Clinical Health Care Research Articles

The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis.

Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD. Data of patients newly commenced on HD between July 2015 and June 2016 were reviewed. Patients were grouped by their VA format: (A) pre-emptive surgically created VA (SCVA), (B) tunneled central venous catheter (CVC) followed by SCVA creation, (C) long-term tunneled CVC only. Clinical events, number of investigations and procedures, hospital admissions, and incurred costs of the three groups were compared. In the multivariable analysis, the cost incurred by the group A patients had no significant difference to that incurred in the group B patients (p = 0.08), while the cost of group C is significantly lower (p < 0.001). Both the 62.7% of group A with successful SCVA who avoided tunneled CVC usage, and those with a functionally matured SCVA in group B (66.1%), used fewer healthcare resources and incurred less cost for their access compared to those did not (p = 0.01, p = 0.02, respectively) during the first year of HD. With comparable cost, a pre-emptive approach enables avoidance of tunneled CVC. Tunneled CVC only access format incurred lower cost and is suitable for carefully selected patients. Successful maturation of SCVA greatly affects patients' clinical journey and healthcare cost.

Development of a Vietnamese version of the Revised Hasegawa's Dementia scale.

ABSTRACTAs the aging population grows worldwide, the problem of age-related health is becoming an important public health concern. Dementia is a devastating disease that places a significant physical, emotional, and financial burden on patients, their caregivers, and society. It is predicted to increase in developing countries. The Revised Hasegawa’s Dementia Scale (HDS-R) has been used in many Asian countries to measure cognitive function. However, there is still no Vietnamese version of the HDS-R. Therefore, this paper describes the development of the HDS-R scale and manual in Vietnamese language. Two Vietnamese researchers translated the HDS-R from English to Vietnamese. To confirm the accuracy of the translation, two other Vietnamese researchers conducted a back-translation. Another pair of Vietnamese researchers compared the back-translated English version to the original one. All six researchers discussed the inconsistencies between English HDS-R scale and manual and derived the most suitable version for the Vietnamese context. In Questions 4 and Question 7, we changed the words from “cherry blossom” and “train” to “daisy flower” and “bicycle” for the first option, and from “plum blossom” to “rose” for the second option. We also changed the expressions in some places in the manual to fit the Vietnamese language. Future studies are needed to validate this version to be able to access cognitive function in both clinical and public healthcare settings.

Enhancing Healthcare Workers’ Capacity in Cancer and Other Non-Communicable Diseases (NCDs) Care in Sub-Saharan Africa (SSA) Through e-Health Innovations: A Case of International Cancer Institute (ICI), Eldoret, Kenya

PURPOSE Sub-Saharan Africa (SSA) hosts 11% of the world’s population yet bears 24% of the global disease burden with only 3% of the world’s health workforce at the frontline. The new threat of NCDs is worsened by the challenge of infrastructure, access to care and health workforce capacity. E-health bridges the gap of formal education and training through telemedicine and virtual e-learning platforms. METHODS International Cancer Institute (ICI) leveraged on telemedicine to build capacity of Health Care Providers (HCPs) in the COVID era. Through bi-weekly virtual multi-disciplinary tumour boards, on-line preceptorship training programs and tele-consultations between healthcare providers across Kenya and SSA, access to quality and timely cancer care was evaluated. RESULTS Between May 2020 and April 2021, ICI conducted 95 virtual multi-disciplinary tumour boards which were attended by 7,483 health care workers from 21 countries across the world, 16 from countries in SSA. ICI also conducted 27 virtual unique training programs in cancer and other NCDs care which attracted 578 participants from across the globe, 95% of which were from SSA. The training participants distribution included 77% clinical healthcare providers; 17% non-clinical health care workers and 6% allied healthcare workers. The online training platform provided the opportunity for HCPs to be trained from their locality thus bridging the gap of cost and distance to advance their training. The innovative e-learning platform has made it possible to reach more healthcare workers across SSA without the limitation of restricted classroom sessions. CONCLUSION Capacity building of HCPs in SSA in cancer and other NCDs care and control goes beyond formal training. On-going peer to peer mentorship and on-job skills training have proved to be effective in building HCP capacity in improved standard of care across the cancer and other NCDs care. Use of a multi-disciplinary approach to care while leveraging on e-health solutions contributes to positive patient outcomes in resource limited settings.

Non-Latinx Healthcare Provider’s Knowledge and Awareness of Latinx Geriatric Clinical Health Needs

ABSTRACT Objectives Due to the exponential growth in the Latinx older adult population, culturally responsive services are needed, especially since most healthcare providers are non-Latinx with limited Spanish or bilingual skills. One place to start is by drawing a formative assessment of the healthcare providers’ knowledge and awareness of the healthcare needs of Latinx older adults. Methods Focus groups were conducted to explore the healthcare providers’ knowledge and awareness of cultural and structural barriers and facilitators to accessing health care services for Latinx older adults. Results Results note that healthcare providers perceived the healthcare needs for Latinx older adults to be underutilized for healthcare services, preventive interventions for healthy diet/lifestyle, and healthcare knowledge. Providers reported Latinx family over-involvement, religiosity, immigration, and language/lack of interpreters as barriers to seeking timely healthcare. Finally, healthcare providers said that family support, the location of healthcare services, and community-based partnerships were all facilitators for seeking healthcare. Conclusions Findings suggest providers’ conflicting perspectives toward the Latinx communities. Clinical Implications Healthcare services can consider implementing trainings for non-Latinx providers to recognize conflicting perspectives and reduce implicit bias toward the Latinx communities.

Healthcare worker trauma and related mental health outcomes during the COVID-19 outbreak in New York City.

Healthcare workers (HCWs) faced a range of stressors during the coronavirus (COVID-19) pandemic, contributing to psychological stress. We use a psychological trauma framework to characterize the mental health burden for clinical and non-clinical healthcare worker occupations during the COVID-19 pandemic. The objective was to measure and characterize risk factors for trauma and anxiety-related mental health problems among HCWs at a public hospital in the epicenter of the COVID-19 pandemic in New York City (NYC). This study reports findings from a cross-sectional survey of NYC HCWs shortly after the initial 2020 infection surge. Over 800 hospital employees completed the survey that assessed professional quality of life indicators (compassion satisfaction [CS], burnout [BO], secondary traumatic stress [STS]), Coronavirus Anxiety (CS), Obsession with Coronavirus (OC), and PTSD symptoms. The survey also assessed pandemic-related work and life circumstances such as “do you have a family member or friend who tested positive for COVID”. Relatively small percentages of HCWs endorsed probable Coronavirus Anxiety (6%), PTSD (13%), and Coronavirus Obsession (21%). We observed higher proportions of Burnout (29%), Moderate or High Secondary Traumatic Stress (45%), and High Compassion Satisfaction (52%). Adjusted regression models showed important implications for prior behavioral/emotional health concerns among HCWs, providing care for a patient that died from COVID-19, and other characteristics. This study supports prior studies documenting the mental health consequences for the healthcare workforce during the COVID-19 pandemic. This study builds on that base by including non-clinical staff in the sample and assessing pandemic life-stressors such as caring for sick family members.

Factors Associated with Mental Health Outcomes in Hospital Workers during the COVID-19 Pandemic: A Mixed-Methods Study.

Background: We investigated some of the factors associated with depression, perceived stress, and anxiety in clinical and nonclinical healthcare workers of two hospitals. Methods: A mixed-methods approach was used. The sample included clinical (physicians, nurses, and others) and nonclinical (security and cleaning staff) healthcare workers of two tertiary hospitals in Peru. Participants completed an online self-survey. In the qualitative analysis, data were subjected to thematic analysis. Results: We analyzed data from 613 participants, of which 8.6%, 9.0%, and 78.2% had moderate-to-severe anxiety, depression, and perceived stress, respectively. Having a previous mental health problem, being concerned about losing one’s job, having at least two COVID-19 symptoms in the preceding two weeks, and being afraid of infecting family members increased the prevalence of experiencing moderate-to-severe depression and anxiety. The qualitative analysis allowed us to identify five recurring factors that caused a negative impact on workers’ lives during the pandemic: emotional distress linked to hospital experiences of suffering and death, modification of routines, fear of COVID-19, exacerbation of mental disorders, and physical problems associated with emotional distress. Conclusions: Clinical and nonclinical healthcare workers in Peru have experienced depression, anxiety, and stress during the COVID-19 pandemic. Future research and interventions are necessary to improve psychological support for hospital workers.

Beacon v2 and Beacon networks: A "lingua franca" for federated data discovery in biomedical genomics, and beyond.

Beacon is a basic data discovery protocol issued by the Global Alliance for Genomics and Health (GA4GH). The main goal addressed by version 1 of the Beacon protocol was to test the feasibility of broadly sharing human genomic data, through providing simple “yes” or “no” responses to queries about the presence of a given variant in datasets hosted by Beacon providers. The popularity of this concept has fostered the design of a version 2, that better serves real‐world requirements and addresses the needs of clinical genomics research and healthcare, as assessed by several contributing projects and organizations. Particularly, rare disease genetics and cancer research will benefit from new case level and genomic variant level requests and the enabling of richer phenotype and clinical queries as well as support for fuzzy searches. Beacon is designed as a “lingua franca” to bridge data collections hosted in software solutions with different and rich interfaces. Beacon version 2 works alongside popular standards like Phenopackets, OMOP, or FHIR, allowing implementing consortia to return matches in beacon responses and provide a handover to their preferred data exchange format. The protocol is being explored by other research domains and is being tested in several international projects.

Healthcare utilization and outcomes of spinal cord injured veterans with stage 3–4 pressure injuries

Background Pressure injuries (PI) are a significant source of morbidity for individuals with spinal cord injury/disease (SCI/D). They are also associated with significant healthcare resource utilization including prolonged hospitalizations. However, the long-term outcomes in terms of wound recurrence-free survival, hospital readmission rates, and all-cause mortality in this population remain largely unknown. Objective To examine the clinical characteristics, healthcare utilization and outcomes of SCI Veterans hospitalized at the VA North Texas Health Care System (VANTHCS) SCI inpatient unit with stage 3 and 4 PI, and compare these between those who received a myocutaneous flap surgery (flap patients (FP)) and those treated medically (non-flap patients (NFP)). Methods A retrospective chart review was conducted of all adult patients admitted to the VANTHCS SCI/D unit with stage 3 or 4 pelvic PI between 1/1/2013 and 12/31/2018. Healthcare utilization and outcome information was extracted for pre-specified time points. Results 78 patients met criteria (113 hospitalizations; 27 FP; 51 NFP). Average length of stay (LOS) was 122 days; FP had a significantly higher LOS than NFP (P = 0.01). Average number of consults was 24. Estimated cost per hospitalization was $175,198. Readmission rate within 30 days was 12.39%. The mortality rate within 1 year of discharge was 21.57% for NFP, as opposed to 3.70% in the FP group. Only 5.00% of NFP wounds were healed at discharged with sustained healing at 1 year, significantly less than FP wounds (55.26%, P < 0.01). Conclusions Despite the high investment in terms of healthcare utilization, outcomes in terms of wound healing are poor. Additionally, nearly 22% of NFP died within one year of discharge. This calls into question the utility of prolonged hospitalizations for PI in the SCI/D population in terms of wound treatment efficacy, healthcare costs, and patient morbidity/mortality.

Malnutrition and low muscle strength are independent predictors of clinical outcomes and healthcare costs after liver transplant.

Malnutrition and sarcopenia are associated with increased morbidity and mortality in cirrhosis but conflicting data are reported after liver transplantation (LT), with little known about the economic burden of malnutrition at LT. This study aims to investigate the impact of pre-transplant malnutrition and muscle strength on post-transplant clinical outcomes and healthcare costs. Pre-transplant nutritional status (via subjective global assessment, SGA) and handgrip strength (HGS) were assessed in patients transplanted from 2009-2017. Descriptive statistics and regression analysis were used to analyse the association between nutrition and muscle function with post-LT clinical outcomes and hospital costs. 373 patients (70% male, median age 55 [IQR: 47, 60]) were transplanted, with 79% malnourished and mean HGS 31.4±9.35kg for males and 17.6±5.78kg for females. Malnutrition and reduced HGS independently predicted adverse post-transplant outcomes. ICU length of stay (LOS) was associated with severe malnutrition (HR (time to discharge (TTD)) 0.706, p=0.014) and low HGS (HR (TTD) 0.692, p=0.003); hospital LOS with severe malnutrition (HR (TTD) 0.759, p=0.049) and low HGS (HR (TTD) 0.730, p=0.011), and post-transplant infection with severe malnutrition (OR 1.76, p=0.042) and low HGS (OR 1.83, p=0.015). Accordingly, hospital costs were 30% higher in severely malnourished compared to well-nourished recipients (p=0.012). Neither malnutrition or impaired HGS were associated with post-transplant mortality. This large cohort study demonstrates malnutrition and muscle weakness are independently associated with early post-transplant morbidity, namely infection and ICU and hospital LOS; with significantly increased hospital costs. Strategies to combat malnutrition and deconditioning pre-transplant may improve patient and health system outcomes after LT.

Usability of augmented reality technology in tele-mentorship for managing clinical scenarios-A study protocol.

Tele-mentorship is considered to offer a solution to training and providing professional assistance at a distance. Tele-mentoring is a method in which a mentor interactively guides a mentee at a different geographic location in real time using a technological communication device. During a healthcare procedure, tele-mentoring can support a medical expert, remote from the treatment site, to guide a less-experienced practitioner at a different geographic location. Augmented Reality (AR) technology has been incorporated in tele-mentoring systems in healthcare environments globally. However, evidence is absent about the usability of AR technology in tele-mentoring clinical healthcare professionals in managing clinical scenarios. This study aims to evaluate the usability of Augmented Reality (AR) technology in tele-mentorship for managing clinical scenarios. This study uses a quasi-experimental design. Four experienced health professionals and a minimum of twelve novice health practitioners will be recruited for the roles of mentors and mentees, respectively. In the experiment, each mentee wearing the AR headset performs a maximum of four different clinical scenarios in a simulated learning environment. A mentor who stays in a separate room and uses a laptop will provide the mentee remote instruction and guidance following the standard protocols for the treatment proposed for each scenario. The scenarios of Acute Coronary Syndrome, Acute Myocardial Infarction, Pneumonia Severe Reaction to Antibiotics, and Hypoglycaemic Emergency are selected, and the corresponding clinical management protocols developed. Outcome measures include the mentors and mentees' perception of the AR's usability, mentorship effectiveness, and the mentees' self-confidence and skill performance. The protocol was approved by the Tasmania Health and Medical Human Research Ethics Committee (Project ID: 23343). The complete pre-registration of our study can be found at https://osf.io/q8c3u/.

Antithrombotic therapy in patients with non-valvular atrial fibrillation and high risk of stroke after successful endovascular left atrial appendage occlusion

Aim. To assess the antithrombotic therapy after left atrial appendage occlusion (LAAO) with the Watchman device (WD) and Amplarzer Cardiac Plug (ACP) for stroke prevention in patients with nonvalvular atrial fibrillation (AF) with contraindications for long anticoagulation therapy.Methods. 200 consecutive patients with nonvalvular AF and contraindications to oral anticoagulation therapy with contraindications for long anticoagulation who undergone LAAO implantation using WD (n=108; WD group) and ACP (n=92; ACP group) were enrolled into this study. Antithrombotic therapies were prescribed after successful LAAO implantation according to indications. Patients were followed at 45 days, 3, 6 and 12 months after enrollment. At each follow-up visit the data regarding clinical events and healthcare utilization were collected. Transesophageal echo (TEE) was perfomed at 45 days and 6 months after successful LAAO implantation. The efficacy end point was the composite of transit ischemic attack (TIA)/stroke, device thrombosis and procedure-related death.Results. During the follow-up TIA/stroke has occurred in 4.8% of patients in the WD group with no such events in ACP group (4.8% vs 0%, p=0.062). These patients had 4 or more points on the CHA2 DS2 -VASc, and they were prescribed various combinations of antithrombotic therapy, except warfarin, while patients from the WD group with 4 or more points on the CHA2 DS2 -VASc score taking warfarin had no thromboembolic events. Device thrombosis during TEE at 45 days after successful LAAO implantation was confirmed in 3 patients (2,9%) with WD with no such events in ACP group (2.9% vs 0%, p=0.251). The efficacy end point events in all groups were 4.6%: 8 events in WD group (7.6%) and 1 case in ACP group (1.1%). One patient in the ACP group died in 6 weeks after LAAO implantation. No autopsy was performed; therefore, the exact cause of death was not determined (p=0.038). Survival rate showed significantly higher rate events in WD group versus ACP group (p=0.027).Conclusion. Any combinations of antithrombotic therapy could be prescribed to patients with contraindications for anticoagulant therapy and high risk of stroke who undergone successful (LAAO) implantation with Amplatzer Cardiac Plug. It’s possible to cancel oral anticoagulants in this patient. Patients aged 70 and older with a CHA2 DS2 -VASc &gt;4 and a history of stroke are recommended to take warfarin after successful Watchman Device implantation.

Comparative effectiveness of non-pharmacological interventions for preventing delirium in critically ill adults: A systematic review and network meta-analysis

BackgroundDelirium presents a serious health problem in critically ill patients in intensive care units. However, knowledge regarding the selections of the optimal non-pharmacological interventions remains unclear. ObjectivesTo compare the effects of non-pharmacological interventions by combining direct and indirect evidence on the incidence and duration of delirium in intensive care units. DesignA systematic review and network meta-analysis. Data sourcesA comprehensive search of five electronic databases, including PubMed, EMBASE, CINAHL, Cochrane CENTRAL, and ProQuest Dissertations and Theses A&I were conducted. Only randomized control trials published from the inception to December 28, 2021 were included. Review methodsTwo reviewers independently screened the title and abstract for eligibility according to the inclusion and exclusion criteria. The random-effect network meta-analysis was used to estimate the comparative effects of non-pharmacological interventions in reducing delirium incidence and duration. ResultsA total of 29 studies with 7005 critically ill patients were enrolled. Twenty-six and eleven studies reported the delirium incidence and duration, respectively. Component-based intervention comparison revealed that multicomponent strategy was the most effective non-pharmacological intervention compared to usual care in reducing incidence of ICU delirium (Odd ratio [OR]=0.43, 95% CI= 0.22–0.84) but not ICU delirium duration. Treatment-based intervention comparisons indicated that specific multi-treatment interventions significantly reduced the ICU delirium incidence and duration, particularly the involvement of early mobilization and family participation (OR = 0.12 with 95% CI = 0.02 to 0.83; mean difference = -1.34 with 95% CI = -2.52 to -0.16, respectively). ConclusionOur study suggests that the multicomponent strategy was the most effective non-pharmacological intervention in reducing the incidence of ICU delirium. Early mobilization and family participation involvement in non-pharmacological interventions seemed to be more effective in reducing the incidence of ICU delirium. These results of network-meta analysis could be an important evidence-based for clinical healthcare providers to optimize the critical care protocol.Tweetable abstract: Network meta-analysis of 29 randomised controlled trials with 7005 patients finds that multicomponent interventions, particularly those involving early mobilization, family participation, cognitive stimulation, reorientation, sensory stimulation, environment control and clinical adjustment, is the most effective non-pharmacological strategy to reduce the incidence of delirium in intensive care units.

Associations between Time Processing Ability, Daily Time Management, and Dementia Severity.

This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this cross-sectional study. Bivariate analyses were used to investigate associations between TPA and DTM and the dementia severity. Linear regression models were used to further predict the contribution of the subtests in the Mini Mental State Examination (MMSE) for TPA results. The results showed significant correlations between TPA and dementia severity, where visuospatial functions were the most highly correlated. TPA also showed a significant correlation to proxy-rated DTM. In addition, proxy-rated DTM was significantly correlated with dementia severity and PwDs’ own self-ratings of their DTM. Knowledge of the association between TPA, dementia severity, and visuospatial functions can enable early detection of TPA impairments. For a comprehensive assessment of TPA and DTM, objective measures should be used in combination with self-ratings and proxy-ratings. The findings can be used in clinical research and healthcare settings to develop methods to compensate for impaired TPA and support DTM in PwDs.

Reflex single-gene non-invasive prenatal testing is associated with markedly better detection of fetuses affected with single-gene recessive disorders at lower cost

Objective To evaluate the clinical benefits and achievable cost savings associated with the adoption of a carrier screen with reflex single-gene non-invasive prenatal test (sgNIPT) in prenatal care. Method A decision-analytic model was developed to compare carrier screen with reflex sgNIPT (maternal carrier status and fetal risk reported together) as first-line carrier screening to the traditional carrier screening workflow (positive maternal carrier screen followed by paternal screening to evaluate fetal risk). The model compared the clinical outcomes and healthcare costs associated with the two screening methods. These results were used to simulate appropriate pricing for reflex sgNIPT. Results Reflex sgNIPT carrier screening-detected 108 of 110 affected pregnancies per 100,000 births (98.5% sensitivity), whereas traditional carrier screening-detected 46 of 110 affected pregnancies (41.5% sensitivity). The cost to identify one affected pregnancy was reduced by 62% in the reflex sgNIPT scenario compared to the traditional scenario. Adding together the testing cost savings and the savings from earlier clinical intervention made possible by reflex sgNIPT, the total cost savings was $37.6 million per 100,000 pregnancies. Based on these cost savings, we simulated appropriate reflex sgNIPT pricing range: if the cost to identify one affected pregnancy is the unit cost, carrier screening with reflex sgNIPT can be priced up to $1,859 per test (or $7,233 if sgNIPT is billed separately); if the cost per 100,000 pregnancies is the unit cost, carrier screening with sgNIPT can be priced up to $1,070 per test (or $2,336 if sgNIPT is billed separately). Conclusion Using the carrier screen with reflex sgNIPT as first-line screening improves the detection of affected fetuses by 2.4-fold and can save costs for the healthcare system. A real-life experience will be needed to assess the clinical utility and exact cost savings of carrier screen with reflex sgNIPT.

Exploring the experiences, psychological well-being and needs of frontline healthcare workers of government hospitals in India: a qualitative study

The present study aims to understand the experiences, challenges, psychological well-being and needs of clinical and non-clinical government healthcare workers (HCWs) during the COVID-19 pandemic in the Hyderabad-Karnataka (H-K) region. This qualitative study used purposive sampling method to recruit 221 HCWs working in the H-K region government hospitals during the COVID-19 pandemic. Semi-structured interviews were carried out with those HCWs who agreed to participate. The data analyzed using conventional content analysis revealed three main themes: (1) experiences and challenges faced by HCWs; (2) psychological well-being and coping strategies used by HCWs; and (3) experience of and need for social support. The main findings of the current study are as follows: The HCWs experienced fear and apprehension during the early stages of the pandemic, but gradually, their fears reduced, and they perceived the situation to be the “new normal”. They experienced work-related (scarcity of resources, problems with PPE, communication issues, violence, and stigma) and family-related (fear of infecting family members, choosing work over family, inability to undertake family roles) challenges while serving during the pandemic. They reported increased psychological issues (psychological distress, experience of loss, and feelings of guilt and helplessness). Conversely, they reported a need for emotional stability. The HCWs reported using adaptive (emotion-focused, problem-focused, and religious) and maladaptive (avoidance and substance abuse) coping strategies to cope with these challenges and psychological problems. They also sought social support (from family, friends, colleagues, and superiors) and raised the need for organizational, personal, and societal support to cope with the pandemic. The HCWs experienced physical and psychological burnout, especially from stretching beyond the assigned roles due to a shortage of resources and workforce. However, amidst juggling with work and family responsibilities, HCWs were found to be emotionally stable and reported to have a positive outlook in general. Besides, emphasizing the regulation of policies for meeting their primary needs, they stressed the need for professional psychological services with need-based intervention strategies.

Mapping Canadian Data Assets to Generate Real-World Evidence: Lessons Learned from Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration's RWE Data Working Group.

Canadian provinces routinely collect patient-level data for administrative purposes. These real-world data (RWD) can be used to generate real-world evidence (RWE) to inform clinical care and healthcare policy. The CanREValue Collaboration is developing a framework for the use of RWE in cancer drug funding decisions. A Data Working Group (WG) was established to identify data assets across Canada for generating RWE of oncology drugs. The mapping exercise was conducted using an iterative scan with informant surveys and teleconference. Data experts from ten provinces convened for a total of three teleconferences and two in-person meetings from March 2018 to September 2019. Following each meeting, surveys were developed and shared with the data experts which focused on identifying databases and data elements, as well as a feasibility assessment of conducting RWE studies using existing data elements and resources. Survey responses were compiled into an interim data report, which was used for public stakeholder consultation. The feedback from the public consultation was used to update the interim data report. We found that databases required to conduct real-world studies are often held by multiple different data custodians. Ninety-seven databases were identified across Canada. Provinces held on average 9 distinct databases (range: 8–11). An Essential RWD Table was compiled that contains data elements that are necessary, at a minimal, to conduct an RWE study. An Expanded RWD Table that contains a more comprehensive list of potentially relevant data elements was also compiled and the availabilities of these data elements were mapped. While most provinces have data on patient demographics (e.g., age, sex) and cancer-related variables (e.g., morphology, topography), the availability and linkability of data on cancer treatment, clinical characteristics (e.g., morphology and topography), and drug costs vary among provinces. Based on current resources, data availability, and access processes, data experts in most provinces noted that more than 12 months would be required to complete an RWE study. The CanREValue Collaboration’s Data WG identified key data holdings, access considerations, as well as gaps in oncology treatment-specific data. This data catalogue can be used to facilitate future oncology-specific RWE analyses across Canada.

Community pharmacists' attitudes toward practice-based research and their perceived utilization of scientific evidence.

BackgroundEnhancing the contribution of practicing pharmacists into scientific evidence via practice-based research (PBR) is crucial in maintaining high-quality clinical practice and healthcare delivery. Involving community pharmacists in PBR can potentially can also help break barriers to the utilization of the current best evidence in everyday pharmacy practice. The impact of pharmacists’ attitude towards PBR on their utilization of current best evidence in pharmacy practice is understudied.ObjectivesThe aim of the study was to investigate the impact of community pharmacists’ attitudes toward PBR on their utilization of current best evidence, barriers for conducting PBR in clinical practice were also investigated.MethodsIn this cross-sectional study, 169 community pharmacists working across Jordan filled a questionnaire to assess their attitudes towards PBR, barriers to PBR, and their utilization of the current best evidence in clinical practice.ResultsPharmacists in this study showed a positive attitude toward PBR (attitude mean score >3.5). A positive attitude towards PBR was associated with high utilization of the best current scientific evidence. We also investigated several barriers to PBR and their association with utilization those included; the lack of perceived benefits, lack of institutional support, and lack of self-engagements of community pharmacists to PBR. The lack of perceived benefit was found to be negatively associated with pharmacists’ utilization of the current best scientific evidence.ConclusionIn this study, pharmacists’ utilization of current best evidence was found to be significantly impacted by their attitude toward PBR. The current study findings highlight the importance of supporting, promoting, and facilitating PBR among community pharmacists which can potentially enhance their utilization of the current best evidence in their everyday pharmacy practice.

The Impact of COVID-19 on Interventional Radiology Practice Worldwide: Results from a Global Survey

BackgroundThe COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves.MethodsAn anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis.ResultsInterventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis.ConclusionWhile the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic.

A US Retrospective Claims Analysis Comparing Healthcare Costs of Patients Transitioning from Immediate-Release Oxycodone to Two Different Formulations of Extended-Release Oxycodone: Xtampza ER or OxyContin.

PurposeOpioid therapy for managing chronic pain remains a challenge, as providers must weigh the medical benefit to the patient with the risk of adverse events. Manipulation of many extended-release (ER) opioid formulations may lead to increased serious medical outcomes or death. The economic burden of opioid use disorders due to opioid misuse and abuse may vary depending on which abuse deterrent opioid formulation is prescribed. The study aimed to compare demographic and clinical characteristics and healthcare costs of chronic pain patients treated with two different abuse-deterrent opioid formulations, Xtampza ER and reformulated OxyContin.MethodsThe source of data was IBM® MarketScan® Commercial Claims and Encounters Medicare Supplemental database, from January 2016 through February 2020. Patients with chronic pain were assigned to either the Xtampza ER or the OxyContin cohort based on the initial ER opioid prescription set as the index date. Continuous healthcare coverage was required during a minimum 3-month pre-index and 9-month post-index periods. Pre-index patients’ characteristics were analyzed. Healthcare costs of Xtampza ER vs OxyContin were assessed in the post-index period.ResultsAfter applying selection criteria, 464 patients were observed in the Xtampza ER cohort versus 1927 patients in the OxyContin cohort. In unmatched patients, ER opioid costs were lower for Xtampza ER than OxyContin ($2645 vs $3141; p<0.001), which ultimately led to lower total prescription costs for the Xtampza ER cohort compared to the OxyContin cohort ($7492 vs $8754; p=0.016). In matched patients, the total healthcare costs were significantly lower in the Xtampza ER cohort than in the OxyContin cohort, $22,630 vs $28,386 (p=0.005), respectively.ConclusionThis study suggests that Xtampza ER may result in lower healthcare costs than OxyContin for a population of chronic pain patients switching from immediate release oxycodone based on real-world data.

Use of Soft Systems Methodology for Implementing Clinical Practice Guidelines in a General Hospital

Background: It is challenging to implement evidence-based care and update and improve health care policy. Adhering to evidence-based Clinical Practice Guidelines (CPGs) serves as a guide for making decisions based on the best evidence and making an attempt to improve the quality of patient care and outcomes. Despite the need for implementing CPGs in Iranian hospitals, the concept and implementation method of CPGs are not clear yet. This action research aims to propose the soft systems methodology (SSM) to facilitate the implementation of CPGs in a general hospital in Iran. Methods: We employed the SSM to conceptualize the situation for the implementation of CPGs. Semi-structured in-depth interviews and group discussions with different stakeholders were used to define the purposeful activity model. The SSM tools and techniques were used to identify the main areas of change and select necessary measures to facilitate the implementation of CPGs. Flexible qualitative methods for data collection and analysis were utilized throughout the study. Results: Applying SSM for implementing CPGs could generate knowledge by recognizing hyper-complexity in healthcare setting, adopting an attitude of inquiry, and fostering dynamic changes in diverse and numerous worldviews of professionals in the accommodation process. This knowledge can provide a model for the successful implementation of CPGs at a macro-system level and facilitate the persuasion process for its implementation at the mesosystem level. More importantly, adopting SSM can create iterative learning loops over time and, thus, help the clinical microsystems face future healthcare complexities. Conclusion: The application of systems thinking approaches, especially SSM is recommended for implementing CPGs and addressing complex issues in healthcare settings and other system levels.