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Artykuły w czasopismach na temat "Outcome assessment (medical care)"
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Farris, Karen B., i Duane M. Kirking. "Assessing the Quality of Pharmaceutical Care II. Application of Concepts of Quality Assessment from Medical Care". Annals of Pharmacotherapy 27, nr 2 (luty 1993): 215–23. http://dx.doi.org/10.1177/106002809302700218.
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Objective To present a framework that facilitates quality assessment of pharmaceutical care (PC) so that the profession and the public may identify pharmacists in ambulatory settings who provide quality care in all aspects of their practices. Data Sources A MEDLINE search augmented by a review of International Pharmacy Abstracts was used to identify pertinent quality assessment and pharmacy practice literature; indexing terms included quality assurance, healthcare, pharmacists, community pharmacy services, ambulatory, pharmacy, and process and outcome assessment. Study Selection All identified quality assessments of community pharmacy practice were considered. Studies that documented the effectiveness of specific pharmacist activities and patient satisfaction were also included. Data Extraction The literature was independently reviewed by the primary author. Data Synthesis The structure–process–outcome paradigm is presented as a framework for quality assessment of PC. Structure should be assessed at periodic intervals because it identifies the potential for the provision of quality care. Process, the care that pharmacists provide, must be documented and linked to outcomes before either structure or process can be used to make inferences about the quality of PC. Technical and interpersonal processes should be examined. Outcomes require an interdisciplinary approach that not only considers other medical care inputs but also recognizes the psychologic, economic, and social factors that affect health status and quality of life. Process and outcome must both be assessed to distinguish the contribution of pharmacists from that of other healthcare providers. Examples of criteria are provided and a model to integrate PC within the healthcare system is discussed. Conclusions It is pharmacists’ duty to ensure that patients receive an acceptable level of PC. The structure-process-outcome paradigm provides a framework to identify and link pharmacists’ processes with patients’ outcomes.
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Granger, Carl V., i Carol M. Brownscheidle. "Outcome Measurement in Medical Rehabilitation". International Journal of Technology Assessment in Health Care 11, nr 2 (1995): 262–68. http://dx.doi.org/10.1017/s0266462300006875.
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AbstarctThe Uniform Data System for Medical Rehabilitation (UDSmr) provides a method for uniform assessment of the severity of patient disability and the outcomes of medical rehabilitative care. The effectiveness and efficiency of medical rehabilitation services may be analyzed using the Functional Independence Measure (FIM), the functional assessment component of the UDS, and other data. Program evaluation models based on the UDSMR and the FIM are useful for measuring resource cost of disability.
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Camacho, Luiz Antonio Bastos, i Haya Rahel Rubin. "Reliability of medical audit in quality assessment of medical care". Cadernos de Saúde Pública 12, suppl 2 (1996): S85—S93. http://dx.doi.org/10.1590/s0102-311x1996000600009.
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Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6), depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.
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Bauer, Seth R., i Sandra L. Kane-Gill. "Outcome Assessment of Critical Care Pharmacist Services". Hospital Pharmacy 51, nr 7 (lipiec 2016): 507–13. http://dx.doi.org/10.1310/hpj5107-507.
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Spiridonov, V. A., L. G. Aleksandrova, V. A. Kalyanov i R. R. Latfullina. "Medical legal assessment of medical care for tick-borne encephalitis with lethal outcome". Kazan medical journal 99, nr 4 (8.08.2018): 678–84. http://dx.doi.org/10.17816/kmj2018-678.
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Aim. Study of regulatory and legal base according to the criminal case file submitted for expert and medico-legal assessment of a case of failure of health care in tick-borne viral encephalitis in an endemic zone.
Methods. During the research, the expert and legal analysis was performed to establish the cause-and-effect relationship between health workers’ actions and lethal outcome of tick-borne viral encephalitis on the basis of standard and legal acts of the Russian Federation. Special authors’ attention was paid to the assessment of influence of quality of preventive measures organization concerning this viral infection.
Results. Features and possible defects were studied and revealed not only at a stage of diagnosis and treatment of patients with tick-borne encephalitis, but also when taking preventive measures, taking into account the operating standard and legal base. Based on the research results the algorithm of actions during an expert legal assessment of efficiency of health care in similar cases was offered.
Conclusion. The correct expert assessment of the revealed defects of health care is possible if overcoming all complexity of interpretation of epidemiological, clinical, laboratory and morphological data.
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Nelson, Jessica L., Stephanie P. Chambers, Holly E. Brakke i Jessica H. Hus. "Decreasing the Frequency of Nursing Assessment for Medically Stable Hospitalized Patients". Clinical Nurse Specialist 37, nr 5 (wrzesień 2023): 223–27. http://dx.doi.org/10.1097/nur.0000000000000768.
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Purpose/Objectives During the COVID-19 pandemic, a large Midwest tertiary care medical center had prolonged hospitalizations due to strained staffing and few options for post–acute care recovery. Patients deemed medically ready for discharge were receiving the same care interventions as all other hospitalized medical-surgical patients. The study objective was to appropriately match care assessment frequency for these patients with their individual needs by reducing the frequency of routine nursing assessments. Description of the Project/Program This quality improvement initiative reduced the frequency of nursing assessments, including routine monitoring of vital signs, to once daily for medically stable patients whose discharge was delayed. Outcome During the 4-week pilot, 40 hospitalized patients were enrolled; 960 assessments were eliminated, and nurses were able to reallocate approximately 500 hours to other nursing tasks. No adverse outcomes were observed among patients who received once-daily assessment. Conclusion By decreasing nursing assessment frequency for hospitalized patients with discharge delays, nurses appropriately matched care interventions with the patient's needs.
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Nakajima, Nobuhisa. "Palliative Care Outcome Scale Assessment for Cancer Patients Eligible for Palliative Care: Perspectives on the Relationship between Patient-Reported Outcome and Objective Assessments". Current Oncology 29, nr 10 (28.09.2022): 7140–47. http://dx.doi.org/10.3390/curroncol29100561.
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(1) Background: The importance of patient-reported outcome (PRO), i.e., prioritizing patient voice, has increased in cancer treatment, as well as palliative and supportive settings. The Integrated Palliative Care Outcome Scale (IPOS), a hybrid evaluation consisting of “patient evaluation” (PRO) and “peer evaluation” by medical professionals, was developed as a successor version of the Support Team Assessment Schedule (STAS) in 2013 and has been utilized worldwide. The Japanese version of the IPOS (IPOS-J) was developed and released in 2019. The purpose of this study was to explore the applicability of the IPOS-J to clinical practice in the future. (2) Methods: We conducted the following two studies with terminally ill cancer patients: (i) Can an evaluation with the IPOS-J performed by medical professionals (peer evaluation) replace the STAS-J evaluation? (ii) Can the quality of palliative care improve by combining the IPOS-J patient evaluation with the peer evaluation? (3) Results: The overall intervention rate and urgent intervention rate for the STAS-J and IPOS-J was 34.4 vs. 34.1% (p = 0.91) and 10.4 vs. 9.9% (p = 0.78), respectively. The patients selected “intervention required” but the medical professionals selected “no intervention required” in 47 cases. The medical team performed appropriate intervention after re-assessment. As a result, more than 70% of the patients were “intervention-free” after 1 week of intervention. (4) Conclusions: The IPOS-J peer evaluation was as useful as the STAS-J evaluation. A hybrid type of evaluation, combining patient evaluation (PRO) and peer evaluation, may help us to understand patient needs and improve the quality of palliative care.
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Gray, James E., Marie C. McCormick, Douglas K. Richardson i Steven Ringer. "Normal Birth Weight Intensive Care Unit Survivors: Outcome Assessment". Pediatrics 97, nr 6 (1.06.1996): 832–38. http://dx.doi.org/10.1542/peds.97.6.832.
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Rationale/Objective. Although the short-and long-term outcome of low birth weight neonatal intensive care unit (NICU) survivors has been extensively studied, much less information is available for normal birth weight (NBW) infants (greater than or equal to 2500 g) who require NICU care. Methods. To address this issue, we retrospectively examined the neonatal hospitalizations and 6-month health status of 521 consecutive NBW admissions to a single NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone survey techniques. Results. NBW infants comprised 88.1% of births in this hospital and 35.4% of NICU admissions during the study period. The in-hospital mortality rate for this group was 2%. The median length of stay was 7.7 days (range 1 to 110 days) with median hospital charges of $5222 (range $565 to $317,820). Only 59% of infants required active intensive care therapy; the remainder received only intensive monitoring. The need for intensive therapy on admission day along with the presence of prematurity and congenital anomalies were significant predictors of hospital charges (R2 = 0.31, P < .01). After initial discharge, 10.1% of these infants required rehospitalization in the first 6 to 8 months of life. The rate of readmission among infants with congenital anomalies was over 30%. In addition to its association with neonatal resource consumption, the presence of congenital anomalies along with low 5-minute Apgar scores was associated with higher postdischarge resource use, as measured by frequency of physician visits, need for special medical items, and rate of rehospitalization (P < .05). Conclusions. NBW infants represent a significant percentage of NICU admissions, but for many of these patients NICU admission could be avoided if alternative care settings that provided intensive monitoring were available. In addition, these infants also incur higher rates of postdischarge use of medical care.
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Suljic, Enra, Admir Mehicevic i Aida Gavranovic. "Stroke Emergency Medical Care: Initial Assessment, Risk Factors, Triage and Hospitalization Outcome". Materia Socio Medica 25, nr 2 (2013): 83. http://dx.doi.org/10.5455/msm.2013.25.83-87.
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Bontsevich, Roman, Yulia Kirienko, Viktoriya Bogatova, Elena Milutina, Vladimir Kovalenko, Aleksandra A. Melnichenko, Galina Batishcheva, Natalia Goncharova i Andrey Agapov. "Assessment of senior medical care majors’ knowledge in antimicrobial chemotherapy". Research Results in Pharmacology 4, nr 4 (18.12.2018): 107–13. http://dx.doi.org/10.3897/rrpharmacology.4.31960.
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Introduction: The resistance of microorganisms to antimicrobials has been gradually increasing since 2011 and is now recognized by the World Health Organization as a global biological threat. Causes of antimicrobial resistance must be actively addressed. Healthcare workers’ awareness of rational antimicrobial prescribing practices is of great importance. The increasing relevance of this issue is considered within this study, which started in 2014. Materials and methods: The article represents the results of anonymous prospective surveys within the framework of the KANT multi-centered research project aimed at assessing students’ knowledge of rational antimicrobial prescribing practices also known as “antimicrobial stewardship”. The survey involved 309 Medical Care majors in their fifth- and sixth- years in two Russian regional centers: Belgorod and Voronezh. The answers to four main questions of the survey were analyzed in this work. Results and discussion: According to the survey, 51.5% of the respondents properly identified a pharmacological group of an antimicrobial; 79.3% of the students would change an antibiotic if the desired therapeutic outcome was not achieved within two or three days of treatment; 29.8% of the students believed that an antimicrobial substitution was required even when a positive therapeutic outcome was achieved; and nobody could correctly identify all the proposed pharmacologically irrational combinations of antimicrobials. Conclusions: The survey showed that senior medical students have insufficient knowledge in antimicrobial stewardship. Appropriate use of antibiotics and antimicrobial prescribing practices need to be considered more thoroughly in Pharmacology, Clinical Pharmacology and Medical Care curricula. Likewise, educational activities on antimicrobial stewardship and best prescribing practices are of great importance for students as they will help with improving the knowledge of future doctors.
Rozprawy doktorskie na temat "Outcome assessment (medical care)"
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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, i 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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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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Yung, Wing-yan Ada, i 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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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.
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Shelby, Rebecca Ann. "Understanding the effectiveness of interventions for cancer patients a study of patient characteristics and intervention evaluations /". Columbus, Ohio : Ohio State University, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1148322580.
Pełny tekst źródłaKsiążki na temat "Outcome assessment (medical care)"
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Rehabilitation outcome measures. Edinburgh: Churchill Livingstone, 2010.
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1940-, Kane Robert L., red. Understanding health care outcomes research. Gaithersburg, Md: Aspen Publishers, 1997.
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Smith, Richard M., Ph. D., Rehabilitation Foundation (Wheaton, Ill.), University of Chicago. MESA Psychometric Laboratory. i International Outcome Measurement Conference (1st : 1996 : Chicago, Ill.), red. Outcome measurement. Philadelphia: Hanley & Belfus, 1997.
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National Center for Health Services Research and Health Care Technology Assessment (U.S.), red. Patient outcome assessment research program extramural assessment teams. Rockville, MD: National Center for Health Services Research and Health Care Technology Assessment, 1988.
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1940-, Kane Robert L., red. Understanding health care outcomes research. Wyd. 2. Boston: Jones and Bartlett, 2004.
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Stokes, Emma K. Rehabilitation outcome measures. Edinburgh: Churchill Livingstone, 2011.
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1931-, Williamson John W., red. Healthcare informatics and information synthesis: Developing and applying clinical knowledge to improve outcomes. Thousand Oaks, Calif: Sage Publications, 2002.
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M, Kleinpell Ruth, red. Outcome assessment in advanced practice nursing. New York: Springer, 2001.
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G, Yeomans Steven, red. The clinical application of outcomes assessment. Stamford, Conn: Appleton & Lang, 2000.
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J, Lambert Michael, i Fields Scott A. 1972-, red. Essentials of outcome assessment. New York: Wiley, 2002.
Znajdź pełny tekst źródłaCzęści książek na temat "Outcome assessment (medical care)"
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Sayed, Rola El, Zahi Abdul-Sater i Deborah Mukherji. "Cancer Care During War and Conflict". W Cancer in the Arab World, 461–76. Singapore: Springer Singapore, 2022. http://dx.doi.org/10.1007/978-981-16-7945-2_29.
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AbstractThe Arab World has sadly witnessed protracted conflict affecting several of its regions in recent years. Conflict-affected populations have been significantly impacted by chronic deficiencies in medical care including unprecedented numbers of refugees and migrants requiring ongoing support in neighbouring countries. Humanitarian response to crisis has historically focused on the supply of nutrition, water, and emergent trauma relief, followed by control and prevention of infections. Prevention and management of non-communicable diseases, specifically cancer, have been relatively neglected; however, with regional conflicts lasting for many years, cancer care has become an increasingly urgent issue to be addressed. The humanitarian community has stressed the need for situational assessment regarding disease prevalence and available resources, with identification of specific regional challenges. Lack of infrastructure, important diagnostic and treatment modalities, clinical experts and regulatory bodies are the main obstacles to cancer care at all stages from screening and prevention to therapeutics and palliation. The initial step to improving cancer care provision should be implementing needs-based priority assessment and policies within the context of governing bodies that control and monitor performance. Collaboration and coordination among national and international organizations and stakeholders are essential to improve data collection on which to base resource allocation and address growing disparities in cancer outcomes.
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Park, Eugene, Carolina Restrepo, Karen W. Y. Wong Riff i Alex Campbell. "Outcome Assessment". W Global Cleft Care in Low-Resource Settings, 507–14. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-59105-2_37.
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Webb, A. R. "Assessment of Medical Devices". W Evaluating Critical Care, 244–54. Berlin, Heidelberg: Springer Berlin Heidelberg, 2002. http://dx.doi.org/10.1007/978-3-642-56719-3_17.
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Daly, Kathleen, i David Bihari. "Assessment of outcome from acute renal failure". W Critical Care Nephrology, 153–61. Dordrecht: Springer Netherlands, 1998. http://dx.doi.org/10.1007/978-94-011-5482-6_14.
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Knaus, W. A. "Process of Care Assessment and the Evaluation of Outcome from Intensive Care". W Evaluating Critical Care, 41–50. Berlin, Heidelberg: Springer Berlin Heidelberg, 2002. http://dx.doi.org/10.1007/978-3-642-56719-3_4.
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Gemke, R. J. B. J., G. J. Bonsel i A. J. van Vught. "Outcome Assessment and Quality Assurance in Pediatric Intensive Care". W Update in Intensive Care and Emergency Medicine, 117–32. Berlin, Heidelberg: Springer Berlin Heidelberg, 1996. http://dx.doi.org/10.1007/978-3-642-80227-0_10.
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Szalados, James E. "The Science of Teamwork in Healthcare: Importance to Patient Outcome". W The Medical-Legal Aspects of Acute Care Medicine, 191–218. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-68570-6_8.
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Daly, Mel P. "Medical Assessment and Care of the Surgical Patient". W Family Medicine, 430–39. New York, NY: Springer New York, 1994. http://dx.doi.org/10.1007/978-1-4757-4005-9_57.
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Emmett, Anne. "Outcome Analysis". W Quality Management and Accreditation in Hematopoietic Stem Cell Transplantation and Cellular Therapy, 43–52. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-64492-5_6.
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AbstractTo understand and hence improve the positive impact of any healthcare activity, procedure or intervention, it is essential that there is an objective analysis of the activity, procedure or intervention based on predetermined standards.In the field of haematopoietic stem cell transplantation, outcome analysis is the process by which the results of a transplant procedure are formally assessed. It includes a series of reviews for evaluating the effectiveness of the health care provided and for identifying the most promising therapies and transplant approaches, given the available medical evidence and healthcare resources.Outcome analysis allows the transplant team to understand the effects of their practice and improve quality. Its relevance is due to transplant involving high treatment-related risk, significant practice variations, and continual practice developments – for example, recent developments in CAR-T and IEC therapies.The main aim of this chapter is to discuss how to find outcome data and how and when to present it. This will need to be adapted to the local programme.
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Youngstrom, Paul, David Boyd i M. Frances Rhoton. "Computerized Quality Assurance Assessment of Obstetric Anesthesia Care: New Outcome Indicators". W Computing and Monitoring in Anesthesia and Intensive Care, 304–5. Tokyo: Springer Japan, 1992. http://dx.doi.org/10.1007/978-4-431-68201-1_94.
Pełny tekst źródłaStreszczenia konferencji na temat "Outcome assessment (medical care)"
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Zeljkovic, V., C. Druzgalski i P. Mayorga. "Quantitative Outcome Assessment of Lower Rhytidectomy Surgery Images". W 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, i Evgeny Barinov. "Expert assessment of causal relationships with adverse outcomes of infection in clinical practice". W 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 i Dzintra Iliško. "Assessment of a Professional Competence of Healthcare Personnel". W 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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Schooley, Ben, Akanksha Singh, Sarah Floyd, Stephan Pill i John Brooks. "Direct Weighting Interactive Design of Patient Preferences for Shared Decision Making in Orthopaedic Practice". W 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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Samara, Haya, i Lily OHara. "Nurses’ Knowledge and Attitudes about Adult Post-operative Pain Assessment and Management: A Cross-Sectional Study in Qatar". W 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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Alamdari, Nasim, Nicholas MacKinnon, Fartash Vasefi, Reza Fazel-Rezai, Minhal Alhashim, Alireza Akhbardeh, Daniel L. Farkas i Kouhyar Tavakolian. "Effect of Lesion Segmentation in Melanoma Diagnosis for a Mobile Health Application". W 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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Malfait, Annelien, Martine Van Puyvelde, Frederic DETAILLE, Xavier Neyt, Francois Waroquier i Nathalie Pattyn. "Unveiling Readiness of Medical First Responders in Simulation Trainings: Insights beyond Queries". W AHFE 2023 Hawaii Edition. AHFE International, 2023. http://dx.doi.org/10.54941/ahfe1004375.
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In military deployments, medical professionals face complex operational situations that are not encountered in civilian health care practice. Defence Departments invest a huge budget of time and money to the training of military medical personnel in order to ensure medical proficiency and successful care of patients in this specific context, However, these previously trained skills may have decayed through disuse. Although past research efforts have provided a greater understanding of the mechanisms underlying skill acquisition and decay, there are still no detailed models of skill acquisition and skill decay, no understanding of mediating or mitigating factors, and more importantly no mitigation strategies in military medical tasks (Perez et al., 2013). The current paper describes the methodology to quantify performance in the framework of a project addressing this need for further research in emergency military medical care, specifically understanding and quantifying medical skill acquisition and skill decay. Method In a first descriptive part, skill acquisition and practice were investigated in a qualitative way by observation and in-depth interviews with emergency medical personnel (N = 23, nurses and physicians, from civilian and military backgrounds). In a second part, a set of methodologies was designed to objectify skill acquisition, not only by measuring outcomes (e.g. the successful intubation of a patient), but also refining the technical analyses of skills and assessing the psychophysiological readiness of the performer.Results For the first, qualitative study, all the interviewees described as a major impact on performance several examples of (extreme) stressful and/or dangerous events that they experienced during mass events, accidents, events with serious injuries and/or vulnerable victims (e.g., children), the situational context in combination with extreme high workload and patient flux. In military respondents, additional war-related aspects such as difficult and dangerous working circumstances and war-specific injuries were described. Being exposed to danger was often mentioned, even in civilian participants. Overall, personnel is continuously searching to position themselves on a continuum between emotional disconnection from the patient to preserve operationality on the one hand; and remaining enough empathic to preserve humanity on the other hand. We further identified an ambivalent awareness regarding emotions and stress; which are quoted as a major impact on performance, but without the awareness of own performance degradation. Based on these results, we decided to include an assessment of the psychophysiological allostatic load during the performance of specific skills, in order to factor this variable in when quantifying performance during simulation trainings. Considering the physical load during these trainings (running to the casualty, carrying equipment), measuring individual physiological activation does not make much sense regarding signal-to-noise ratio. Hence two other methods were adopted, which rely on the systemic measures of psychophysiological functioning. These were recordings of facial expression on the one hand, and voice analysis on the other hand. Facial expression is recorded through an add-on of the recording system equipping the simulation multi-room observation lab: the Noldus-Viso (© Noldus) system (i.e., a synchronized 4 high-quality camera system) that allows for real-live observation with a marker interface system and retrospective micro-analyses (The Observer XT) based on in-depth coding of interventions and skill performance. This combination of analyses on a macro and micro level will deliver information on what (macro) went well and what went wrong but also why (micro). The Noldus suite includes an automated emotion and action unit (AU) coding software (FaceReader7). In addition, voice recording is used and our model of Voice Stress Analysis is applied (Van Puyvelde et al., 2018). Conclusion The novel content of this project is to integrate what are usually termed “hard” and “soft” skills. Indeed, emergency medicine, and especially so in military contexts, still suffers from a historical “macho” culture. The evaluation methodology designed for the current project allows for a detailed skill acquisition analysis, by coupling the macro-outcome to micro-recordings of performance coupled to facial expression and voice recordings that offer a unique insight in health care providers’ performance.References Perez RS, Skinner A, Weyhrauch P, Niehaus J, Lathan C, Schwaitzberg SD, Cao CG. Prevention of surgical skill decay. Mil Med. 2013 Oct;178(10 Suppl):76-86. doi: 10.7205/MILMED-D-13-00216. PMID: 24084308.Van Puyvelde M, Neyt X, McGlone F, Pattyn N. Voice Stress Analysis: A New Framework for Voice and Effort in Human Performance. Front Psychol. 2018 Nov 20;9:1994. doi: 10.3389/fpsyg.2018.01994. PMID: 30515113; PMCID: PMC6255927.
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Nasser, H., Y. Jha, G. Keane, C. Carreño i Group Mental Health Working. "Innovative interventions for learning and development: improving psychiatric care through remote training and supervision". W MSF Scientific Days International 2022. NYC: MSF-USA, 2022. http://dx.doi.org/10.57740/n1mm-y210.
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INTRODUCTION In December 2019, following a request from MSF’s intersectional working group for mental health and psychosocial services, MSF’s telemedicine (TM) services team implemented a full-time psychiatrist based in Amman, Jordan. This was in the context of a global shortage of mental health (MH) clinicians, and rapidly increasing demand for MSF to provide MH care. This specialist’s main responsibility was to deliver psychiatric training and supervision using WHO’s MH global action plan intervention guide (mhGAP-IG). Prior to implementation, psychiatric training was delivered face-to-face by national and international psychiatrists in the field, or if this was not operationally possible, patients with MH conditions went untreated or were managed with advice provided by distance. We hoped that intervention would improve MSF clinician capacity, therefore increasing access to quality care for patients with MH conditions across all projects and in particular those settings where it had not previously been feasible. METHODS Intervention impact was assessed by analysing the total number of countries and projects where support was provided, the number of clinicians trained, and the number of supervision sessions provided. Analysis was supplemented through analysis of 15 structured interviews with stakeholders, including clinicians (8), activity managers (4), section mental health advisors (4) and the TM psychiatrist. ETHICS This work met the requirements for exemption from MSF Ethics Review Board review, and was conducted with permission from Clair Mills, former Medical Director, Operational Centre Paris, MSF, and Sebastien Spenser, former Medical Director, Operational Centre Brussels, MSF. RESULTS A total of 13 MSF projects across eight countries received TM support in 2020. mhGAP-IG training was provided online to 39 clinicians, followed by 123 supervision sessions. Structured interviews demonstrated delivery of mhGAP-IG training online in MSF projects, with adherence to MSF guidelines. Improved capacity building was reported, with clinicians observed to have greater clinical confidence and being considered more likely to provide MH assessment and care. Impact in terms of increased volume of patient care was difficult to analyse, partly related to restrictions and activity alterations occurring during the COVID-19 pandemic. CONCLUSION Ongoing challenges requiring future consideration include ensuring adequate information technology infrastructure (internet connection, access to adequate communication equipment, broader use of secure platforms such as Siilo) and standardised approaches to supervision. Future analyses could consider impact on quality of care, for example by measuring secondary outcomes such as MH activity and default rates. This project continues; we propose it comprises an innovative way to improve access to patient care and to provide clinician learning and development. CONFLICTS OF INTEREST None declared.
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Alcalá, Luis, Juan M. García-Gómez i Carlos Sáez. "Project based learning in Biomedical Data Science using the MIMIC III open dataset". W INNODOCT 2020. Valencia: Editorial Universitat Politècnica de València, 2020. http://dx.doi.org/10.4995/inn2020.2020.11890.
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The subjects Health Information Systems and Telemedicine and Data Quality and Interoperability of the Degree and Master in Biomedical Engineering of the Universitat Politècnica de València, Spain, address learning outcomes related to managing and processing biomedical databases, using health information standards for data capture and exchange, data quality assessment, and developing machine-learning models from these data. These learning outcomes cover a large range of distinct activities in the biomedical data life-cycle, what may hinder the learning process in the limited time assigned for the subject. We propose a project based learning approach addressing the full life-cycle of biomedical data on the MIMIC-III (Medical Information Mart for Intensive Care III) Open Dataset, a freely accessible database comprising information relating to patients admitted to critical care units. By means of this active learning approach, students can achieve all the learning outcomes of the subject in an integrated manner: understanding the MIMIC-III data model, using health information standards such as International Classification of Diseases 9th Edition (ICD-9), mapping to interoperability standards, querying data, creating data tables and addressing data quality towards applying reliable statistical and machine learning analysis and, developing predictive models for several tasks such as predicting in-hospital mortality. MIMIC-III is widely used in the academia and science, with a large amount of publicly available resources and scientific articles to support the students learning. Additionally, the students will gain new competences in the use of Open Data and Research Ethics and Compliance Training.
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Seoud, Lama, Farida Cheriet, Hubert Labelle i Stefan Parent. "Non-invasive quantitative assessment of scoliosis spinal surgery outcome". W SPIE Medical Imaging, redaktorzy John B. Weaver i Robert C. Molthen. SPIE, 2013. http://dx.doi.org/10.1117/12.2007515.
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Moore, Gabriel, Anton du Toit, Susie Thompson i Jillian Hutchinson. Effectiveness of secondary triage models for residents of aged care facilities. The Sax Institute, marzec 2021. http://dx.doi.org/10.57022/uvfy9478.
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This Evidence Snapshot provides a rapid review of the evidence around the effectiveness of secondary triage models for residents of aged care facilities. Models analysed included those with or without medical support, those with additional intervention in the residential aged care facilities (RACFs), and those with referral to vs collaboration with alternative services. Outcomes included were ED presentations, hospital admissions and ambulance demand. While the strength of the overall evidence is low, the strongest evidence was found for interventions in RACFs and a community-based early pre-hospital assessment model. The authors also looked at other outcomes of interest including cost-effectiveness; staffing, training and qualifications; and resident and patient participation in decision-making.
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Little, Bonnie. Outcome evaluation of medical care utilizing Goal attainment scaling. Portland State University Library, styczeń 2000. http://dx.doi.org/10.15760/etd.2801.
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Marsteller, Jill A., Vadim Dukhanin, So-Yeon Kang, Lauren E. Russell, Montrell Vass, Allen Zhang, Ritu Sharma, Eric B. Bass i Claire Snyder. Measuring Healthcare Organization Characteristics in Cancer Care Delivery Research. Agency for Healthcare Research and Quality (AHRQ), czerwiec 2023. http://dx.doi.org/10.23970/ahrqepctb43.
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Objectives. This Technical Brief aims to identify: 1) frameworks that describe organizational context and process characteristics relevant to cancer care delivery research, and compare these frameworks to the Integrated Framework recently developed by National Cancer Institute staff Weaver, Breslau, and colleagues; 2) approaches used to improve understanding of how organizational characteristics are described, measured, and analyzed in the context of cancer screening, diagnosis, or treatment; and 3) organizational context and process characteristics examined in studies assessing cancer care; and 4) evidence gaps and future research needs to advance the science of assessing the effects of organizational characteristics on cancer care. Review methods. We integrated discussions with Key Informants and syntheses of evidence from searches of literature published from 2010 to 2023, using PubMed, CINAHL, SCOPUS, PsycINFO, and the Cochrane Central Register of Controlled Trials, as well as select grey literature. Findings. We identified 17 frameworks that were developed or applied to examine the effects of organizational characteristics (including structures, context, and processes) on cancer care delivery. Our analysis of these frameworks supported the comprehensiveness of the Integrated Framework, though a few identified characteristics were not explicitly included in the Integrated Framework. We found 90 studies that take various approaches to describe, measure, and analyze organizational characteristics in the context of cancer care research. Of these, we identified 25 that tested associations between organization characteristics and screening, diagnosis, or treatment outcomes, and described measurement in detail. Cancer-related studies that include organizational measures have used a wide range of study designs and focused mostly on structural characteristics (e.g., type, size), total care models such as the patient-centered medical home, and processes of improvement project implementation and barrier assessment (such as guideline implementation). We identified specific organizational measures examined in the cancer care literature, noting little standardization of measures across studies and a need for multilevel inquiry. Our discussions with Key Informants and review of the literature indicated that many characteristics of healthcare organizations are relevant to cancer care delivery and useful to assess when precisely defined. Studies with stronger designs and more rigorous organizational measurement are needed to better determine the effects of organizational characteristics on the outcomes of cancer care. Conclusion. Our findings suggest that the Integrated Framework generally covers relevant organizational context and process characteristics. The literature has a wide array of studies examining organizational characteristics, but few studies directly associate organizational factors with clinical outcomes. Research and collaboration are needed to improve measurement of organizational factors, to clarify our understanding of multilevel aspects of organizational context and process and how they affect care, and to standardize terminology and measures.
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Parsons, Helen M., Hamdi I. Abdi, Victoria A. Nelson, Amy M. Claussen, Brittin L. Wagner, Karim T. Sadak, Peter B. Scal, Timothy J. Wilt i Mary Butler. Transitions of Care From Pediatric to Adult Services for Children With Special Healthcare Needs. Agency for Healthcare Research and Quality (AHRQ), maj 2022. http://dx.doi.org/10.23970/ahrqepccer255.
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Objective. To understand the evidence base for care interventions, implementation strategies, and between-provider communication tools among children with special healthcare needs (CSHCN) transitioning from pediatric to adult medical care services. Data sources. We searched Ovid MEDLINE, Ovid Embase, the Cochrane Central trials (CENTRAL) registry, and CINAHL to identify studies through September 10, 2021. We conducted grey literature searches to identify additional resources relevant to contextual questions. Review methods. Using a mixed-studies review approach, we searched for interventions or implementation strategies for transitioning CSHCN from pediatric to adult services. Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials, quasi-experimental observational studies, and mixed-method studies of CSHCN, their families, caregivers, or healthcare providers. We extracted basic study information from all eligible studies and grouped interventions into categories based on disease conditions. We summarized basic study characteristics for included studies and outcomes for studies assessed as low to medium risk of bias using RoB-2. Results. We identified 9,549 unique references, 440 of which represented empirical research; of these, 154 (16 major disease categories) described or examined a care transition intervention with enough detail to potentially be eligible for inclusion in any of the Key Questions. Of these, 96 studies met comparator criteria to undergo risk of bias assessment; however only 9 studies were assessed as low or medium risk of bias and included in our analytic set. Low-strength evidence shows transition clinics may not improve hemoglobin A1C levels either at 12 or 24 months in youth with type 1 diabetes mellitus compared with youth who received usual care. For all other interventions and outcomes, the evidence was insufficient to draw meaningful conclusions because the uncertainty of evidence was too high. Some approaches to addressing barriers include dedicating time and resources to support transition planning, developing a workforce trained to care for the needs of this population, and creating structured processes and tools to facilitate the transition process. No globally accepted definition for effective transition of care from pediatric to adult services for CSHCN exists; definitions are often drawn from principles for transitions, encompassing a broad set of clinical aspects and other factors that influence care outcomes or promote continuity of care. There is also no single measure or set of measures consistently used to evaluate effectiveness of transitions of care. The literature identifies a limited number of available training and other implementation strategies focused on specific clinical specialties in targeted settings. No eligible studies measured the effectiveness of providing linguistically and culturally competent healthcare for CSHCN. Identified transition care training, and care interventions to
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Bland, Cynthia, Sara Zuckerbraun, Lisa M. Lines, Anne Kenyon, Marjorie Hinsdale-Shouse, Amy Hendershott, Rebekah Sanchez i in. Challenges Facing CAHPS Surveys and Opportunities for Modernization. RTI Press, listopad 2022. http://dx.doi.org/10.3768/rtipress.2022.op.0080.2211.
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Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are a standard survey tool for obtaining patient assessments of health plans, hospitals, and health care providers. These surveys measure patient experiences of care, which is considered a component of health care quality. Providers use their survey results to improve patient experience, which is associated with better health care outcomes and reduced costs. CAHPS data also empower consumers and payers to make more informed choices about providers or facilities. Some people argue that CAHPS surveys are outdated and distract providers from clinical health care quality. In this paper, we review the benefits of CAHPS, the current challenges of these surveys, and ideas for modernization and innovation to ensure these surveys remain relevant. We encourage the Centers for Medicare & Medicaid Services (CMS) and its contractors to review and implement these innovations to the CAHPS surveys and the dissemination of their results.
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Hogaboam, Liliya. Assessment of Technology Adoption Potential of Medical Devices: Case of Wearable Sensor Products for Pervasive Care in Neurosurgery and Orthopedics. Portland State University Library, styczeń 2000. http://dx.doi.org/10.15760/etd.6093.
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Leavy, Michelle B., Costas Boussios, Robert L. Phillips, Jr., Diana Clarke, Barry Sarvet, Aziz Boxwala i Richard Gliklich. Outcome Measure Harmonization and Data Infrastructure for Patient-Centered Outcomes Research in Depression: Final Report. Agency for Healthcare Research and Quality (AHRQ), czerwiec 2022. http://dx.doi.org/10.23970/ahrqepcwhitepaperdepressionfinal.
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Objective. The objective of this project was to demonstrate the feasibility and value of collecting harmonized depression outcome measures in the patient registry and health system settings, displaying the outcome measures to clinicians to support individual patient care and population health management, and using the resulting measures data to support patient-centered outcomes research (PCOR). Methods. The harmonized depression outcome measures selected for this project were response, remission, recurrence, suicide ideation and behavior, adverse effects of treatment, and death from suicide. The measures were calculated in the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, and displayed on the registry dashboards for the participating pilot sites. At the conclusion of the data collection period (March 2020-March 2021), registry data were analyzed to describe implementation of measurement-based care and outcomes in the primary care and behavioral health care settings. To calculate and display the measures in the health system setting, a Substitutable Medical Apps, Reusable Technology (SMART) on Fast Healthcare Interoperability Resource (FHIR) application was developed and deployed at Baystate Health. Finally a stakeholder panel was convened to develop a prioritized research agenda for PCOR in depression and to provide feedback on the development of a data use and governance toolkit. Results. Calculation of the harmonized outcome measures within the PRIME Registry and PsychPRO was feasible, but technical and operational barriers needed to be overcome to ensure that relevant data were available and that the measures were meaningful to clinicians. Analysis of the registry data demonstrated that the harmonized outcome measures can be used to support PCOR across care settings and data sources. In the health system setting, this project demonstrated that it is technically and operationally feasible to use an open-source app to calculate and display the outcome measures in the clinician’s workflow. Finally, this project produced tools and resources to support future implementations of harmonized measures and use of the resulting data for research, including a prioritized research agenda and data use and governance toolkit. Conclusion. Standardization of outcome measures across patient registries and routine clinical care is an important step toward creating robust, national-level data infrastructure that could serve as the foundation for learning health systems, quality improvement initiatives, and research. This project demonstrated that it is feasible to calculate the harmonized outcome measures for depression in two patient registries and a health system setting, display the results to clinicians to support individual patient management and population health, and use the outcome measures data to support research. This project also assessed the value and burden of capturing the measures in different care settings and created standards-based tools and other resources to support future implementations of harmonized outcome measures in depression and other clinical areas. The findings and lessons learned from this project should serve as a roadmap to guide future implementations of harmonized outcome measures in depression and other clinical areas.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, lipiec 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.
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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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James-Scott, Alisha, Rachel Savoy, Donna Lynch-Smith i tracy McClinton. Impact of Central Line Bundle Care on Reduction of Central Line Associated-Infections: A Scoping Review. University of Tennessee Health Science Center, listopad 2021. http://dx.doi.org/10.21007/con.dnp.2021.0014.
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Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use. Methods A literature review was completed of nine critically appraised articles from the years 2010-2021. The association of the use of central line bundles and CLABSI rates was examined. These relationships were investigated to determine if the adherence to a central line bundle directly reduced the number of CLABSI rates in critically ill adult patients. A summary evaluation table was composed to determine the associations related to the implementation or current central line bundle care use. Results Of the study sample (N=9), all but one demonstrated a significant decrease in CLABSI rates when a central line bundle was in place. A trend towards reducing CLABSI was noted in the remaining article, a randomized controlled study, but the results were not significantly different. In all the other studies, a meta-analysis, randomized controlled trial, control trial, cohort or case-control studies, and quality improvement project, there was a significant improvement in CLABSI rates when utilizing a central line bundle. The extensive use of different levels of evidence provided an excellent synopsis that implementing a central line bundle care would directly affect decreasing CLABSI rates. Implications for Nursing Practice Results provided in this scoping review afforded the authors a diverse level of evidence that using a central line bundle has a direct outcome on reducing CLABSI rates. This practice can be implemented within the hospital setting as suggested by the literature review to prevent or reduce CLABSI rates. Implementing a standard central line bundle care hospital-wide helps avoid this hospital-acquired infection.
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Smit, Amelia, Kate Dunlop, Nehal Singh, Diona Damian, Kylie Vuong i Anne Cust. Primary prevention of skin cancer in primary care settings. The Sax Institute, sierpień 2022. http://dx.doi.org/10.57022/qpsm1481.
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Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.