Scaling Innovation in a Publicly Funded System: A UK Pathway From Evidence to Adoption.

P 15 PARROT Ireland – Placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity – A stepped wedge cluster randomised control trial

National scale hydrological models are required for many types of water sector applications, for example water resources planning. Existing UK national-scale model frameworks are based on conceptual numerical schemes, with an emerging trend towards incorporating deep learning models. Existing literature has shown that groundwater/surface water interactions are key for accurately representing future flows, and these processes are most accurately represented with physically-based hydrological models. In response to this, our study undertakes a comparative analysis of three national model frameworks (Neural Hydrology, HBV, SHETRAN) to investigate the necessity for physically-based hydrological modelling. The models were run with the full ensemble of bias-corrected UKCP18 12km RCM data which enabled a direct comparison of future flow projections. We show that whilst many national frameworks perform well for the historical period, physically-based models can give substantially different projections of future flows, particularly low flows. Moreover, our study illustrates that the physically-based model exhibits a consistent trajectory in Budyko space between the baseline and future simulations, a characteristic not shared by conceptual and deep learning models. To provide context for these results, we incorporate insights from other national model frameworks, including the eFlag project.

Emergency department (ED) computed tomography (CT) use has increased significantly during the past decade. It has been suggested that adherence to clinical decision support (CDS) may result in a safe decrease in CT ordering. In this study, the authors quantified the percentage agreement between routine and CDS-recommended care and the anticipated consequence of strict adherence to CDS on CT use in mild traumatic brain injury (mTBI). This was a prospective observational study of patients with mTBI who presented to an urban academic ED of a tertiary care hospital. Patients 18 years or older, presenting within 24 hours of nonpenetrating trauma to the head, from August 2010 to July 2011, were eligible for enrollment. Structured data forms were completed by trained research assistants (RAs). The primary outcome was the percentage agreement between routine head CT use and CDS-recommended head CT use. CDS examined were: the 2008 American College of Emergency Physicians [ACEP] neuroimaging, the New Orleans rule, and the Canadian head CT rule. Differences between outcome groups were assessed using the chi-square test for categorical variables and the Kruskal-Wallis rank test for continuous variables. The percentage agreement between routine practice and CDS-recommended practice was calculated. Of the 169 patients enrolled, 130 (76.9%) received head CT scans, and five of the 130 (3.8%) had acute traumatic intracranial findings. For all subjects, agreement between routine practice and CDS-recommended practice was 77.5, 65.7, and 78.1%, for the ACEP, Canadian, and New Orleans CDS, respectively. Strict adherence to the 2008 ACEP neuroimaging CDS would result in no statistically significant difference in head CT use (routine care, 76.9%; CDS-recommended, 82.8%; p = 0.17). Strict adherence to the New Orleans CDS would result in an increase in head CT use (routine care, 76.9%; CDS-recommended, 94.1%; p < 0.01). Strict adherence to the Canadian CDS would result in a decrease in head CT use (routine care, 76.9%; CDS-recommended, 56.8%; p < 0.01). There is a 60% to 80% agreement between routine and CDS-recommended head CT use. Of the three CDS systems examined, the only one that may result in a reduction in head CT use if strictly followed was the Canadian head CT CDS. Further studies are needed to examine reasons for the less than optimal agreement between routine care and care recommended by the Canadian head CT CDS.

IntroductionPublic healthcare institutions (PHIs) experience rising and discordant implant costs. Implementing subsidies for implants without concurrent price harmonization through national procurement contracts impedes equitable patient access. This abstract describes the collaboration between the Agency for Care Effectiveness (ACE), Singapore’s national health technology assessment (HTA) agency, and the public healthcare supply chain agency (ALPS) to establish the Implant Subsidy List (ISL).MethodsThe alignment between ISL and concurrent national procurement contracts for implants required close coordination and co-development of streamlined and scalable processes. To achieve this, ACE and ALPS collaborated to understand the complex implant landscape by leveraging on known vendors and products and pre-empting upcoming ones, identifying key opinion leaders, and sharing technical expertise. Both agencies also developed common-use templates and streamlined vendor submission processes. Of note, joint request-for-proposal (RFP) exercises for national subsidy and procurement listings combined negotiation efforts to achieve lower implant prices. Regular cross-agency discussions enabled continuous knowledge sharing and process refinement in an evolving implants landscape.ResultsFor phase one rollout of ISL, 15 implant topics across eight clinical functions were evaluated, supported by concurrent establishment of 15 national procurement contracts. As of December 2023, ACE listed 22,689 ISL implants for implementation, with more topics onboarded on a rolling basis. ACE and ALPS streamlined process flows, standardized communications channels and information, and utilized contractual tools. Vendors could submit for both subsidy and procurement through the secure ALPS portal, reducing duplication of work and errors while allowing procurement and subsidy consideration processes to proceed concurrently. Combined negotiation efforts have resulted in an average price reduction of 19 percent.ConclusionsThe alignment between national HTA and procurement agencies is important for successful scaling. The ACE–ALPS collaboration has synergized both agencies’ understanding of the complex implant landscape and established streamlined workplans and processes to support initial establishment of ISL and its maintenance. Challenges include navigating strict procurement rules and continuous cross-agency improvement efforts to ensure applicability in an evolving landscape.

In recent years, the recommendation for and use of patient-reported outcome measures (PROMs) in routine diabetes care has significantly increased. We review recent evidence and highlight key opportunities and challenges related to the active clinical use of PROMs to support person-centered diabetes care and focus areas for future research in the area. Recent pragmatic studies support that integration of multi-dimensional PROMs for diabetes in clinical care as part of a care improvement strategy can be acceptable for and valued by people with diabetes (PWD) and healthcare professionals (HCPs) and may improve multiple aspects of quality of care, including screening, medical care monitoring and decision support, individualization of self-management support and goal-setting, and broader benefits related to active patient participation and person-centred diabetes care. We identify multiple intervention, individual, and care setting characteristics, which influence acceptability, feasibility, implementation, and effectiveness of PROMs in routine care. Recent clinical PROM studies highlight the value of mixed methods research and systematic involvement of PWD, clinicians, and other stakeholders in the design and implementation of questionnaires for patient input in routine diabetes care. We identified a new significant trend towards participatory development of multi-dimensional PROMs with the aim of IT-enabled integration into routine diabetes care to facilitate multiple components of person-centered diabetes care and better clinical, quality of life, and cost outcomes. While results from large-scale randomized controlled studies are still limited, a growing number of pragmatic implementation studies support that user-centric PROM interventions have the potential to facilitate significant improvements in care for PWD.

Hydropower and sustainability: Resilience and vulnerability in China's powersheds

Management of cystic fibrosis (CF) is burdensome and adherence is often suboptimal. Family routines are associated with adherence and health outcomes in other disease populations. Few studies have examined routines in CF. The study's aim was to describe parent experiences developing and utilizing CF care routines. Semi-structured interviews with a convenience sample of 25 parents of children under 13 years of age with CF were analyzed using phenomenological analysis. Three domains emerged: parent experiences developing a routine, support systems facilitating maintenance of routines, and challenges with maintaining care routines. Parents found routines difficult to establish, used trial and error, encountered barriers, and found support helpful to manage care demands. Some parents chose to deviate from their routine. Providing anticipatory guidance to promote the use of care routines and strategies to manage potential challenges may facilitate use of routines and improve CF management.

Soil erosion, in its various forms, has been identified as one of the major soil threats worldwide because it is one of the most significant forms of land degradation (soil truncation, loss of fertility, slope instability, etc.) and loss of soil- based ecosystem services; causing irreversible effects on the poorly renewable soil resource. The Revised Universal Soil Loss Equation (RUSLE) is one of the most widespread adopted empirical model approaches for assessing long-term average soil loss rate by water erosion. The assessed soil loss rate is an indicator that describes (or measures) the state of the soil erosion in a specific area (field, catchment, region, country) which we are interested in. The quality of this indicator relies on the scale which it represents and its required data. Many European countries, such as Italy, do not have harmonised national soil erosion databases at the different scales required by decision makers (regional, provincial, local) and national scale assessments have been carried out using EU data (JRC 2015, LUCAS 2018). However, national scale assessments are not often coherent with the more detailed information available at regional scale for some Italian regions in which RUSLE based potential soil erosion maps have been produced. Although it would be predictable, it is of particular interest to assess how reliable a national scale assessment can be in providing information on the state of soil erosion at a regional scale. A regional soil database is available for the Tuscany region (IT) and it is suitable for soil erosion assessment at regional scale. In this context, within the framework of the EJP SOIL project SERENA, the study was aimed at comparing three RUSLE applications carried out i) at regional scale by means of the available regional soil/climate/digital terrain model data; ii) at national scale by means of the same datasets upscaled at country level; iii) at national scale based on datasets actually available for all the Italian territory. This scale effect is likely due to 2 components. First, the spatial density and quality of the observations needed to estimate the RUSLE factors. To this regard, soil and climate data quality and availability are usually higher for small territories than for the whole national territory. Secondly, the reference scale adopted for the aggregation and spatialization of the data, which is particularly important for the LS factor. These two reasons lead to a lower reliability of the RUSLE applications at national scale as compared to a regional one. The assessment at the regional scale of the soil loss rate using the Tuscany Region dataset was used as reference to evaluate the results obtained with the other two datasets at the same regional scale. Such comparisons were made using both the differences among the erosion maps, and through statistical indices that measure the deviations between the reference map and the other spatial products.

Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals

Adolescents’ and Young Adults’ Routine Care Use: The Role of Their Mothers’ Care Use Behaviors

Universities have been forced to raise higher education fees with above inflation rates due to increasing operating costs and higher student numbers and decreasing real term government funding. While free higher education or other alternative funding models are being considered, the higher education sector is at stake: a sector that plays a vital role in creating improved lives for all South Africans. A sustainable framework is desperately required or universities will once again need to increase student fees at unreasonable rates to maintain quality. We therefore performed a mixed method documentary analysis to prove that fee-free higher education is not viable in South Africa as significant funds will either need to be reallocated from other sectors that also require funding, or it will have to be collected from already overburdened tax payers. The present study also developed a viable student fee regulatory framework with the use of grounded theory: subsidised higher education with the effective use of the already implemented National Student Financial Aid Scheme.

People living with HIV (PLWH)have multidimensional concerns requiring person-centred care. Routine use of patient-reported outcome measures (PROMs) improves outcomes. No brief PROM currently reflects the breadth of concernsfor PLWH. This study sought to identify priority outcomes for PLWH, model current practice, explore views on introducing PROMs into routine care, and devise a model for person-centred care incorporating the PROM. A cross-national multi-centre study (London, Brighton and Dublin) was carried out. Semi-structured qualitative interviews with adult PLWH, HIV health care professionals and HIV commissioners (responsible for planning and commissioning services) were performed. Interviews were analysed using thematic and framework analysis. PLWH (n=28), professionals (n=21) and commissioners (n=8) described concerns related to living with HIV across six domains: physical (e.g. pain and gastrointestinal symptoms), cognitive (e.g. memory and sleep), psychological (e.g. anxiety and depression), social (e.g. isolation and intimacy), welfare (e.g. finances and fears regarding change of immigration status), and information (e.g. long-term outcomes) needs. Themes were highly inter-related, impacting across domains of need (e.g. physical and cognitive problems impacting on psychological and social wellbeing). Perceived benefits of using PROMs in routine HIV care included improved person-centredness, patient empowerment, fewer missed concerns, increased engagement with services, and informed planning of services. Potential challenges included heterogeneity of PLWH, literacy, and utility for those who struggle to engage with care. This study presents a novel model of person-centred care incorporating an HIV-specific PROM. The model reflects priorities of key stakeholders. Explicit use of PROMs in routine HIV care could afford benefits forPLWH, clinical teams and commissioners.

There are three objectives for this project: 1) support OBP in meeting MYPP stated performance goals for the Sustainability Platform, 2) develop integrated feedstock production system designs that increase total productivity of the land, decrease delivered feedstock cost to the conversion facilities, and increase environmental performance of the production system, and 3) deliver to the bioenergy community robust datasets and flexible analysis tools for establishing sustainable and viable use of agricultural residues and dedicated energy crops. The key project outcome to date has been the development and deployment of a sustainable agricultural residue removal decision support framework. The modeling framework has been used to produce a revised national assessment of sustainable residue removal potential. The national assessment datasets are being used to update national resource assessment supply curves using POLYSIS. The residue removal modeling framework has also been enhanced to support high fidelity sub-field scale sustainable removal analyses. The framework has been deployed through a web application and a mobile application. The mobile application is being used extensively in the field with industry, research, and USDA NRCS partners to support and validate sustainable residue removal decisions. The results detailed in this report have set targets for increasing soil sustainability by more » focusing on primary soil quality indicators (total organic carbon and erosion) in two agricultural residue management pathways and a dedicated energy crop pathway. The two residue pathway targets were set to, 1) increase residue removal by 50% while maintaining soil quality, and 2) increase soil quality by 5% as measured by Soil Management Assessment Framework indicators. The energy crop pathway was set to increase soil quality by 10% using these same indicators. To demonstrate the feasibility and impact of each of these targets, seven case studies spanning the US are presented. The analysis has shown that the feedstock production systems are capable of simultaneously increasing productivity and soil sustainability. « less

BackgroundVenous thromboembolism (VTE) can considerably limit patients' functioning and quality of life. Using patient-reported outcome measures (PROMs), the full impact of VTE on individual patients can be captured.MethodsTo evaluate the experiences of patients and healthcare professionals with the routine use of PROMs for VTE patients visiting the outpatient clinic, a mixed-methods study was performed at Leiden University Medical Center, the Netherlands. VTE PROMs were incorporated into routine care since March 2023, through a digital application sending patients invitations to complete PROMs. Quantitative and qualitative data were obtained from semi-structured interviews with patients and involved healthcare professionals. The NoMAD (normalization measure development) questionnaire was used to assess the implementation process from the professionals' perspective. Patients aged ≥18 years who experienced VTE and completed PROMs at two follow-up time points during ≥3 months follow-up and VTE patients who did not complete PROMs at both time points were asked to participate.ResultsEight patients (five completed PROMs; three did not) and four professionals were interviewed. Both patients and professionals experienced the use of PROMs as neutral to predominantly positive (lower limit 3 on a scale of 1–5). All professionals valued the effects of PROMs on their work. Most patients felt the questionnaires contained too many questions. Suggestions to improve the completion rate, accessibility, PROMs content, and the digital tool were shared.ConclusionPROMs were believed to provide additional value during preparation for the appointment and during the consultation. The first experiences of patients and professionals, tending toward positive, can be used to improve PROMs application and support implementation in routine thrombosis care.

Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel