Categorization Of Interventions Research Articles

Development of Ethical and Operational Guidelines for the Delivery of Surgical Care in a COVID-19 Referral Hospital

Introduction. The COVID-19 pandemic has not only resulted in a public health crisis but has also strained hospital services. The provision of surgical care should therefore also be guided by ethical, and whenever applicable, also legal, principles.
 Methods. An integrative approach that covers clinical and ethical dimensions, as well as spans the spectrum of surgical care, is therefore necessary. This action research involved three key steps: 1) identification of ethical dilemmas related to the provision of surgical care during the COVID-19 pandemic; 2) preparation of clinical scenarios that highlight these dilemmas; and 3) determination of the appropriate options for the said scenarios, based on the best available evidence as well as most applicable ethical principles.
 Results. Ethical theories included utilitarianism, human rights, and communitarianism. Ethical principles included non-maleficence, justice, autonomy, and beneficence. Values considered were duty, reciprocity, human life, efficiency, fairness, fidelity, ownership, social value, and fair innings. Also incorporated were informed consent, allocation principles, resource allocation, and triage. In terms of operational issues and surgical technical concerns, the following were considered: phased standards of care, categorization of interventions, prioritization, surgical approaches, infection control, diagnostics, patient welfare, staff welfare, operations protocols, surgical training, and communication. Key points derived from the ethical and technical considerations of surgical care delivery during the COVID-19 pandemic are presented.
 Conclusion. This action research involving a review of the literature and stakeholder engagement has provided a concise ethical and technical resource for surgical administrators, practitioners, and trainees.

Collaborative practice agreement in solid organ transplantation.

Background Given the complexity of solid organ transplant recipients, a multidisciplinary approach is required. To promote medication safety and enable providers to focus on the medical and surgical needs of these patients, our department of pharmacy created a collaborative practice agreement between physicians and pharmacists. Through this agreement, credentialed pharmacists are empowered to provide inpatient services including initiation and adjustment of medications through independent review of laboratory results after multidisciplinary rounds. Objective Toevaluate the effect of our collaborative practice agreement on clinical care and institutional finances. Setting Aninpatient setting at a large academic medical center. Methods Three transplant pharmacists entered all clinical interventions made on abdominal transplant recipients between September and October 2013 into Quantifi®, a software application that categorizes and assigns a cost savings value based on impact and type of intervention. Main outcome measure The main outcome measures in this study were number and categorization of interventions, as well as estimated cost savings to the institution. Results There were 1060 interventions recorded, an average of 20 interventions per pharmacist per day. The most common interventions were pharmacokinetic evaluations (36%) and dose adjustments (19%). Over the time period, these interventions translated into an estimated savings of $107,634.00, or an annual cost savings of $373,131.20 per pharmacist, or a cost-benefit ratio of 2.65 to the institution. Conclusions Based on our study, implementation of a collaborative practice agreement enables credentialed pharmacists to make clinically and financially meaningful interventions in a complex patient population.

Restricted and Repetitive Behaviour in Persons with Autism (Ages 0-18): An Integrative Review of Treatment Related to Occupational Therapy

Objective: To identify evidence-based behavioural interventions used to decrease restricted and repetitive behaviour (RRB) in children with autism (ages 0-18); to understand the application of these strategies within the PEO (Person, Environment, Occupation) Model of Occupational Performance and the role of the occupational therapist in addressing this limitation. Background: RRB is a core feature of autism that often impedes functional behaviour. Decreasing RRB to enable functional behaviours is central to the occupational therapist’s role with this population. Many interventions identified as effective for this impairment are based on the principles of applied behaviour analysis (ABA). Method: An integrative review of the literature was completed to identify interventions targeting RRBs. Those found to be effective are described within an ABA framework and within the PEO Model of Occupational Performance. Results: This review identified twenty-eight effective interventions used to treat RRBs in autism relevant to the field of occupational therapy. Categorization of interventions using an ABA framework and the PEO Model allowed comparison between approaches and application to occupational therapy practice. Conclusion: A functional behaviour approach (FBA) used in combination with the PEO model will enable greater understanding of RRBs and provide a more comprehensive approach to the treatment of RRBs in children with autism.

The Need for a Comprehensive Approach to Managing Confined Space Entry: Summary of the Literature and Recommendations for Next Steps

Despite all the regulatory and standard-setting efforts that have been made in North America, judging from the most recent statistics many fatal incidents related to work in confined spaces still occur. In Canada, fatal incidents in the province of Quebec reveal failures in and absence of the identification and preparation of work situations in confined spaces and in risk management. In this study, we performed a literature review consisting of 77 documents on existing hazards and risk assessment for confined spaces. Moreover, we formulated proposals regarding the design of specific and improved tools for assessing such risks. We found that atmospheric hazards monopolized attention in the literature on confined spaces, while risk estimation specific to confined space interventions received little practical coverage overall, apart from atmospheric hazards. The parameters used to establish classes or groupings of confined spaces in existing tools were imprecise. The development of a risk analysis process that is (i) more systematic and based on the concepts recognized in risk management standards, (ii) multidisciplinary, and (iii) adapted to the specific characteristics of confined spaces is therefore needed. Such a process will better support managers and occupational health and safety (OH&S) personnel in their efforts to prioritize and reduce risks. Suggestions on such a risk analysis tool and categorization of interventions in confined spaces are proposed in this article. Lastly, risk analysis tools adapted to confined space interventions are needed to ensure the inherently safe design of these spaces.

Work of the Cochrane Bone, Joint and Muscle Trauma Review Group: making sense of complexity

This article examines the ways in which members of the Cochrane Bone, Joint and Muscle Trauma Review Group have tackled the intrinsic complexity of a large clinical area. This features a diversity of injuries in people of all ages, predominantly physical and surgical interventions that are inherently complex interventions, and a huge array of outcome measures. The methods described include a purposeful focus on common injuries, such as fragility fractures in older people; and the generation of groups of "all intervention" reviews whose structure is informed by a systematic approach, incorporating knowledge of clinical pathways and categorization of interventions. The article concludes with some thoughts about the challenges ahead, particularly in terms of selecting the scopes of future reviews.