionalism increases confidence of clients in medical personal and it manifests the best practice in a particular hospital. The professional development and a lifelong learning of healthcare professionals play a key role according to the requirements of the professional competence of medical personnel. Different EU countries apply different approaches and experience in determining the levels of professionalism in choosing criteria of assessment of quality of medical personnel. The aim of the study: is to explore and to analyse the existing procedures for assessing the professional competence of health care personnel. The methodology of the study: For the purpose of this study the authors have carried out a questionnaire with nurses aiming at evaluation of their professional competence. The results of the study: The authors of the study have analysed the requirement for the assessment of professional competence of health care staff in a hospital as well as data gained in the questionnaire and designed the competence model. The significance of the studyis to highlight the importance of raising competence of medical personnel.
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Alamdari, Nasim, Nicholas MacKinnon, Fartash Vasefi, Reza Fazel-Rezai, Minhal Alhashim, Alireza Akhbardeh, Daniel L. Farkas, and Kouhyar Tavakolian. "Effect of Lesion Segmentation in Melanoma Diagnosis for a Mobile Health Application." In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3522.
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In 2016, more than 76,380 new melanoma cases were diagnosed and 10,130 people were expected to die from skin cancer in the United States (one death per hour) [1]. A recent study demonstrates that the economic burden of skin cancer treatment is substantial and, in the United States, the cost was increased from $3.6 billion in 2002–2006 to $8.1 billion in 2007–2011 [2]. Monitoring moderate and high-risk patients and identifying melanoma in the earliest stage of disease should save lives and greatly diminish the cost of treatment. In this project, we are focused on detection and monitoring of new potential melanoma sites with medium/high risk patients. We believe those patients have a serious need and they need to be motivated to be engaged in their treatment plan. High-risk patients are more likely to be engaged with their skin health and their health care providers (physicians). Considering the high morbidity and mortality of melanoma, these patients are motivated to spend money on low-cost mobile device technology, either from their own pocket or through their health care provider if it helps reduce their risk with early detection and treatment. We believe that there is a role for mobile device imaging tools in the management of melanoma risk, if they are based on clinically validated technology that supports the existing needs of patients and the health care system. In a study issued in the British Journal of Dermatology [2] of 39 melanoma apps [2], five requested to do risk assessment, while nine mentioned images for expert review. The rest fell into the documentation and education categories. This seems like to be reliable with other dermatology apps available on the market. In a study at University of Pittsburgh [3], Ferris et al. established 4 apps with 188 clinically validated skin lesions images. From images, 60 of them were melanomas. Three of four apps tested misclassified +30% of melanomas as benign. The fourth app was more accurate and it depended on dermatologist interpretation. These results raise questions about proper use of smartphones in diagnosis and treatment of the patients and how dermatologists can effectively involve with these tools. In this study, we used a MATLAB (The MathWorks Inc., Natick, MA) based image processing algorithm that uses an RGB color dermoscopy image as an input and classifies malignant melanoma versus benign lesions based on prior training data using the AdaBoost classifier [5]. We compared the classifier accuracy when lesion boundaries are detected using supervised and unsupervised segmentation. We have found that improving the lesion boundary detection accuracy provides significant improvement on melanoma classification outcome in the patient data.
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Samara, Haya, and Lily OHara. "Nurses’ Knowledge and Attitudes about Adult Post-operative Pain Assessment and Management: A Cross-Sectional Study in Qatar." In Qatar University Annual Research Forum & Exhibition. Qatar University Press, 2021. http://dx.doi.org/10.29117/quarfe.2021.0101.
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Background: Pain has been described by clinicians, patients, and researchers alike as a complex and challenging phenomenon. People have different experiences of pain. Nurses’ negative attitudes and lack of knowledge are major impediments to effective pain management. Methods: The study was a cross-sectional online survey using a validated self-administered questionnaire for post-operative registered nurses working in Hamad Medical Corporation in Qatar. The dependent outcome was the score on the Knowledge and Attitudes Survey Regarding Pain. Results: A total of 151 post-operative nurses participated in the study. The mean knowledge and attitudes (K&A) score was 19.6 (SD 4.5) out of 41 (48%), indicating a huge deficit in the nurses’ knowledge and attitudes about adult post-operative pain. No sociodemographic variables were associated with K&A scores. Neither the facility the nurses worked at nor hours of previous pain education were associated with K&A scores. Conclusions: There is a significant deficit in post-operative nurses’ knowledge and attitudes about pain in Hamad Medical Corporation, with no significant differences based on demographics or other characteristics. This suggests the deficit is widespread within the nursing workforce in Qatar. This deficit is potentially impacting significantly on pain assessment and management for adults in post-operative settings. Pragmatic research on evidence-based nursing educational courses focused on pain assessment and management is required to enhance nurses’ knowledge and attitudes and improve patient care. Key messages: Strategies to strengthen nurses’ knowledge and attitudes toward pain in Qatar must be developed and tested.
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Schooley, Ben, Akanksha Singh, Sarah Floyd, Stephan Pill, and John Brooks. "Direct Weighting Interactive Design of Patient Preferences for Shared Decision Making in Orthopaedic Practice." In 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002105.
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Patients need the ability to accurately and efficiently communicate their preferences across outcome domains to their healthcare providers.1-7 No existing system provides an efficient and timely approach to collect and communicate patient preferences across outcome domains to support shared decision making (SDM) in orthopaedic practice.2-4,8-19 The overarching goal of this research is to design, build, and test an app that collects baseline patient preferences and health status across orthopaedic outcomes and reports this information to the provider for use in patient care. A core component of the app is a Direct-Weighting (DW) preference assessment approach, originated from our prior research, and applied in a touchscreen based interactive design. It is envisioned that patients will use the app after scheduling a first visit to a surgeon for a new orthopaedic condition. Direct weighting (DW) approaches calculate patient-specific preference weights across outcomes by asking patients to disperse portions of a hypothetical “whole” across outcomes in a manner that reflects a patient’s preferences.20 DW has low respondent burden but it requires respondents to make “implicit” comparisons which may be difficult to conceptualize.20 However, the DW approach has become generally accepted in the quality-of-life literature and it has been shown that patients dividing up pieces of a “pie” across quality-of-life domains yields valid representations of patient preferences across the domains.20-22 However, the DW approach has not been validated with specific clinical scenarios using a clinically focused set of outcomes or by using a mobile software app. Drawing on prior research, we iteratively design and develop the app with input from prior DW research, informaticians, and clinicians. We use a qualitative approach to pilot test the app with 20 first-time visit patients presenting with joint pain and/or function deficiency. Participants were interviewed about their outcome preferences for care, used the app to prioritize outcome preferences, answered interview questions about their experience using the app, and completed a mHealth App Usability Questionnaire (MAUQ). Interview questions focused on the utility and usability of the mobile app for communicating with their provider, and capability of the app to capture their outcome preferences. Results validated five core preference domains, with most users dividing their 100-point allocation across 1-3 domains. The tool received moderate to high usability scores. Patients with older age and lower literacy found the DW approach more difficult in terms of allocating 100 points across 5 domains. Suggestions for DW interface interaction improvement included instantiation of a token/points oriented DW preference scoring methodology rather than a 1-10 sliding scale approach for improved preference weighting cognition and SDM with a provider. As more patient reported outcome (PRO) apps hit the marketplace across a broad spectrum of health conditions, these results provide evidence for a DW approach and interactive design for patients to communicate their treatment preferences to their providers.References:1.Baumhauer JF, Bozic KJ. Value-based Healthcare: Patient-reported Outcomes in Clinical Decision Making. Clin Orthop Relat Res. 2016;474(6):1375-1378.2. Slim K, Bazin JE. From informed consent to shared decision-making in surgery. J Visc Surg. 2019;156(3):181-184.3. Damman OC, Jani A, de Jong BA, et al. The use of PROMs and shared decision-making in medical encounters with patients: An opportunity to deliver value-based health care to patients. J Eval Clin Pract. 2020;26(2):524-540.4. Sorensen NL, Hammeken LH, Thomsen JL, Ehlers LH. Implementing patient-reported outcomes in clinical decision-making within knee and hip osteoarthritis: an explorative review. BMC Musculoskelet Disord. 2019;20(1):230.5. Kamal RN, Lindsay SE, Eppler SL. Patients Should Define Value in Health Care: A Conceptual Framework. J Hand Surg Am. 2018;43(11):1030-1034.6. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Social Science & Medicine. 1999;49(5):651-661.7. Niburski K, Guadagno E, Mohtashami S, Poenaru D. Shared decision making in surgery: A scoping review of the literature. Health Expect. 2020.8. Selten EM, Geenen R, van der Laan WH, et al. Hierarchical structure and importance of patients' reasons for treatment choices in knee and hip osteoarthritis: a concept mapping study. Rheumatology (Oxford). 2017;56(2):271-278.9. Kannan S, Seo J, Riggs KR, Geller G, Boss EF, Berger ZD. Surgeons' Views on Shared Decision-Making. J Patient Cent Res Rev. 2020;7(1):8-18.10. Briffa N. The employment of Patient-Reported Outcome Measures to communicate the likely benefits of surgery. Patient Relat Outcome Meas. 2018;9:263-266.
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Amin Zada, Sayamak. "COVID-19 Health Management and Business Continuity." In SPE Annual Caspian Technical Conference. SPE, 2021. http://dx.doi.org/10.2118/207050-ms.
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Abstract Considering the world faces an unprecedented challenge with economies everywhere affected by the COVID-19 pandemic there was an extreme need for coming together to combat the COVID-19 pandemic bringing governments, organizations from across industries and individuals together to manage this global outbreak. From the early stages of pandemic escalation, SOCAR AQS realized that only diversified measures would minimize risks, fulfil the duty of care responsibilities and promote workforce resilience. The establishment of the COVID-19 crisis management team ensured the continuous application of a proactive risk-based approach aligned with governmental regulations on the ground of the most up to date local and international information including the industry best practices. Access to the offices for all relevant staff and visitors was minimized, and the specific procedure for work from home was developed. A combination of preventive measures at all worksites and transportation facilities is held through regular effective disinfection, health checks, continuous access to the required personal protection and hygiene facilities, maintaining social distancing, and careful tracing close contacts for all suspected cases. Health promotion to all staff is conducted through various communication means. Two-stage pre-mobilization COVID-19 screening was implemented through a comprehensive health questionnaire prior to commuting at the entrance of quarantine facilities. There was a week of individual isolation in the designated controlled quarantine facilities with optimal detectability of the virus by the fifth day followed by highly-specific PCR testing before entering operational worksites enables early revealing of an infection prior to its manifestation in the human body. Specific post-illness medical assessment is a key for individual healthy return to work is carried out. Considering vaccines as a critical new tool in the battle against COVID-19, vaccination of all offshore personnel is implemented. As an outcome, the entire process provided a prudent way to ensure the continuation of uninterrupted operations resulted in zero COVID-19 detection at the quarantine worksites by follow-up of suspected cases during first eight months of the pandemic fight in Azerbaijan. In conclusion, the abovementioned statement provides the guidelines for the workforce working on worksites or in offices, and clear expectations of the measures to be taken to ensure COVID-19 health management and smooth business continuity are maintained.
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Amin Zada, Sayamak. "COVID-19 Health Management and Business Continuity." In SPE Annual Caspian Technical Conference. SPE, 2021. http://dx.doi.org/10.2118/207050-ms.
Full textAbstract:
Abstract Considering the world faces an unprecedented challenge with economies everywhere affected by the COVID-19 pandemic there was an extreme need for coming together to combat the COVID-19 pandemic bringing governments, organizations from across industries and individuals together to manage this global outbreak. From the early stages of pandemic escalation, SOCAR AQS realized that only diversified measures would minimize risks, fulfil the duty of care responsibilities and promote workforce resilience. The establishment of the COVID-19 crisis management team ensured the continuous application of a proactive risk-based approach aligned with governmental regulations on the ground of the most up to date local and international information including the industry best practices. Access to the offices for all relevant staff and visitors was minimized, and the specific procedure for work from home was developed. A combination of preventive measures at all worksites and transportation facilities is held through regular effective disinfection, health checks, continuous access to the required personal protection and hygiene facilities, maintaining social distancing, and careful tracing close contacts for all suspected cases. Health promotion to all staff is conducted through various communication means. Two-stage pre-mobilization COVID-19 screening was implemented through a comprehensive health questionnaire prior to commuting at the entrance of quarantine facilities. There was a week of individual isolation in the designated controlled quarantine facilities with optimal detectability of the virus by the fifth day followed by highly-specific PCR testing before entering operational worksites enables early revealing of an infection prior to its manifestation in the human body. Specific post-illness medical assessment is a key for individual healthy return to work is carried out. Considering vaccines as a critical new tool in the battle against COVID-19, vaccination of all offshore personnel is implemented. As an outcome, the entire process provided a prudent way to ensure the continuation of uninterrupted operations resulted in zero COVID-19 detection at the quarantine worksites by follow-up of suspected cases during first eight months of the pandemic fight in Azerbaijan. In conclusion, the abovementioned statement provides the guidelines for the workforce working on worksites or in offices, and clear expectations of the measures to be taken to ensure COVID-19 health management and smooth business continuity are maintained.