ResearchPad - nurses https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Development and validation of a questionnaire to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy]]> https://www.researchpad.co/article/elastic_article_7826 Cardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancyMethodsThe study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire.ResultsThe expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach’s alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts’ test of sphericity was greater than the critical value for chi-square, and significant (p < .0001).ConclusionsFindings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy. ]]> <![CDATA[Deep learning assessment of breast terminal duct lobular unit involution: Towards automated prediction of breast cancer risk]]> https://www.researchpad.co/article/N8ae86a5e-90c1-41b1-ba31-58a5a939e3bc

Terminal duct lobular unit (TDLU) involution is the regression of milk-producing structures in the breast. Women with less TDLU involution are more likely to develop breast cancer. A major bottleneck in studying TDLU involution in large cohort studies is the need for labor-intensive manual assessment of TDLUs. We developed a computational pathology solution to automatically capture TDLU involution measures. Whole slide images (WSIs) of benign breast biopsies were obtained from the Nurses’ Health Study. A set of 92 WSIs was annotated for acini, TDLUs and adipose tissue to train deep convolutional neural network (CNN) models for detection of acini, and segmentation of TDLUs and adipose tissue. These networks were integrated into a single computational method to capture TDLU involution measures including number of TDLUs per tissue area, median TDLU span and median number of acini per TDLU. We validated our method on 40 additional WSIs by comparing with manually acquired measures. Our CNN models detected acini with an F1 score of 0.73±0.07, and segmented TDLUs and adipose tissue with Dice scores of 0.84±0.13 and 0.87±0.04, respectively. The inter-observer ICC scores for manual assessments on 40 WSIs of number of TDLUs per tissue area, median TDLU span, and median acini count per TDLU were 0.71, 0.81 and 0.73, respectively. Intra-observer reliability was evaluated on 10/40 WSIs with ICC scores of >0.8. Inter-observer ICC scores between automated results and the mean of the two observers were: 0.80 for number of TDLUs per tissue area, 0.57 for median TDLU span, and 0.80 for median acini count per TDLU. TDLU involution measures evaluated by manual and automated assessment were inversely associated with age and menopausal status. We developed a computational pathology method to measure TDLU involution. This technology eliminates the labor-intensiveness and subjectivity of manual TDLU assessment, and can be applied to future breast cancer risk studies.

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<![CDATA[Assessing and preventing low back pain in nurses. Implications for practice management]]> https://www.researchpad.co/article/Na4c74345-8537-4d8e-a319-259a1e2e7513

Background and aims:

The prevention of low back pain (LBP) among nurses employed in hospital departments represents a special concern for healthcare organizations globally. A growing literature evidences the need of workplace policy development related to organizational issues as strategic contribution to minimize the occurrence of LBP in healthcare sector. The purposes of this study were: 1) to analyze the relationship between shiftwork and acute LBP among female shift nurses; 2) to detect preventive interventions targeted on organizational issues.

Methods:

The authors conducted a cross-sectional nested case-control analysis of data concerning acute LBP and staffing data for 671 nurses employed in the Departments of General Practice and Elderly Care Medicine. The statistical analysis consisted of a logistic regression to calculate incidence odds ratios with 95% confidence intervals. Chi-square test and t-test were used to examine the relationship between categorical and continuous data, respectively.

Results:

The occurrence of acute LBP resulted significantly related to nightshift, extended shifts, obesity; the adoption of forward rotating schedules was found a protective factor in moderating the occupational risk of acute LBP in shift nurses.

Conclusions:

In this study the authors observed an association between shiftwork and acute LBP; improvement interventions should be aimed at: 1) moderating organizational risks linked with shiftwork schedules; 2) promoting healthy lifestyles. These interventions are suggested as a strategic way to effectively manage the phenomenon among female rotating shift nurses. (www.actabiomedica.it)

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<![CDATA[Emotional exhaustion among healthcare professionals: the effects of role ambiguity, work engagement and professional commitment]]> https://www.researchpad.co/article/Nb9baaa41-7f61-4690-a873-1832ad111da8

Background and aim:

The study aims at identifying the antecedents and consequences of emotional exhaustion in health professionals and, particularly, examining the process that leads from a hindrance demand, like role ambiguity, to exhaustion and job satisfaction. Emotional exhaustion is a phenomenon that affect health professionals with negative consequence on job satisfaction, and literature has underlined that job demands could be may be a cause of this chronic stress. However, the relationship among job demands, work engagement and exhaustion has produced results not always converging.

Method:

A self-report questionnaire was administered to 66 health professionals.

Results:

The results showed that the effect of role ambiguity on emotional exhaustion was mediated by work engagement and the emotional exhaustion impairs job satisfaction when workers are not committed to their profession.

Conclusions:

Role ambiguity represents a psychosocial risk factor that influence workers’ wellbeing diminishing the level of motivation and this process leads to emotional exhaustion. However, professional commitment appears to be a resource that can protect professionals preventing a decrease in satisfaction. These findings suggest that human resource management should remove hindrance stressors and enhance the mission of Healthcare Professionals in order to increase employees’ work engagement and prevent exhaustion. (www.actabiomedica.it)

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<![CDATA[Predicting resource-dependent maternal health outcomes at a referral hospital in Zanzibar using patient trajectories and mathematical modeling]]> https://www.researchpad.co/article/5c8823d5d5eed0c4846390ee

Poor intra-facility maternity care is a major contributor to maternal mortality in low- and middle-income countries. Close to 830 women die each day due to preventable maternal complications, partly due to the increasing number of women giving birth in health facilities that are not adequately resourced to manage growing patient populations. Barriers to adequate care during the ‘last mile’ of healthcare delivery are attributable to deficiencies at multiple levels: education, staff, medication, facilities, and delays in receiving care. Moreover, the scope and multi-scale interdependence of these factors make individual contributions of each challenging to analyze, particularly in settings where basic data registration is often lacking. To address this need, we have designed and implemented a novel systems-level and dynamic mathematical model that simulates the impact of hospital resource allocations on maternal mortality rates at Mnazi Mmoja Hospital (MMH), a referral hospital in Zanzibar, Tanzania. The purpose of this model is to provide a rigorous and flexible tool that enables hospital administrators and public health officials to quantitatively analyze the impact of resource constraints on patient outcomes within the maternity ward, and prioritize key areas for further human or capital investment. Currently, no such tool exists to assist administrators and policy makers with effective resource allocation and planning. This paper describes the structure and construct of the model, provides validation of the assumptions made with anonymized patient data and discusses the predictive capacity of our model. Application of the model to specific resource allocations, maternal treatment plans, and hospital loads at MMH indicates through quantitative results that medicine stocking schedules and staff allocations are key areas that can be addressed to reduce mortality by up to 5-fold. With data-driven evidence provided by the model, hospital staff, administration, and the local ministries of health can enact policy changes and implement targeted interventions to improve maternal health outcomes at MMH. While our model is able to determine specific gaps in resources and health care delivery specifically at MMH, the model should be viewed as an additional tool that may be used by other facilities seeking to analyze and improve maternal health outcomes in resource constrained environments.

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<![CDATA[Differential completeness of spontaneous adverse event reports among hospitals/clinics, pharmacies, consumers, and pharmaceutical companies in South Korea]]> https://www.researchpad.co/article/5c6f14f7d5eed0c48467abbe

The differential pattern and characteristics of completeness in adverse event (AE) reports generated by hospitals/clinics, pharmacies, consumer and pharmaceutical companies remain unknown. Thus, we identified the characteristics of complete AE reports, compared with those of incomplete AE reports, using a completeness score. We used Korea Institute of Drug Safety and Risk Management-Korea Adverse Event Reporting System Database (KIDS-KD) between January 1, 2016 and December 31, 2016. The completeness score was determined out of a total of 100 points, based on the presence of information on temporal relationships, age and sex of patients, AE progress, name of reported medication, reporting group by profession, causality assessment, and informational text. AE reports were organized into four groups based on affiliation: hospitals/clinics, pharmacies, consumers, and pharmaceutical companies. Affiliations that had median completeness scores greater than 80 points were classified as ‘well-documented’ and these reports were further analyzed by logistic regression to estimate the adjusted odds ratios and 95% confidence intervals. We examined 228,848 individual reports and 735,745 drug-AE combinations. The median values of the completeness scores were the highest for hospitals/clinics (95 points), followed by those for consumers (85), pharmacies (75), and manufacturers (72). Reports with causality assessment of ‘certain’, ‘probable’, or ‘possible’ were more likely to be ‘well-documented’ than reports that had causality assessments of ‘unlikely’. Serious reports of AEs were positively associated with ‘well-documented’ reports and negatively associated with hospitals/clinics.

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<![CDATA[Austerity measures and the transforming role of A&E professionals in a weakening welfare system]]> https://www.researchpad.co/article/5c6dca19d5eed0c48452a785

In 2010, the UK embarked on a self-imposed programme of contractionary measures signalling the beginning of a so-called “age of austerity” for the country. It was argued that budgetary cuts were the most appropriate means of eliminating deficits and decreasing national debt as percentage of General Domestic Product (GDP). Although the budget for the National Health Service (NHS) was not reduced, a below-the-average increase in funding, and cuts in other areas of public spending, particularly in social care and welfare spending, impacted significantly on the NHS. One of the areas where the impact of austerity was most dramatically felt was in Accidents and Emergency Departments (A&E). A number of economic and statistical reports and quantitative studies have explored and documented the effects of austerity in healthcare in the UK, but there is a paucity of research looking at the effects of austerity from the standpoint of the healthcare professionals. In this paper, we report findings from a qualitative study with healthcare professionals working in A&E departments in England. The study findings are presented thematically in three sections. The main theme that runs through all three sections is the perceptions of austerity as shaping the functioning of A&E departments, of healthcare professions and of professionals themselves. The first section discusses the rising demand for services and resources, and the changed demographic of A&E patients—altering the meaning of A&E from ‘Accidents and Emergencies’ to the Department for ‘Anything and Everything’. The second section in this study’s findings, explores how austerity policies are perceived to affect the character of healthcare in A&E. It discusses how an increased focus on the procedures, time-keeping and the operationalisation of healthcare is considered to detract from values such as empathy in interactions with patients. In the third section, the effects of austerity on the morale and motivations of healthcare professionals themselves are presented. Here, the concepts of moral distress and burnout are used in the analysis of the experiences and feelings of being devalued. From these accounts and insights, we analyse austerity as a catalyst or mechanism for a significant shift in the practice and function of the NHS–in particular, a shift in what is counted, measured and valued at departmental, professional and personal levels in A&E.

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<![CDATA[Patients’ experiences with a behaviour change intervention to enhance physical activity in primary care: A mixed methods study]]> https://www.researchpad.co/article/5c6c757cd5eed0c4843cfe09

Objective

To explore the experiences of patients at risk for cardiovascular disease in primary care with the Activate intervention in relation to their success in increasing their physical activity.

Methods

A convergent mixed methods study was conducted, parallel to a cluster-randomised controlled trial in primary care, using a questionnaire and semi-structured interviews. Questionnaires from 67 patients were analysed, and semi-structured interviews of 22 patients were thematically analysed. Experiences of patients who had objectively increased their physical activity (responders) were compared to those who had not (non-responders). Objective success was analysed in relation to self-perceived success.

Results

The questionnaire and interview data corresponded, and no substantial differences among responders and non-responders emerged. Participating in the intervention increased patients’ awareness of their physical activity and their physical activity level. Key components of the intervention were the subsequent support of nurses with whom patients’ have a trustful relationship and the use of self-monitoring tools. Patients highly valued jointly setting goals, planning actions, receiving feedback and review on their goal attainment and jointly solving problems. Nurses’ support, the use of self-monitoring tools, and involving others incentivised patients to increase their physical activity. Internal circumstances and external circumstances challenged patients’ engagement in increasing and maintaining their physical activity.

Conclusion

Patients experienced the Activate intervention as valuable to increase and maintain their physical activity, irrespective of their objective change in physical activity. The findings enable the understanding of the effectiveness of the intervention and implementation in primary care.

Trial registration

ClinicalTrials.gov NCT02725203.

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<![CDATA[Perceptions of nurses on human papillomavirus vaccinations in the Republic of Korea]]> https://www.researchpad.co/article/5c648cc6d5eed0c484c81769

Background

In June 2016, the Republic of Korea included free human papillomavirus (HPV) vaccinations for all 12-year-old girls in its national immunization program.

Purpose

This study investigated perceptions of nurses on HPV vaccination and their intent to vaccinate preteens at the best ages.

Methods

Recruited for the survey were 514 health teachers (181, 35.2%), public health nurses (168, 32.7%), and clinical nurses (165, 32.1%). Factor-analysis was conducted to validate the Vaccine-Hesitancy Scale for Korean nurses. Related variables associated with vaccine-acceptance were examined using the Kruskal–Wallis test and Spearman’s rho coefficients, due to lack of normalization.

Results

Factor-analysis results showed that two factors of positive acceptance (7 items) and negative acceptance (3 items) accounted for 67.46% of the total variance, and explained 47.4% and 20.1%, respectively. Nurses who positively accepted HPV vaccine differed significantly in agreement to vaccinate girls or boys. For the proper vaccination age, a significant difference emerged between answers for girls and vaccine-acceptance scores, whereas no difference emerged between answers for boys and the scores. The vaccinated status of respondents significantly related to higher HPV vaccine acceptance, although age, religion, marital status, education, and working duration did not.

Conclusions

This study showed that vaccine-acceptance levels reflect nurses’ attitudes and opinions about HPV vaccination for girls and boys.

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<![CDATA[Is there an association between consent rates in Swiss hospitals and critical care staffs' attitudes towards organ donation, their knowledge and confidence in the donation process?]]> https://www.researchpad.co/article/5c6730d8d5eed0c484f38205

This study investigated the critical care staff’s attitude, knowledge and involvement with donation, skills and confidence with donation-related tasks and their association with consent rates at the hospital level. In 2015, we conducted a cross-sectional survey among critical care staff of hospitals involved in organ donation using an anonymous online questionnaire with a response rate of 56.4% (n = 2799). The hospital level consent rate was obtained from the Swiss Monitoring of Potential Donors database (2013–2015). For each hospital, we calculated a mean score for each predictor of interest of the Hospital Attitude Survey and investigated the association with hospital consent rates with generalized linear mixed-effect models. In univariable analysis, one score point increase in doctors' confidence resulted in a 66% (95% CI: 45%–80%) reduction in the odds to consent, and one score point increase in nurses' attitudes resulted in a 223% (95% CI: 84%–472%) increase in the odds to consent. After simultaneously adjusting for all major predictors found in the crude models, only levels of education of medical and nursing staff remained as significant predictors for hospital consent rates. In Switzerland, efforts are needed to increase consent rates for organ donation and should concentrate on continuous support as well as specific training of the hospital staff involved in the donation process.

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<![CDATA[Adherence to isoniazid preventive therapy among child contacts in Rwanda: A mixed-methods study]]> https://www.researchpad.co/article/5c6b269fd5eed0c484289d89

Background

The World Health Organization recommends isoniazid preventive therapy (IPT) for six months for child contacts without tuberculosis (TB), who are exposed to an adult with active TB. The effectiveness of IPT depends on 80% or greater adherence to medication. In the current study, we assessed IPT adherence and explored barriers to and facilitators of adherence among eligible child contacts in Kigali, Rwanda.

Methods

A mixed method study design was used to prospectively assess adherence to IPT among eligible child contacts and its associated factors through a quantitative, observational cohort study, and to explore barriers to and facilitators of adherence to IPT through a descriptive qualitative study.

Results

Of the 84 child contacts who started IPT, 74 (88%) had complete adherence and ten (12%) had incomplete adherence. There were no factors (individual characteristics of index cases, households and or health facility characteristics) found to be significantly associated with IPT adherence in the bivariate and multivariate analysis. In the qualitative analysis, we identified factors relating to parents/caregivers, disease, household and health-care providers as major themes determining IPT adherence.

Conclusion

There was a high rate of IPT completion in this cohort of eligible child contacts living in Kigali. However, structural factors (poverty and relocation) were found to be the main barriers to IPT adherence that could be addressed by health-care providers.

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<![CDATA[Development and validation of a questionnaire to assess the doctors and nurses knowledge of acute oxygen therapy]]> https://www.researchpad.co/article/5c61e924d5eed0c48496f865

Background

Prescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health care providers on various aspects of oxygen therapy, and this may be a barrier to optimal oxygen administration. Hence, it is essential to ascertain providers’ knowledge of acute oxygen therapy so that appropriate educational interventions are instituted for better delivery. There is no available validated instrument to assess knowledge of acute oxygen therapy. The study aimed to develop, validate and evaluate the test-retest reliability of a questionnaire to determine the doctors and nurses understanding of acute oxygen therapy.

Methods

This study involved the development of the questionnaire contents by a literature review, assessment of face validity (n = 5), content validity, using a panel of experts (n = 10), item analysis and test-retest reliability among a sample (n = 121) of doctors and nurses.

Results

Face validity indicated that the questionnaire was quick to complete (10–15 min), most items were easy to follow and comprehensible. The global content validity index (S-CVI) was 0.85. The test-retest reliability statistics showed a kappa coefficient of 0.546–0.897 (all P<0.001) and percentage agreement of 80–98.3% indicating high temporal stability in the target population. In total, 90% of the items fulfilled the reliability acceptance criteria. Item discrimination analysis showed that most questions were at an acceptable level. The final questionnaire included 37 item questions and eight sections.

Conclusion

The designed questionnaire is a reliable and valid tool for assessing knowledge of acute oxygen therapy among doctors and nurses.

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<![CDATA[Economic benefits of subcutaneous trastuzumab administration: A single institutional study from Karolinska University Hospital in Sweden]]> https://www.researchpad.co/article/5c61e8f9d5eed0c48496f56c

Introduction

Adjuvant trastuzumab is a standard of care in the treatment of Human Epidermal growth factor Receptor 2 (HER2) positive early breast cancer (eBC). Initially trastuzumab could only be administered intravenously (IV), however since 2013, a subcutaneous (SC) formulation with comparable efficacy and safety profile is available and preferred by patients. Trastuzumab SC does not require pharmacy preparation and has shorter administration time. The objective of this study was to estimate the economic efficiency of the SC formulation of trastuzumab by assessing the economic benefits of actual SC-driven process changes at one single Swedish healthcare institution.

Methods

This study analyzes changes in trastuzumab administration practice after the SC formulation was introduced at the Karolinska University Hospital. Process changes were identified and introduced in order to capitalize on the inherent work efficiency benefits of the SC formulation. Actual hospital data for 2015 were used to quantitatively estimate the annual economic impact of the changes. It encompassed administrative (i.e. non-medical) data of 178 newly diagnosed HER2-positive eBC patients and a total of 2,769 SC administrations. Realized economic benefits were expressed in hours saved by nurses, direct monetary cost savings and potential infusion fee revenue that could be earned through infrastructural revenue gains.

Results

In 2015, the replacement of IV infusion to SC administration generated total time savings of more than 1,100 hours, and led to direct monetary cost savings of 603,000 EUR. It unlocked a capacity gain of 1–2 additional administrations daily within the existing facility infrastructure. Given the current remuneration structure per administration, this revenue gain translated into an incremental revenue potential of up to 3 million EUR.

Conclusion

Data from this study showed that the shift from trastuzumab IV to SC formulation resulted in significant economic effects in terms of departmental resources related to time, direct monetary cost savings, and infrastructural revenue gains.

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<![CDATA[Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents]]> https://www.researchpad.co/article/5c5df351d5eed0c48458114b

Background and objectives

Nurses serve as gatekeepers of the health of long-term care facility (LTCF) residents and are key members deciding whether residents should visit an emergency department (ED). Inappropriate decisions as to ED visits may result in ED overcrowding, excessive medical expenses, and nosocomial infections. Currently, there is a lack of effective tools for assessing the barriers and level of difficulty experienced by LTCF nurses. The purposes of this study were to develop a Patient Transfer Decision Difficulty Scale (PTDDS) and test its effectiveness.

Methods

This study randomly sampled LTCFs in Taiwan and surveyed two or three nurses in every institution selected. Registered return envelopes were provided for participants to return self-completed questionnaires. Three steps were used to develop the scale and items: in step I, the instrument was developed; in step II, psychometric testing was conducted, which entailed performing an exploratory factor analysis (EFA) to verify the construct validity and reliability of the developed items; and in step III, a confirmation study was conducted using a confirmatory factor analysis (CFA) and structural equation modeling to cross-validate the factors and items.

Results

The cumulative sum of variance explained by the measurement models of the three factors in the PTDDS was 63.54%.When deciding whether to transfer LTCF residents to EDs, the most pronounced barrier experienced by nurses were for judging the severity of “clinical episodes”, which had an explanatory power of 37.49%. The second and third pronounced barriers and decision difficulty experienced by nurses were “communication and information” and “timing of the residents’ emergency visits,” which explained 16.81% and 9.24% of the variance, respectively.

Conclusions

The cross-validation results obtained using the EFA and CFA showed favorable reliability and validity of the PTDDS. For future studies, this study recommends performing large-scale investigations of the level of decision difficulty and related factors experienced by nurses in LTCFs of varying levels and types.

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<![CDATA[The Copenhagen Triage Algorithm is non-inferior to a traditional triage algorithm: A cluster-randomized study]]> https://www.researchpad.co/article/5c61e8bdd5eed0c48496f08e

Introduction

Triage systems with limited room for clinical judgment are used by emergency departments (EDs) worldwide. The Copenhagen Triage Algorithm (CTA) is a simplified triage system with a clinical assessment.

Methods

The trial was a non-inferiority, two-center cluster-randomized crossover study where CTA was compared to a local adaptation of Adaptive Process Triage (ADAPT). CTA involves initial categorization based on vital signs with a final modification based on clinical assessment by an ED nurse. We used 30-day mortality with a non-inferiority margin at 0.5%. Predictive performance was compared using Receiver Operator Characteristics.

Results

We included 45,347 patient visits, 23,158 (51%) and 22,189 (49%) were triaged with CTA and ADAPT respectively with a 30-day mortality of 3.42% and 3.43% (P = 0.996) a difference of 0.01% (95% CI: -0.34 to 0.33), which met the non-inferiority criteria. Mortality at 48 hours was 0.62% vs. 0.71%, (P = 0.26) and 6.38% vs. 6.61%, (P = 0.32) at 90 days for CTA and ADAPT. CTA triaged at significantly lower urgency level (P<0.001) and was superior in predicting 30-day mortality, Area under the curve: 0.67 (95% CI 0.65–0.69) compared to 0.64 for ADAPT (95% CI 0.62–0.66) (P = 0.03). There were no significant differences in rate of admission to the intensive care unit, length of stay, waiting time nor rate of readmission within 30 or 90 days.

Conclusion

A novel triage system based on vital signs and a clinical assessment by an ED nurse was non-inferior to a traditional triage algorithm by short term mortality, and superior in predicting 30-day mortality.

Trial registration

Clinicaltrials.gov NCT02698319

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<![CDATA[Scoping review to identify and map the health personnel considered skilled birth attendants in low-and-middle income countries from 2000–2015]]> https://www.researchpad.co/article/5c5df337d5eed0c484580f2e

Introduction

The “percentage of births attended by a skilled birth attendant" (SBA) is an indicator that has been adopted by several global monitoring frameworks, including the Sustainable Development Goal (SDG) agenda for regular monitoring as part of target 3.1 for reducing maternal mortality by 2030. However, accurate and consistent measurement is challenged by contextual differences between and within countries on the definition of SBA, including the education, training, competencies, and functions they are qualified to perform. This scoping review identifies and maps the health personnel considered SBA in low-to-middle-income-countries (LMIC).

Methods and analysis

A search was conducted inclusive to the years 2000 to 2015 in PubMed/MEDLINE, EMBASE, CINAHL Complete, Cochrane Database of Systematic Reviews, POPLINE and the World Health Organization Global Index Medicus. Original primary source research conducted in LMIC that evaluated the skilled health personnel providing interventions during labour and childbirth were considered for inclusion. All studies reported disaggregated data of SBA cadres and were disaggregated by country.

Results

The search of electronic databases identified a total of 23,743 articles. Overall, 70 articles were included in the narrative synthesis. A total of 102 unique cadres names were identified from 36 LMIC countries. Of the cadres included, 16% represented doctors, 16% were nurses, and 15% were midwives. We found substantial heterogeneity between and within countries on the reported definition of SBA and the education, training, skills and competencies that they were able to perform.

Conclusion

The uncertainty and diversity of reported qualifications and competency of SBA within and between countries requires attention in order to better ascertain strategic priorities for future health system planning, including training and education. These results can inform recommendations around improved coverage measurement and monitoring of SBA moving forward, allowing for more accurate, consistent, and timely data able to guide decisions and action around planning and implementation of maternal and newborn health programmes.

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<![CDATA[Prospective evaluation of a dynamic insulin infusion algorithm for non critically-ill diabetic patients: A before-after study]]> https://www.researchpad.co/article/5c58d61bd5eed0c48403163c

Introduction

Insulin infusion is recommended during management of diabetic patients in critical care units to rapidly achieve glycaemic stability and reduce the mortality. The application of an easy-to-use standardized protocol, compatible with the workload is preferred. Glycaemic target must quickly be reached, therefore static algorithms should be replaced by dynamic ones. The dynamic algorithm seems closer to the physiological situation and appreciates insulin sensitivity. However, the protocol must meet both safety and efficiency requirements. Indeed, apprehension from hypoglycaemia is the main deadlock with the dynamic algorithms, thus their application remains limited. In contrary to the critical care units, to date, no prospective study evaluated a dynamic algorithm of insulin infusion in non-critically ill patients.

Aim

This study primarily aimed to evaluate the efficacy of a dynamic algorithm of intravenous insulin therapy in non-critically-ill patients, and addressed its safety and feasibility in different departments of our university hospital.

Methods

A "before-after" study was conducted in five hospital departments (endocrinology and four “non-expert” units) comparing a dynamic algorithm (during the "after" period-P2) to the static protocol (the “before” period-P1). Static protocol is based on determining insulin infusion according to an instant blood glycaemia (BG) level at a given time. In the dynamic algorithm, insulin infusion rate is determined according to the rate of change of the BG (the previous and actual BG under a specific insulin infusion rate). Additionally, two distinct glycaemic targets were defined according to the patients’ profile: 100–180 mg/dl (5.5–10 mmol/l) for vigorous patients and 140–220 mg/dl (7.8–12.2 mmol/l) for frail ones. Different BG measurements for each patient were collected and recorded in a specific database (e-CRF) in order to analyse the rates of hypo- and hyperglycaemia. A satisfaction survey was also performed. A study approval was obtained from the institutional revision board before starting the study.

Results

Over 8 months, 72 and 66 patients during P1 and P2 were respectively included. The dynamic algorithm was more efficient, with reduced time to control hyperglycaemia (P1 vs P2:8.3 vs 5.3 hours; HR: 2.02 [1.27; 3.21]; p<0.01), increased the number of in-target BG measurements (P1 vs P2: 37.0% vs 41.8%; p<0.05), and reduced the glycaemic variability related to each patient (P1 vs P2, %CV: 40.9 vs 38.2;p<0.05, Index Correlation Class:0.30 vs 0.14; p<0.05). In patients after the first event of hypoglycemia after having started the infusion, new events were lower (P1 vs P2: 19.4 vs 11.4; p<0.001) thanks to an earlier reaction to hypoglycaemia (8.3% during P1 vs 44.3% during P2; p = 0.004). With the dynamic algorithm, the percentage of recurrence of mild hypoglycaemia was significantly lower in frail patients (20.5% vs 10.2%; p<0.001), and in patients managed in the non-expert units (18 vs 7.1%, p<0.001). The %CV was significantly improved in frail patients (36.9%). Mean BG measurements for each patient/day were 5.5±1.1 during P1 and 6.0±1.6 during P2 (p = 0.6). The threat from hypoglycaemia and the difficulty in using dynamic algorithm are barriers for nurses’ adherence.

Conclusions

This dynamic algorithm for non-critically-ill patients is more efficient and safe than the static protocol, and adapted for frail patients and non-expert units.

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<![CDATA[A model based on intensity of medical care may improve outcomes for internal medicine patients in Italy]]> https://www.researchpad.co/article/5c5ca2a1d5eed0c48441e7b2

Background

In medical wards, to guarantee safe, sustainable and effective treatments to heterogeneous and complex patients, care should be graduated into different levels of clinical intensity based on a standardised assessment of acute-illness severity. To support this assumption, we conducted a prospective observational study on all unselected admissions of 3,381 patients to a medium size internal Italian Medicine Unit by comparing Standard Medical Care model (SMC) to a new paradigm of patient admission based on Intensity of Medical Care (IMC).

Methods

The SMC operated during 2013, while an IMC organizational model started in 2014. In SMC, patient’s admission was performed according to bed availability only. In IMC, after the stratification of clinical instability performed using the National Early Warning Score (NEWS) and clinical judgment, patients were allocated to three different ward areas (high, middle, and post-acute medical care). We compared clinical and organizational outcomes of IMC patients (2015) to SMC patients (2013), performing adjusted logistic regression model.

Results

We managed 1,609 and 1,772 patients using SMC and IMC, respectively. The IMC seemed to be associated to a lower risk of clinical worsening for patients. Comparing IMC to SMC, the odds ratio (aOR) for urgent transfers to intensive care units was 0.69 (p = 0.03), and for combination of urgent transfers and early deaths was 0.68 (p<0.01).

Conclusions

Redesigning the configuration of internal medicine ward to support urgency and competency of the clinical response by applying IMC paradigm based on the NEWS, improved outcomes in patients with acute illness and enhanced ward performances.

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<![CDATA[Urinary incontinence and its relation to delivery circumstances: A population-based study from rural Kilimanjaro, Tanzania]]> https://www.researchpad.co/article/5c521845d5eed0c4847979a0

Objectives

To investigate the prevalence and risk factors of urinary incontinence (UI), the different UI subtypes and the association between UI and delivery circumstances.

Design

Cross-sectional population-based study conducted in Kilimanjaro Region, Tanzania.

Participants and settings

1048 women aged 18–90 women living in rural Kilimanjaro. Simple random sampling was done to select villages, households and participants. Community health workers helped in identifying eligible women and trained nurses/midwives conducted face-to-face interviews. Data were analysed using descriptive statistics and Univariate and Multivariate logistic regression modelling.

Results

The overall prevalence rate of UI was 42%. When focusing on the different types of UI, 17% of the women had stress UI, 9% had urge UI and 16% had mixed UI. Only one woman (0.1%) with vesico-vaginal fistula was identified. UI was found to be significantly associated with increasing parity (OR = 2.41 (1.55–3.74). In addition, women who in relation to their first delivery had delivered at home or had been in labour for more than 24 hours, had increased adjusted ORs of 1.70(1.08–2.68) and 2.10(1.08–4.10), respectively, for having UI.

Conclusion

UI is common in rural Tanzania and of the subtypes of UI, Stress Urinary Incontinence (SUI) is the commonest followed by Mixed Urinary Incontinence (MUI). Home delivery, prolonged labour and increasing parity especially having 5 or more deliveries are associated with increased risk for developing UI.

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<![CDATA[Development and validation of two questionnaires: Dental home care and dental health in Swedish dogs]]> https://www.researchpad.co/article/5c644887d5eed0c484c2e86e

Background

Dental disease is one of the most common health problems in dogs. However, no studies have investigated the attitudes, opinions and practices of dog owners, veterinarians and veterinary nurses regarding dental health and preventative dental home care in dogs. The objective of this study was therefore to develop and validate questionnaires for this purpose, in accordance with survey methodology guidelines.

Methods

Questionnaire items were determined based on the authors’ academic knowledge and clinical experience, and modified throughout the validation process. Several measures were taken to reduce sampling, coverage, measurement and non-response errors. Content validity was assessed by Subject-Matter Experts (SME) and cognitive interviews were conducted in accordance with the “think-aloud protocol”. Non-response analysis was performed using several methods.

Results

Constructs were identified using exploratory factor analysis and two predefined constructs from the dog owner questionnaire were confirmed “Dog owners’ attitudes towards brushing their dog’s teeth” (Cronbach’s α = 0.86) and “Dog owners’ assessment of their dog’s dental health” (α = 0.76). Additionally, exploratory factor analysis identified three potential constructs. In the veterinary health practitioner questionnaire, two constructs were identified: “Veterinary health practitioners’ attitudes towards dental chews and dental feed” (α = 0.78) and “Veterinary health practitioners’ attitudes and opinions on dental problems and dental cleaning” (α = 0.73). Non-response analysis showed a higher proportion of women in the sample of dog owners and veterinarians compared to the target populations. Veterinarians in the sample were also younger. In contrast, gender and age distributions in veterinary nurses did not differ between sample and target.

Conclusion

The validation presented in this work showed that the developed questionnaires could be used as accurate and reliable tools for measuring attitudes and practices regarding dental home care in dogs among Swedish dog owners, veterinarians and veterinary nurses.

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