Checklist Domains Research Articles

Applying the blended KTA-Sprint framework to a usability assessment of a digital health module for informal caregivers co-managing heart failure

AimsThe main purpose of this study was to design and evaluate core features of a patient-informal caregiver shared digital health module, Caretown, to support chronic disease management. The secondary purpose was to explore the efficacy of ongoing implementation of an innovative KTA-Sprint framework through usability testing of the Caretown module. MethodsGuided by the KTA-Sprint framework, seven core features of the Caretown module were designed through a multi-method approach: symptom live reports, care cards, trends, medication wallet, medical events timeline, messenger, and caregiver resources. Results and discussionWe tested the prototype of the module with seven informal caregivers. Findings from quantitative usability metrics and qualitative interviews were translated into required refinements (e.g., how to improve intuitiveness of icons, interpretation of presented data, and system navigation) and mapped onto a subset of Ravden checklist domains. Qualitative usability feedback highlighted opportunities to further improve: visual clarity, consistency, compatibility with user expectations, how to provide informative feedback with clear structure, functionality, flexibility and control. Throughout the design process, we identified considerations for supporting future implementation outcomes including equity, acceptability, adoption, appropriateness, and fidelity. Moreover, the KTA-Sprint framework effectively guided the design and evaluation process for the Caretown module. ConclusionsThis development and usability testing of the Caretown module illustrates the implementation of the rapid and iterative KTA-Sprint framework. Scenario-based testing and multi-method analyses of user feedback allowed for triangulation of feedback. Results informed key considerations for product deployment and future implementation.

Landscape and challenges in economic evaluations of artificial intelligence in healthcare: a systematic review of methodology

BackgroundThe potential for artificial intelligence (AI) to transform healthcare cannot be ignored, and the development of AI technologies has increased significantly over the past decade. Furthermore, healthcare systems are under tremendous pressure, and efficient allocation of scarce healthcare resources is vital to ensure value for money. Health economic evaluations (HEEs) can be used to obtain information about cost-effectiveness. The literature acknowledges that the conduct of such evaluations differs between medical technologies (MedTechs) and pharmaceuticals, and poor quality evaluations can provide misleading results. This systematic review seeks to map the evidence on the general methodological quality of HEEs for AI technologies to identify potential areas which can be subject to quality improvements. We used the 35-item checklist by Drummond and Jefferson and four additional checklist domains proposed by Terricone et al. to assess the methodological quality of full HEEs of interventions that include AI.ResultsWe identified 29 studies for analysis. The included studies had higher completion scores for items related to study design than for items related to data collection and analysis and interpretation of results. However, none of the studies addressed MedTech-specific items.ConclusionsThere was a concerningly low number of full HEEs relative to the number of AI publications, however the trend is that the number of studies per year is increasing. Mapping the evidence of the methodological quality of HEEs of AI shows a need to improve the quality in particular the use of proxy measures as outcome, reporting, and interpretation of the ICER.

Assessment of Racial Misclassification Among American Indian and Alaska Native Identity in Cancer Surveillance Data in the United States and Considerations for Oral Health: A Systematic Review.

Misclassification of American Indian and Alaska Native (AI/AN) peoples exists across various databases in research and clinical practice. Oral health is associated with cancer incidence and survival; however, misclassification adds another layer of complexity to understanding the impact of poor oral health. The objective of this literature review was to systematically evaluate and analyze publications focused on racial misclassification of AI/AN racial identities among cancer surveillance data. The PRISMA Statement and the CONSIDER Statement were used for this systematic literature review. Studies involving the racial misclassification of AI/AN identity among cancer surveillance data were screened for eligibility. Data were analyzed in terms of the discussion of racial misclassification, methods to reduce this error, and the reporting of research involving Indigenous peoples. A total of 66 articles were included with publication years ranging from 1972 to 2022. A total of 55 (83%) of the 66 articles discussed racial misclassification. The most common method of addressing racial misclassification among these articles was linkage with the Indian Health Service or tribal clinic records (45 articles or 82%). The average number of CONSIDER checklist domains was three, with a range of zero to eight domains included. The domain most often identified was Prioritization (60), followed by Governance (47), Methodologies (31), Dissemination (27), Relationships (22), Participation (9), Capacity (9), and Analysis and Findings (8). To ensure equitable representation of AI/AN communities, and thwart further oppression of minorities, specifically AI/AN peoples, is through accurate data collection and reporting processes.

The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study

BackgroundThe application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in their care.MethodsIn a multi-methods study, we combined direct observations of care episodes with semi-structured interviews with nurses in two affiliated university hospitals. Topics were based on Flottorp’s checklist of determinants of practice.ResultsIn total, we observed 205 care episodes and interviewed 10 nurses. Observations revealed that the combination of NSG and HH was correctly applied in 19% of care episodes in which a single procedure was executed, and in 2% of care episodes in which multiple procedures were performed. From the interviews, we found determinants that influenced compliance, covered mainly by three out of seven of Flottorp’s checklist domains. Nurses indicated that their knowledge of protocols was limited to HH and protocols were hardly ever actively consulted; visual reminders within their workplace were used as sources of information. Nurses’ behavior was primarily influenced by their ability to operationalize this information and their ability to integrate both infection prevention measures into their care. The intention to apply and combine HH and NSG use was influenced by their risk assessment of cross-contamination, by the urge to self-protect and gut feeling. The feasibility to execute HH and NSG protocols is influenced by the urgency and the complexity of the care episode.ConclusionsThe combined correct application with HH and NSG measures by nurses is low. Nurses are instructed in a fragmented way while in the day to day care HH and NSG use are highly intertwined. Operationalization and simplification of infection prevention protocols, in which instructions on both infection prevention measures are fused, should be considered. Strategies to improve practice should consider the power of habit and nurses urge to self-protect.

Validated checklist for assessing communication skills in undergraduate medical students: bridging the gap for effective doctor-patient interactions.

Communication skills are fundamental in healthcare, but assessing them among medical students presents challenges. In the Indian context, the lack of a specific assessment tool further compounds the issue. Thus this study aimed to develop and validate an observation-based communication skills checklist tailored to Phase I Bachelor of Medicine and Bachelor of Surgery (MBBS) students. The checklist was developed using both inductive and deductive approaches and underwent rigorous testing to ensure its reliability and validity. After piloting, the finalized version was administered to 84 Phase I MBBS students. Results indicated a critical content validity ratio of 0.78, face validity of 0.80, and an impressive Cronbach's alpha of 0.91, indicating good internal consistency and reliability of the checklist. The students scored over 80% in all checklist domains, except for empathy (73%) and support (74%), highlighting areas for potential improvement. Nonetheless, about 75% of students expressed satisfaction with the checklist's communication skills assessment. The feedback from faculty members was positive, as they found the checklist was easy to use, quick, and effective for evaluating communication skills. Consequently, the checklist's introduction has been well received by both students and faculty. In conclusion, the developed checklist proves to be an effective and valid instrument for assessing communication skills in Phase I MBBS students. By integrating this tool into observed station clinical examinations, medical educators can comprehensively evaluate students' communication behaviors. Moreover, the checklist serves as a valuable resource for bridging the gap between theoretical knowledge and practical application, enabling future physicians to excel in doctor-patient interactions, a crucial aspect of patient-centered care.NEW & NOTEWORTHY This article presents a highly unique and novel approach by introducing a structured checklist for communication skill assessment in medical students. Its rigorous validation process ensures reliability and effectiveness, while its adaptation to sociocultural norms highlights its relevance and applicability. The user-friendly design with a single-page layout and dichotomous scale further enhances its practicality in objective structured clinical examinations. The developed checklist equips educators with a valuable resource to assess and improve students' communication abilities.

Predictors of Speech Language Pathology Referral Following Pediatric Concussion Using a Speech Language Checklist: A Brief Report.

Speech language pathologists (SLPs) have the training to treat pediatric concussion issues in communication; however, they have traditionally not been included in initial concussion treatment. Despite physician understanding of SLP engagement in traumatic brain injury, SLP referrals happen only after significant issues in returning to school occurred. Therefore, the purpose of this study was to investigate predictors of physician referral to SLP using an SLP screening checklist. This was a retrospective, cross-sectional study from an academic outpatient clinic. Our study included 60 concussion patients (57% female, 67% white, age: 18.3 ± 4.0 years) who were evaluated by specialist physicians. The independent variables include age, sex, and the speech screening checklist domains (attention, memory/organization, social interactions, word finding, executive function) and their associated subcategories. The primary study outcome was referral to SLP following concussion. Twenty-six patients (43%) were referred to SLP. The speech checklist domains significantly associated with a referral to SLP were attention and memory/organization. Individuals who reported trouble with attention or memory/organization on the speech language checklist were most likely to be referred in a concussion treatment plan. The use of a SLP checklist during patient visits may expedite referrals to SLP, achieve earlier therapeutic intervention, and facilitate recovery.

Development of a predictive model using the Kihon Checklist for older adults at risk of needing long-term care based on cohort data of 19months.

AimThis study developed a risk scoring tool and examined its applicability using data from the Kihon Checklist cohort dataset for 19 months to predict the transition from no certification for long‐term care to long‐term care level 3 or above.MethodsData were collected from 26 357 functionally independent, community‐dwelling older adults in a Japanese city who answered the Checklist in 2014 and were followed for 19 months. Individuals certified for long‐term care during the follow‐up period were classified into three levels depending on their certification status: low, moderate, and high long‐term care levels. Relationships between the Kihon Checklist domains and high long‐term care levels were examined using the logistic regression model. A score chart predicting incidents of high long‐term care levels was created to facilitate its applicability.ResultsAs of 2016, 971 participants were certified for long‐term care (3.7%), of which 168 (0.6%), 357 (1.4%), and 446 (1.7%) were certified as high, moderate, and low long‐term care levels, respectively. Variables associated with the certification of high long‐term care level included difficulties in activities of daily living, a decline in locomotor and cognitive function in the Kihon Checklist domains, and age. The score chart was created based on these variables and demonstrated excellent discriminatory ability, with an area under curve of 0.817 (95% confidence interval: 0.785–0.849).ConclusionsThe Kihon Checklist can predict the future development of a high degree of dependency. The score chart we developed can be easily implemented to identify older adults at high risk with reasonable accuracy. Geriatr Gerontol Int 2022; 22: 797–802.

Hospitals early challenges and interventions combatting COVID-19 in the Eastern Mediterranean Region.

BackgroundDuring rapidly evolving outbreaks, health services and essential medical care are interrupted as facilities have become overwhelmed responding to COVID-19. In the Eastern Mediterranean Region (EMR), more than half of countries are affected by emergencies, hospitals face complex challenges as they respond to humanitarian crises, maintain essential services, and fight the pandemic. While hospitals in the EMR have adapted to combat COVID-19, evidence-based and context-specific recommendations are needed to guide policymakers and hospital managers on best practices to strengthen hospitals’ readiness, limit the impact of the pandemic, and create lasting hospital sector improvements towards recovery and resilience.AimGuided by the WHO/EMR’s “Hospital readiness checklist for COVID-19”, this study presents the experiences of EMR hospitals in combatting COVID-19 across the 22 EMR countries, including their challenges and interventions across the checklist domains, to inform improvements to pandemic preparedness, response, policy, and practice.MethodsTo collect in-depth and comprehensive information on hospital experiences, qualitative and descriptive quantitative data was collected between May-October 2020. To increase breadth of responses, this comprehensive qualitative study triangulated findings from a regional literature review with the findings of an open-ended online survey (n = 139), and virtual in-depth key informant interviews with 46 policymakers and hospital managers from 18 out of 22 EMR countries. Purposeful sampling supported by snowballing was used and continued until reaching data saturation, measures were taken to increase the trustworthiness of the results. Led by the checklist domains, qualitative data was thematically analyzed using MAXQDA.FindingsHospitals faced continuously changing challenges and needed to adapt to maintain operations and provide essential services. This thematic analysis revealed major themes for the challenges and interventions utilized by hospitals for each of hospital readiness domains: Preparedness, Leadership, Operational support, logistics, supply management, Communications and Information, Human Resources, Continuity of Essential Services and Surge Capacity, Rapid Identification and Diagnosis, Isolation and Case Management, and Infection, Prevention and Control.ConclusionHospitals are the backbone of COVID-19 response, and their resilience is essential for achieving universal health coverage. Multi-pronged (across each of the hospitals readiness domains) and multi-level policies are required to strengthen hospitals resilience and prepare health systems for future outbreaks and shocks.

Indigenous health equity in health register ascertainment and data quality: a narrative review

BackgroundHealth registers play an important role in monitoring distribution of disease and quality of care; however, benefit is limited if ascertainment (i.e., the process of finding and recruiting people on to a register) and data quality (i.e., the accuracy, completeness, reliability, relevance, and timeliness of data) are poor. Indigenous peoples experience significant health inequities globally, yet health data for, and about, Indigenous peoples is often of poor quality. This narrative review aimed to (i) identify perceived barriers for the ascertainment of Indigenous peoples on health registers, and (ii) collate strategies identified and used by health registers to support comprehensive ascertainment and high-quality data for Indigenous peoples.MethodsA Kaupapa Māori theoretical framework was utilized to guide this work. Four electronic databases were systematically searched for original articles and screened for eligibility. Studies involving health registers with Indigenous population(s) identified were included if either ascertainment or data quality strategies were described. Data extraction focused on the reporting of research involving Indigenous peoples using the CONSIDER checklist domains, ascertainment, and data quality.ResultsSeventeen articles were included spanning publication between 1992 and 2020. Aspects of four of eight CONSIDER domains were identified to be included in the reporting of studies. Barriers to ascertainment were themed as relating to ‘ethnicity data collection and quality’, ‘systems and structures’, ‘health services/health professionals’, and ‘perceptions of individual and community-level barriers’. Strategies to support ascertainment were categorized as ‘collaboration’, ‘finding people’, and ‘recruitment processes’. Categorized strategies to support data quality were ‘collaboration’, ‘ethnicity data collection and quality’, ‘systems-level strategies’, and ‘health service/health professional-level strategies’.ConclusionsPoor-quality data for Indigenous peoples in health registers prevents the achievement of health equity and exemplifies inaction in the face of need. When viewed through a critical structural determinants lens, there are visible gaps in the breadth of strategies, particularly relating to the inclusion of Indigenous peoples in health register and research governance, and actions to identify and address institutional racism. Indigenous led research, meaningful collaboration, and a sharing of knowledge and experiences between health registers is recommended to enable research and health registers that support Indigenous self-determination and health equity.

Validation of an endoscopic flavectomy training model.

to validate a lumbar spine endoscopic flavectomy simulator using the construct method and to assess the acceptability of the simulator in medical education. thirty medical students and ten video-assisted surgery experienced orthopedists performed an endoscopic flavectomy procedure in the simulator. Time, look-downs, lost instruments, respect for the stipulated edge of the ligamentum flavum, regularity of the incision, GOALS checklist (Global Operative Assessment of Laparoscopic Skills), and responses to the Likert Scale adapted for this study were analyzed. all variables differed between groups. Procedure time was shorter in the physician group (p < 0.001). Look-downs and instrument losses were seven times greater among students than physicians. Half of the students respected the designated incision limits, compared to 80% of the physicians. In the student group, about 30% of the incisions were regular, compared to 100% in the physician group (p < 0.001). The physicians performed better in all GOALS checklist domains. All the physicians and more than 96% of the students considered the activity enjoyable, and approximately 90% believed that the model was realistic and could contribute to medical education. the simulator could differentiate the groups' experience level, indicating construct validity, and both groups reported high acceptability.

Trends in Real-World Neovascular AMD Treatment Outcomes in the UK.

PurposeTo report trends in real-world outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) in the United Kingdom (UK) over the last decade.DesignSystematic review.MethodsMedline, PubMed, and Embase databases were searched from 9 April 2010 to 8 April 2020 for publications that met the inclusion criteria: treatment-naïve eyes, UK-only data and ≥1 year of follow-up. ICHOM (International Consortium for Health Outcome Measures) outcomes and study quality were assessed. Visual acuity (VA) trends were assessed in studies with ≥100 eyes at baseline.ResultsTwenty-six studies (n=25,761 eyes) were included, meeting 14–17 out of 20 Institute of Health Economics Quality Appraisal of Case Series checklist domains. Only ranibizumab and aflibercept outcome data were available. The mean injection number in the first year of treatment was 5.9 in publications from 2010 to 2015 and 7.1 from 2015 to 2020. Average baseline VA and mean one-year, two-year and three-year VA gains gradually improved over the last decade. Longer-term studies reported that the visual gains achieved in the first year of treatment were rarely maintained, with under-treatment a likely contributing factor.ConclusionUK real-world outcomes have improved over the last decade with improved service delivery and the adoption of more proactive treatment regimens but are still not always as impressive as registration clinical trial results. Access to longer-acting anti-VEGF therapies would reduce the treatment burden for patients, carers, and the healthcare system, potentially making replication of clinical trial results possible in the NHS.

Patient-reported psychosocial distress in adolescents and young adults with germ cell tumours.

Germ cell tumours are the most common cancer of male adolescents and young adults (AYA, age 18-39). Men in this age group have been healthy much of their lives, and a diagnosis of cancer can cause significant psychosocial distress. We therefore sought to examine the psychosocial needs of patients with germ cell tumour and determine whether needs vary based on age (AYA vs non-AYA). We hypothesized that AYA experience more anxiety and distress in emotional, practical and physical domains. We evaluated the responses of all patients referred to British Columbia (BC) Cancer who completed a pre-consultation health assessment form. This is a validated screening questionnaire for distress, subclinical/clinical symptoms of depression and anxiety and includes the Canadian Problem Checklist domains of emotional, informational, practical, spiritual, social/family and physical concerns. Data were collected for 349 patients (2011-2015). Patient population was predominantly AYA (n = 227) with median age 33 (range 18-83). The top 3 AYA concerns were financial, work/school, frustration and anger. AYA patients more commonly scored positive for symptoms of subclinical/clinical anxiety than non-AYA (39.4% vs. 27.9%, p = 0.028). Those AYA patients with subclinical/clinical anxiety symptoms experienced more fears and worries, concerns regarding work/school, lack of understanding of their disease, finances and frustration and anger. The results of this study indicate that AYA with testicular cancer have unique needs and experience more self-reported anxiety symptoms with emotional, informational and practical concerns. This is valuable information to stakeholders for allocation of resources to address cancer survivorship amongst these patients.

Evidence synthesis in pulmonary arterial hypertension: a systematic review and critical appraisal

BackgroundThe clinical landscape of pulmonary arterial hypertension (PAH) has evolved in terms of disease definition and classification, trial designs, available therapies and treatment strategies as well as clinical guidelines. This study critically appraises published evidence synthesis studies, i.e. meta-analyses (MA) and network-meta-analyses (NMA), to better understand their quality, validity and discuss the impact of the findings from these studies on current decision-making in PAH.MethodsA systematic literature review to identify MA/NMA studies considering approved and available therapies for treatment of PAH was conducted. Embase, Medline and the Cochrane’s Database of Systematic Reviews were searched from database inception to April 22, 2020, supplemented by searches in health technology assessment websites. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) checklist covering six domains (relevance, credibility, analysis, reporting quality and transparency, interpretation and conflict of interest) was selected for appraisal of the included MA/NMA studies.ResultsFifty-two full publications (36 MAs, 15 NMAs, and 1 MA/NMA) in PAH met the inclusion criteria. The majority of studies were of low quality, with none of the studies being scored as ‘strong’ across all checklist domains. Key limitations included the lack of a clearly defined, relevant decision problem, shortcomings in assessing and addressing between-study heterogeneity, and an incomplete or misleading interpretation of results.ConclusionsThis is the first critical appraisal of published MA/NMA studies in PAH, suggesting low quality and validity of published evidence synthesis studies in this therapeutic area. Besides the need for direct treatment comparisons assessed in long-term randomized controlled trials, future efforts in evidence synthesis in PAH should improve analysis quality and scrutiny in order to meaningfully address challenges arising from an evolving therapeutic landscape.

Development of the Stanford Social Dimensions Scale: initial validation in autism spectrum disorder and in neurotypicals

BackgroundThe aim of this paper was to provide an initial validation of a newly developed parent questionnaire—the Stanford Social Dimensions Scale (SSDS), designed to capture individual differences across several key social dimensions including social motivation in children and adolescents with and without psychiatric disorders.MethodsThe initial validation sample was comprised of parents of 175 individuals with autism spectrum disorder (ASD) (35 females, 140 males; Mage = 7.19 years, SDage = 3.96) and the replication sample consisted of 624 parents of children who were either typically developing or presented with a range of neurodevelopmental and neuropsychiatric disorders (302 females, 322 males; Mage = 11.49 years, SDage = 4.48). Parents from both samples completed the SSDS and the Social Responsiveness Scale (SRS-2).ResultsExploratory Structural Equation Modeling indicated that a 5-factor model provided adequate to excellent fit to the data in the initial ASD sample (comparative fit index [CFI] = .940, Tucker-Lewis Index [TLI] = .919, root mean square error of approximation [RMSEA] = .048, standardized root mean square residual [SRMR] = .038). The identified factors were interpreted as Social Motivation, Social Affiliation, Expressive Social Communication, Social Recognition, and Unusual Approach. This factor structure was further confirmed in Sample 2 (CFI = 946, TLI = .930, RMSEA = .044, SRMR = .026). Internal consistency for all subscales was in the good to excellent range across both samples as indicated by Composite Reliability scores of ≥ .72. Convergent and divergent validity was strong as indexed by the pattern of correlations with relevant SRS-2 and Child Behavior Checklist domains and with verbal and non-verbal intellectual functioning scores in Sample 1 and with the Need to Belong Scale and Child Social Preference Scale scores in Sample 2. Across both samples, females had higher social motivation and expressive social communication scores. Discriminant validity was strong given that across all SSDS subscales, the ASD sample had significantly higher impairment than both the typically developing group and the group with other clinical conditions, which in turn, had significantly higher impairment than the typically developing group.ConclusionsOur findings provide initial validation of a new scale designed to comprehensively capture individual differences in social motivation and other key social dimensions in ASD.

PRS11 EVIDENCE SYNTHESIS IN PULMONARY ARTERIAL HYPERTENSION: A CRITICAL APPRAISAL

The clinical landscape of pulmonary arterial hypertension (PAH) has evolved in terms of disease definition and classification, treatment guidelines, available therapies, and trial designs. This study critically appraises published meta-analyses (MAs) and network-meta-analyses (NMAs) to a) better understand their quality, validity and relevance to current clinical practice and b) to provide recommendations on methods, analysis and reporting NMAs in PAH. A systematic literature review to identify MAs/NMAs considering approved and available therapies for treatment of PAH was conducted. Embase, Medline and the Cochrane’s database of systematic reviews (CDSR) were searched from database inception to September 12, 2018, supplemented by searches in the Health Technology Assessment (HTA) websites. The ISPOR checklist covering six domains (relevance, credibility, analysis, reporting quality and transparency, interpretation and conflict of interest) was selected for appraisal of the included MAs/NMAs. Forty-three full publications (31 MAs, 11 NMAs, and 1 MA/NMA) in PAH met the inclusion criteria. The majority of studies were of low quality, with none of the studies being scored as ‘strong’ across all checklist domains. Key limitations included the lack of a clearly defined, relevant decision problem, shortcomings in assessing and addressing between-study heterogeneity, and an incomplete or misleading interpretation of results. This is the first critical appraisal of published MAs/NMAs in PAH, suggesting low quality and validity of published evidence synthesis studies in this therapeutic area. Besides the need for direct treatment comparisons assessed in long-term randomized controlled trials (RCTs), future efforts in evidence synthesis in PAH should improve analysis quality and scrutiny in order to meaningfully address challenges arising from an evolving therapeutic landscape.

Distress Screening in Head and Neck Cancer Patients Undergoing Active Cancer Directed Treatment and Impact of Referral to Psycho-Oncology and Palliative Care

To estimate the prevalence of clinically significant distress (Distress score > or equal to 4) in Head and Neck cancer patients treated with a radical intent using the NCCN Distress thermometer (DT) and to evaluate the impact of referral to psycho-oncology and palliative care. This is a prospective study evaluating distress in head and neck cancer patients and patients were accrued from February 2016 to May 2017 (CTRI No. : CTRI/2016/01/006549). The study was conducted in two parts (Parts A and B). Part A: Total of 600 patients undergoing curative radiation therapy, aged more than 18 years, aware of their diagnosis and treatment plan ECOG 2 or less and signed inform consent were considered for accrual. Patients were screened for distress using DT at baseline. Part B: This is a prospective randomized controlled trial and 212 patients of Part A with score= 4 were randomly assigned to the control (care as usual by the treating physician) or intervention group (referral to psycho-oncology and palliative care). All patients were administered the DT with NCCN problem check list, Edmonton symptom assessment system (ESAS) and EORTC QLQ-C-30 and HN35 questionnaires at baseline and 6 month post treatment. Intention to treat analysis was done for Part B. Part A: Six hundred and twenty one patients were screened for the study and 600 patients were accrued in the study. The median distress score of entire cohort was 4 (IQR: 3-5) and clinically significant distress (score = 4) was seen in 340 patients (56.7%). At a median follow up of 15 months, patients with clinically significant distress had inferior survival (2 year: 91% v/s 96%; p=0.04). Part B: 340 patients with a distress score of 4 or more were screened for the Part B study and 212 patients were accrued in the study. The median distress score at baseline in both groups was 6 (IQR: 5-8). At 6 month follow up, the median distress score in both groups was 2 (IQR: 2-3). At 6 month follow up, there was no difference in clinically significant distress (4 or more) between the two groups (16% v/s 9.3%; p= 0.19). There was no difference in the distress checklist domains (physical, practical, family, spiritual and emotional) between the 2 groups. At 6 months follow up, there was reduction in all symptoms as measured by ESAS and improvement in quality of life (QOL) both groups however not statistically significant. At a median follow up of 23.5 months, 1 year and 2 year overall survival (OS) and disease free survival (DFS) rates were 87%, 66% and 75%, 65% respectively. There was no difference in OS, DFS and locoregional control between the arms. Clinically significant distress was seen in 56% of all head and neck cancer patients treated with a curative intent and the survival was significantly poor. Although there was improvement in the distress scores, symptom scores and QOL domains with psycho-oncology and palliative care referral, there was no statistically significant difference. The survival outcomes were similar between the groups.

A ‘paperless’ wall-mounted surgical safety checklist with migrated leadership can improve compliance and team engagement

BackgroundOutcome benefits of using the WHO Surgical Safety Checklist rely on compliance with checklist administration.ObjectiveTo evaluate engagement of operating room (OR) subteams (anaesthesia, surgery and nursing), and compliance with administering...

Cognition, behavior and social competence of preterm low birth weight children at school age

OBJECTIVE:The aim of this study was to assess the cognitive and behavioral development of preterm and low birth weight newborns living in a disadvantageous socioeconomic environment at school age. METHODS:This cross-sectional study included children aged 6-7 from a historical birth cohort of preterm (gestational age <37 weeks) and low birth weight (<2,500 g) infants. The Wechsler Intelligence Scale for Children III (WISC-III) was administered by a psychologist while the parents completed the Child Behavior Checklist. The results were compared to the test's reference. The perinatal information and follow-up data were collected from the hospital files. The demographic data were collected from the parents. The current performance was compared with the results from the Denver II and Bayley II tests, which were administered during the first years of life.RESULTS:The total intelligence quotient varied from 70 to 140 (mean 98.7±15.8). The borderline intelligence quotient was observed in 9.3% of the children. The Child Behavior Checklist indicated a predominance of social competence problems (27.8%, CI 19.2 to 37.9) compared with behavioral problems (15.5%, CI 8.9 to 24.2). Both the Child Behavior Checklist domains, such as schooling, social and attention problems, and the cognitive scores were significantly associated with maternal education and family income. The results of the Denver and Bayley tests were associated with the cognitive performance (p<0.001) and the Child Behavior Checklist social profile, including aggressive and externalizing behavior (p<0.001).CONCLUSIONS:Our data suggest that even low-risk preterm newborns are at risk for developing disturbances in early school age, such as mild cognitive deficits and behavioral disorders. This risk might increase under unfavorable socioeconomic conditions.

Development of a checklist of safe discharge practices for hospital patients

Discharge from hospital can be a vulnerable period for patients. Multifaceted "discharge bundles" facilitate care transitions and possibly decrease adverse outcomes. We describe a structured approach to discharge planning, starting from admission and proceeding through discharge, using a standardized checklist of tasks to be performed for each hospitalization day. To create an evidence-based checklist of safe discharge practices for hospital patients. In the province of Ontario, the Ministry of Health and Long-Term Care convened a panel of expert members from multiple disciplines and across several healthcare sectors. The panel conducted a systematic search of the literature and used a structured approach to review evidence-based practices that ensure efficient, effective, safe, and patient-centered care transitions. A discharge-checklist tool was created to facilitate safe discharge from hospital. The final checklist describes the processes necessary for a safe and optimal discharge and recommended timeline of when to complete each step, starting from the first day of admission. The checklist domains include (1) indication for hospitalization, (2) primary care, (3) medication safety, (4) follow-up plans, (5) home-care referral, (6) communication with outpatient providers, and (7) patient education. The Checklist of Safe Discharge Practices for Hospital Patients summarizes the sequence of events that need to be completed throughout a typical hospitalization. Standardizing discharge planning and initiating processes early on in a patient's hospital stay may ensure a safe transition home.

Assessing the conceptual clarity and evidence base of quality criteria/standards developed for evaluating decision aids

Promoting patient participation in treatment decision making is of increasing interest to researchers, clinicians and policy makers. Decision aids (DAs) are advocated as one way to help achieve this goal. Despite their proliferation, there has been little agreement on criteria or standards for evaluating these tools. To fill this gap, an international collaboration of researchers and others interested in the development, content and quality of DAs have worked over the past several years to develop a checklist and, based on this checklist, an instrument for determining whether any given DA meets a defined set of quality criteria. In this paper, we offer a framework for assessing the conceptual clarity and evidence base used to support the development of quality criteria/standards for evaluating DAs. We then apply this framework to assess the conceptual clarity and evidence base underlying the International Patient Decision Aids Standards (IPDAS) checklist criteria for one of the checklist domains: how best to present in DAs probability information to patients on treatment benefits and risks. We found that some of the central concepts underlying the presenting probabilities domain were not defined. We also found gaps in the empirical evidence and theoretical support for this domain and criteria within this domain. Finally, we offer suggestions for steps that should be undertaken for further development and refinement of quality standards for DAs in the future.