Clinical Performance Indicators Research Articles

P-217 Keep calm and carry on: assessing the effect of below-benchmark vitrified/warmed donor oocyte survival rates in subsequent laboratory and clinical key performance indicators

Abstract Study question When we experience below benchmark donor oocyte survival rates, are the laboratory and clinical outcomes of the recipient cycle affected? Summary answer Donor-oocyte cryo-survival rates below the benchmark (95-100%) result in slightly lower laboratory KPIs, equivalent live birth rates (LBR) and lower cumulative LBR (CLBR) per cycle. What is known already The use of vitrified/warmed donor oocytes allows overcoming many logistic challenges, but it is hindered by the loss of oocytes due to degeneration after warming. The 2012 Vienna Consensus established the benchmark rate of oocyte survival at 95-100%, competency level at > 85%. Results of < 85% cryo-survival are considered below competency, <70% can be considered poor, and <50% very poor. Below-benchmark rates of survival may not only limit the number of donor oocytes for the cycle, but they can also translate into lower per-oocyte cycle KPIs if the lower survival correlates with lower performance of the surviving oocytes. Study design, size, duration We analyzed 12690 vitrified-warmed donor oocyte recipient cycles, encompassing a total 144793 vitrified/warmed donor oocytes, carried out in a network of European private IVF units from 2018-2022. Cycles with PGT-A and spermatozoa from testicular biopsy were excluded. The primary endpoint of the study was the blastocyst utilization rate per 2PN zygote. Secondary endpoints were fertilization rate, live birth rate after the first single blastocyst transfer (SET-LBR) of each cycle, and cumulative LBR (CLBR). Participants/materials, setting, methods In all cases, fertilization was carried out by ICSI, and embryos were cultured to the blastocyst stage at low oxygen tension. Blastocysts with good or fair quality (A, B & C by ASEBIR Criteria) were considered usable (transferred + cryopreserved blastocyts / zygotes). Differences in proportions were analyzed using chi-square and the adjusted odds ratio (OR) was calculated using multivariable logistic regression. Main results and the role of chance Baseline donor and patient characteristics such as age, stimulation duration and dose, total donor oocytes per cycle, male factor, and fresh/frozen/donor spem were compared between groups and adjusted for when necessary. The mean number of warmed oocytes per cycle was 11.4±3.22 with a mean survival rate of 89.2%. More oocytes per cycle were consumed in the lower survival groups, yet the total oocytes available for ICSI was smaller in the below competency, poor and very poor survival groups. There were differences in the proportion of usable blastocysts per zygote amongst the survival rate groups (benchmark: 48.9%; competence: 47.0%, below-competence: 46.0%; poor: 43.6%; very-poor:43.6%, p < 0.001). Fertilization rates also differed between survival groups (benchmark: 76.9%; competence: 76.5%, below-competence: 75.6%; poor: 74.7%; very-poor:75.4%, p < 0.001) The adjusted odds ratio of live birth on the first SET of the cycle was not lower to the benchmark survival group in all the lower survival groups (Benchmark: 40.9%; Competence: OR:0.995; 95%CI:0.971-1.018; below-competence: OR:0.996; 95%CI:0.970-1.023; poor: OR:1.044; 95%CI:1.003-1.086, and very-poor: OR:1.069; 95%CI:0.976-1.170). The CLBR decreased in lower survival groups, with 80.8% for the benchmark survival group, 80.3% (p = 0.539) for competence, 76.2% (p < 0.001) for below-competence, 72.5% (p < 0.001) for poor, and 74.8% (p = 0.056) for very-poor. Limitations, reasons for caution These results are limited to a donor-oocyte population. Wider implications of the findings Lower oocyte-cryo-survival rates resulted in a lower total number of usable blastocysts obtained for the recipient, and consequently, lower CLBR. However, the competence of surviving oocytes is encouraging, with laboratory KPIs in very close range irrespectively of the cohort survival rates, and similar implantation potential of the obtained blastocysts. Trial registration number not applicable

Update to the essential genomic nursing competencies and outcome indicators.

Genomic healthcare applications have relevance to all healthcare professionals including nursing, and most evidence-based clinical applications impact the quality and safety of healthcare. To guide nursing genomic competency initiatives, the Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics were established through a process of consensus in 2005. A 2009 update incorporated outcome indicators consisting of specific areas of knowledge and clinical performance indicators, to help support academic integration. Almost 20 years have elapsed since these competencies were first established, yet incorporating the competencies into general and specialty scope and standards of nursing practice is inconsistent, competency integration into curricula is highly uneven, continuing education in genomics for nurses is limited, and the genomic capacity of the nursing workforce remains low. These deficits have persisted despite substantial advances in genomic technology which substantially reduced costs and increased evidence-based clinical applications, including direct to consumer genomic tests, the integration of genomics into evidence-based guidelines, and evidence that genomics impacts the quality and safety of healthcare. The aim of this project was to update and achieve consensus on genomic competencies applicable to all registered nurses. This was a mixed methods study. The update to the competencies was performed based first on a literature review to update the competencies based on the current state of the evidence. Using the updated content, a modified Delphi study was conducted with registered nurse panelists from clinical, academic, and research settings. Once consensus was achieved, the competencies were made available through the American Nurses Association for public comment. Public comments were then reviewed and integrated as needed. The literature review resulted in a transition from genetics to genomics, given the reduction in costs, which resulted in an expansion of the scope of testing in both the germline and somatic contexts. Two Delphi rounds were required to reach consensus prior to the public comment period. Public comments were solicited through the American Nurses Association, and each comment was reviewed by the authors and addressed as indicated. The Essentials of Genomic Nursing: Competencies and Outcome Indicators constitute the minimum competency in genomics required of all registered nurses regardless of the level of academic training, role, or specialty. Evidence-based genomic applications span the entire healthcare continuum and, therefore, are relevant for all registered nurses regardless of academic training, role, practice setting, or clinical expertise. These competencies serve as the guide for the minimum requirements for registered nurse practice as well as guide curricula and continuing education for all registered nurses, including but not limited to administrators, educators, nursing leaders, practicing nurses, and researchers.

Design and development of the clinical pharmacy key performance indicators dashboard for equity of service provision at regional and rural hospitals in North Queensland, Australia

AbstractBackgroundProvision of a Medication Action Plan (MAP) on admission and a Discharge Medication Record (DMR) are associated with reduced medication‐related harm.AimTo report factors associated with the provision of MAPs and DMRs in rural and regional hospitals in Queensland, Australia.MethodA literature search, environmental scan and department consultations were conducted to develop Clinical Pharmacy Key Performance Indicators (cpKPIs) and design a cpKPI dashboard. Two of the five KPIs included in the dashboard, relating to medication action plans on admission and medication records on discharge, were reported for all the hospitals and were included in the study. A retrospective, period‐prevalence study was conducted to evaluate the coverage and equity of clinical pharmacy service provision for patients admitted for longer than 24 h. The proportions of patients who received MAPs and DMRs were stratified by age, gender, Indigeneity and hospital type. Statistical analysis used chi‐squared tests and logistic regression in R. This project was exempt due to the local policy requirements that constitute research by the Far North Queensland Human Research Ethics Committee (Reference no: EX/2023/QCH/94383‐1684QA). The justification for this exemption is as follows: the project was determined to be negligible risk research and involved the use of existing collection of data or records that contain only non‐identifiable data about human beings.ResultsIn total, 13 818 patients (37.9% of admissions) received a MAP and 11 631 patients (32.7% of discharges) received a DMR. The proportion of MAPs and DMRs was significantly higher in rural hospitals than in regional hospitals (MAP 50.6% vs 34.6%, DMR 33.1% vs 31.3%) and for male patients than female patients (MAP 42.2% vs 33.7%, DMR 36.4% vs 29.2%). When stratified by age, First Nations patients received a higher proportion of MAPs and DMRs in each age group, except for age 85 years and over. The proportion of First Nations patients aged 50 years and over who received MAP was lower compared to that for non‐Indigenous patients aged 65 years and over (56.3% vs 59.8%), whilst the proportion for DMRs was similar (50.4% vs 49.3%).ConclusionThe study defined the clinical pharmacy key performance indicators for measuring equity of clinical pharmacy service provision in Australia. When adjusted for a difference in life expectancy, the proportion of MAPs for First Nations patients was lower compared to the proportion of MAPs for non‐Indigenous patients. Further improvements are required to achieve equity of service provision for First Nations patients and female patients.

Cutaneous melanoma in adolescents and young adults.

Cutaneous malignant melanoma (CMM) ranks among the five most common cancers in young people in high-income countries and it features peculiar clinicopathological traits. Very few studies have addressed the quality of care and the costs for adolescents and young adults (AYA) population. To provide a comprehensive epidemiological and clinicopathological profile of CMM in AYA. The study also addresses the cost-of-illness and the diagnostic-therapeutic performance indicators by patient age category. This population-based cohort study included 2435 incident CMM (age range 15-65 years; age 15-39 = 394; age 40-65 = 2041), as recorded in 2015, 2017 and 2019 by the Regional Veneto Cancer Registry (Italy). Cramer's-V tested the strength of association between pairs of variables. The Kaplan-Meier method was used to test the association between age and survival rate. The clinical performance indicators were computed using the Clopper-Pearson exact method. In AYA patients (16.2%), CMM incidence rates increased significantly from 1990 to 2019. Low-stage CMM (p = 0.007), radial growth pattern (p = 0.026) and lower Clark levels (p = 0.007) prevailed; males had less advanced malignancies (p = 0.003), with the trunk as the most common primary site (67.5%); the lower limbs (32.6%) were the most common primary site for females (p < 0.001). Overall survival was better in AYA than adults. No significant difference was detected in the clinical management of the two age groups, with the only exception of the margin in wide local excision. The care costs were lower in AYA (€195.99 vs. €258.94, p = 0.004). In AYA patients, the CMM clinicopathological presentation shows a distinctive profile. The present results provide critical information for optimizing primary and secondary prevention strategies and for tailoring diagnostic therapeutic procedures to the peculiar profile of AYA CMM patients.

Evaluating dental student self-assessment across preclinical anatomy waxing and operative exercises.

A career in healthcare is built on the foundations of continuous self-reflection and self-assessment. Previous studies have solely compared student self-assessment to faculty grades in a single discipline. The objective of this study was to investigate whether associations of a student's self-assessment skills exist across multiple disciplines in the predoctoral setting. Sixty-five students from two class years at the Harvard School of Dental Medicine completed preclinical competency exams in dental anatomy waxing and operative dentistry. The difference between the student's self-assessment score and average faculty grade for each exercise was calculated as the student‒faculty (S-F) gap, which served as a proxy to determine how students evaluate their work. Regression analysis was performed to assess associations between wax-up and preclinical operative S-F gaps. Mean S-F gaps for waxing and preclinical operative procedures were positive (5.7±6.1 and 7.6±6.7, respectively). Additionally, students in the lower quartile tended to overestimate performance to a greater degree than their peers in the upper quartile. Furthermore, the waxing S-F gaps were positively associated with S-F gaps of each operative procedure, particularly with the combined operative exercise S-F gaps, where a statistically significant association was seen (coefficient=0.28; p=0.04). Previously, we identified a negative correlation between students' self-assessment skills (S-F gaps) and their preclinical performance. In this study, we further demonstrated an association of S-F gaps in two fundamental exercises: wax-up and operative dentistry. This underscores the roles of S-F gaps as possible indicators of students' preclinical and clinical performance, and it holds potential to become a widely standardized and applicable calculation that may help evaluate the effectiveness of the dental curricula and optimize student learning.

Cutaneous melanoma in older patients

BackgroundIn industrialized countries, the aging population is steadily rising. The incidence of cutaneous malignant melanoma (CMM) is highest in old people. This study focuses on the clinicopathological profile of CMM and indicators of diagnostic-therapeutic performance in older patients.MethodsThis retrospective population-based cohort study included 1,368 incident CMM, as recorded in 2017 by the Regional Veneto Cancer Registry (Northeast Italy). Older subjects were defined as ≥ 80, old as 65–79, and adults as < 65 years of age. The strength of association between pairs of variables was tested by Cramer’s-V. Using age groups as the dependent variable, ordered logistic regression was fitted using the clinicopathological CMM profiles as covariates. In each of the three age-groups, the indicators of clinical performance were computed using the Clopper-Pearson exact method.ResultsCompared to patients aged younger than 80 years (1,187), CMM in older patients (181; 13.2%) featured different CMM topography, a higher prevalence of ulcers (43.3% versus 12.7%; p < 0.001), a higher Breslow index (p < 0.001), a lower prevalence of tumor-infiltrating lymphocytes (64.4% versus 76.5%, p < 0.01), and a more advanced pTNM stage at clinical presentation (p < 0.001). Elderly patients with a positive sentinel-lymph node less frequently underwent sentinel- lymph node biopsy and lymphadenectomy (60.0% versus 94.2%, and 44.4% versus 85.5%, respectively; p < 0.001).ConclusionsIn older CMM patients, the clinicopathological presentation of CMM shows a distinctive profile. The present results provide critical information to optimize secondary prevention strategies and refine diagnostic-therapeutic procedures tailored to older patients.

Hospital standardized mortality ratio: limits and potential of the indicator for assessing hospital performance in the Brazilian Unified National Health System

Comparative analyses based on clinical performance indicators to monitor the quality of hospital care have been carried out for decades in several countries, most notably the hospital standardized mortality ratio (HSMR). In Brazil, studies and the adoption of methodological tools that allow regular analysis of the performance of institutions are still scarce. This study aimed to assess the use of HSMR to compare the performance of hospitals funded by the Brazilian Unified National Health System (SUS). The Hospital Information System was the source of data on adult hospitalizations in Brazil from 2017 to 2019. The methodological approach to estimate HSMR was adapted to the available data and included the causes of hospitalization (main diagnosis) responsible for 80% of deaths. The number of expected deaths was estimated using a logistic regression model that included predictor variables widely described in the literature. The analysis was conducted in two stages: (i) hospitalization level and (ii) hospital level. The final risk adjustment model showed a C-statistic of 0.774, which is considered adequate. The variation in HSMR was wide, especially among the worst-performing hospitals (1.54 to 6.77). Private hospitals performed better than public hospitals. Although the limits of the available data and the challenges still face its more refined use, HSMR is applicable and has the potential to become an important tool for assessing hospital performance in the SUS.

Study protocol: maintaining preventive care during public health emergencies through effective coordination

BackgroundScreening lies at the heart of preventive care. However, COVID-19 dramatically disrupted routine screening efforts, resulting in excess mortality not directly attributable to COVID-19. Screening rates during COVID varied markedly by facility and clinical condition, suggesting susceptibilities in screening and referral process workflow. To better understand these susceptibilities and identify new practices to mitigate interrupted care, we propose a qualitative study comparing facilities that exhibited high, low, and highly variable performance (respectively) in screening rates before and during the pandemic. We will be guided by Weaver et al.’s multi-team systems (MTS) model of coordination, using cancer and mental health screening rates as exemplars.MethodQualitative analysis of interviews and focus groups with primary care personnel, leadership, and patients at 10 VA medical centers. We will select sites based on rurality, COVID-19 caseload at the beginning of the pandemic, and performance on five outpatient clinical performance indicators of cancer and mental health screening. Sites will be categorized into one of five screening performance groups: high performers, low performers, improvers, plummeters, and highly variable.We will create process maps for each performance measure to create a workflow baseline and then interview primary care leadership to update the map at each site. We will clinician conduct focus groups to elicit themes regarding clinician coordination patterns (e.g., handoffs), strategies, and barriers/facilitators to screening during COVID. We will also conduct patient interviews to examine their screening experience during this period, for context. All interviews and focus groups will be audio-recorded, transcribed, and enhanced by field notes. We will analyze clinician transcripts and field notes using iterative, rapid analysis. Patient interviews will be analyzed using inductive/deductive content analysis.DiscussionOur study represents a unique opportunity to inform the multi-team systems literature by identifying specific forms of information exchange, collective problem solving, and decision-making associated with higher and improved clinical performance. Specifically, our study aims to detect the specific points in the screening and referral process most susceptible to disruption and coordination processes that, if changed, will yield the highest value. Findings apply to future pandemics or any event with the potential to disrupt care.

Changes in Health-Related Quality of Life in Patients with Therapy-Resistant Migraine during Treatment with Erenumab in an Ambulatory Care Setting.

Migraine preventive treatment with the CGRP-receptor monoclonal antibody Erenumab can positively impact health-related quality of life (HRQoL) and disease-associated disability. Patient-reported outcome measures (PROMs) are a valuable additional datapoint to real-world evidence covering how treatment affects physical, mental, and social domains of patients' lives. In this real-world, single-center retrospective observational cohort study, we analyzed clinical performance indicators and PROMs for migraine patients who failed at least four other preventive medications and received Erenumab over the course of one year. Endpoints were the average monthly migraine days as well as PROMs including the MIDAS, EQ-5D-VAS and PROMIS-29. Data were collected digitally via the software heartbeat ONE in an ambulatory care setting as part of the clinical routine. A total of 145 patients treated with Erenumab provided data for 12 months. After 12 months, the median number of monthly migraine days decreased from 9 to 7 days. A clinically relevant reduction in migraine days by ≥30% was reported by 40% of the patients. The migraine-specific MIDAS score, the EQ-5D-VAS measuring the overall health status and all PROMIS domains, except sleep disturbance, changed significantly, reflecting a positive disease progression. This study highlights how patients with a treatment-resistant migraine in an outpatient setting benefit from a preventive treatment with Erenumab. A decrease in migraine days and an increase in HRQoL was maintained over one year. It also underscores the significance of collecting real-world evidence, including PROMs, as an integral component of the healthcare cycle, as such data can reveal additional factors relevant to treatment.

Indicators of clinical performance in monitoring soft tissue sarcoma management: a population-based perspective.

Soft tissue sarcomas (STS) are rare malignancies which prognosis varies significantly by primary site, histological subtype, and tumor stage. Their low incidence, and the complexity of their clinico-pathological characteristics demand standardized, cancer-tailored diagnostics and therapies managed at high-volume, multidisciplinary care centers. This study evaluates the quality of STS management in north-east Italy (Veneto Region) through a list of ad hoc defined clinical indicators. This population-based study concerns all incident cases of STS in 2018 (214 cases) recorded in the adult population censored by the Veneto's regional Cancer Registry. Based on the international literature, a multidisciplinary working group of experts identified a set of indicators for monitoring the quality of diagnostic, therapeutic, and end-of-life clinical interventions. The quality of care was assessed by comparing the reference thresholds with the indicators' values achieved in clinical practice. Diagnostic procedures showed poor adherence to the thresholds, with a low percentage of histological diagnoses validated by a second opinion. The indicators relating to the surgical treatment of superficial, small, low-grade STS, or of medium, high-grade STS of the head-neck, trunk, or limbs were consistent with the thresholds, while for intermediate, high-grade (large-sized, deep) and retroperitoneal STS they fell significantly below the thresholds. A critical evaluation of the clinical indicators allowed to uncover the procedures needing corrective action. Monitoring clinical care indicators improves cancer care, confirms the importance of managing rare cancers at highly specialized, high-volume centers, and promotes the ethical sustainability of the healthcare system.

Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter.

in this retrospective single-center study, we aimed to report on the clinical performances achieved with high-flow tunneled CVCs (DualCath or DCath) and compared them with arteriovenous accesses (AVAs, e.g., AV fistula, AV graft, and Thomas Shunt) in a hospital-based dialysis unit. Sixty-eight stage 5 chronic kidney disease dialysis-dependent patients (CKD5D) receiving high volume hemodiafiltration were followed-up with for 30 months. The study consisted of two phases: baseline cross-sectional and longitudinal follow-ups of key performance indicators. Clinical performances consisting of effective blood flow and blood volume, recirculation, urea and ionic Kt/V, total Kt, ultrafiltration volume, and percent reduction in β2-M were measured monthly as part of quality control in our unit. At baseline, the effective blood flow using a DCath was close to 400 mL/min, similar to an AVA. Recirculation with a DCath (7%, 6-13%) was higher than with an AVA. The diffusive dialysis dose delivered with a DCath (spKt and eKt/V) and convective dialysis dose achieved with a DCath were slightly lower than those achieved with AVAs, but they were still much higher than is recommended by guidelines. The percent reduction in β2-M achieved with a DCath was also 4 to 10% lower than that achieved with an AVA. On longitudinal follow-up, the main clinical performance indicators of DCaths (total Kt and total ultrafiltration volume, L/session) were maintained as very stable over time and close to those achieved with AVAs. As shown in this study, high-flow DualCath tunneled two-single-lumen silicone catheters may be used to deliver high volume hemodiafiltration in a reliable and consistent manner without compromising clinical performance. These results relied on the specific design of the two silicone cannulas and the strict adherence to best catheter practices.

The impact of the COVID-19 Pandemic on Emergency Care of Acute Myocardial Infarction: Findings from the Taiwan Clinical Performance Indicator (TCPI).

Acute myocardial infarction (AMI) treatment requires timely diagnosis and treatment for optimal health outcomes. The COVID-19 pandemic has caused changes in healthcare delivery and utilisation; therefore, our study explored the changes in emergency care quality indicators for patients with AMI before and during different periods of government response to the COVID-19 outbreak in Taiwan. The Taiwan Clinical Performance Indicators (TCPI) database was used to evaluate the impact of COVID-19 on acute care quality indicators for patients with AMI during four periods: before the COVID-19 outbreak (Period I, 1 January to 31 December 2019) and during three periods in which the central government imposed different levels of epidemic prevention and response alerts (Period II, 1 January 2020, to 30 April 2021; Period III, 1 May to 31 July 2021; and Period IV, 1 August to 31 December 2021) . A 15.9% decrease in monthly emergency department admission for patients with AMI occurred during Period III. The hospital "door-to-electrocardiogram time being <10 min" indicator attainment was significantly lower during Periods III and IV. The attainment of "dual antiplatelet therapy (DAPT) received within 6 hours of emergency department arrival" indicator improved in Period IV, whereas "the primary percutaneous coronary intervention (PCI) being received within 90 min of hospital arrival" indicator significantly decreased during Periods III and IV. The indicator "in-hospital mortality" was unchanged within our study duration. Overall, the quality of care for patients with AMI was mildly influenced during the assessed pandemic periods, especially in terms of door-to- electrocardiogram times of <10 min and primary PCI received within 90 min of hospital arrival (Period III). Using our study results, hospitals can develop strategies regarding care delivery for patients with AMI during a COVID-19 outbreak on the basis of central government alert levels, even during the height of the pandemic.

Prospective assessment of nighttime respiratory disturbance in multiple myeloma patients

Chronic intermittent hypoxia, a feature of sleep apnea, is a potent driver of solid tumor cancers and promotes lethal engraftment of malignant plasma cells in a mouse model. The objective of this study was to investigate if nighttime respiratory disturbances affect clinical outcomes in a multiple myeloma patient population. To do so, we prospectively assessed nighttime respiratory disturbance index (RDI) in 44 patients (27 male, 17 female) diagnosed with multiple myeloma at the University of Iowa Hospitals and Clinics. Following this assessment, we categorized patients by RDI and utilized electronic medical records to explore differences in routine myeloma clinical measures. We found 93% of the patients had an RDI equal to clinical sleep apnea. 39% of patients had a moderate or severe RDI. In comparing these patients to those with low RDI, there were no statistical differences in any clinical performance indicator. Additionally, there were no differences in disease symptoms, multiple myeloma staging, or antibody type between these groups. However, patients with a higher nighttime RDI were less likely to respond to induction chemotherapy (p=0.046), a predictor of poor disease prognosis. These data support the hypothesis that nighttime respiratory disturbances negatively impact multiple myeloma patients, but this impact may not be evident in routine clinical tests of patient performance. This research is supported by NIH award R01CA244271 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Clinical and laboratory key performance indicators in IVF: A consensus between the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) and the Italian Society of Embryology, Reproduction and Research (SIERR)

PurposeInfertility is increasing worldwide, and many couples seek IVF. Clinical management and laboratory work are fundamental in the IVF journey. Therefore, the definition of reliable key performance indicators (KPIs) based on clinical and laboratory parameters, is essential for internal quality control (IQC). Laboratory performance indicators have been identified and a first attempt to also determine clinical ones has been recently published. However, more detailed indicators are required.MethodsAn Italian group of experts in Reproductive Medicine from both public and private clinics on behalf of SIFES-MR and SIERR was established to define IVF indicators to monitor clinical performance.ResultsThe working group built a consensus on a list of KPIs, performance indicators (PIs) and recommendation indicators (RIs). When deemed necessary, the reference population was stratified by woman age, response to ovarian stimulation and adoption of preimplantation genetic testing for aneuploidies (PGT-A). Each indicator was scored with a value from 1 to 5 and a weighted average formula – considering all the suggested parameters—was defined. This formula generates a center performance score, indicating low, average, good, or excellent performance.ConclusionThis study is intended to provide KPIs, PIs and RIs that encompass several essential aspects of a modern IVF clinic, including quality control and constant monitoring of clinical and embryological features. These indicators could be used to assess the quality of each center with the aim of improving efficacy and efficiency in IVF.

Measuring the Performance of a Training Nurse Angiographer

Background/AimsIn considering whether the new role of nurse angiographer could be developed nationally, radiation exposure was focused on as a performance indicator to demonstrate if patients were positively or negatively impacted when compared to national benchmarks. Measuring this clinical performance indicator in the first 104 training cases would provide evidence to either adapt training to ensure improved clinical performance, or allow the role to be adopted in other hospitals.MethodsA quasi-experimental, retrospective, comparative audit was statistically analysed to compare a training nurse angiographer’s dose area product and screening time against the national X-ray diagnostic reference levels, to identify whether they could consistently perform coronary angiography safely within these parameters.ResultsThis audit provided reasonably robust evidence that appropriately experienced nurses can be trained in coronary angiography safely within the national diagnostic reference levels. This provides assurance that this new role does not negatively impact patients’ procedural outcomes and that existing measures in place provide satisfactory governance. This also indicates that robust background knowledge and pre-learnt motor skills are beneficial to any operator.ConclusionsAlthough this study contributes to research within this area, further research is needed to demonstrate the scope and benefits of this nursing role to a wider healthcare population.

Anticoagulation Interventions by Pharmacists in Acute Care.

Clinical pharmacy key performance indicators (cpKPIs) relate to activities performed by pharmacists that have been shown to improve patient outcomes. Within Saskatchewan Health Authority (SHA) Regina, most cpKPIs are incorporated into the organization's clinical practice standards, which provide guidance in prioritizing care, especially for high-risk medications, including anticoagulants. To track pharmacists' interventions associated with clinical practice standards, a locally developed electronic data-capture system (known as AIM High) was implemented. To quantify and describe pharmacists' anticoagulation interventions on 16 wards with dedicated ward-based clinical pharmacists and to compare intervention rates between the cardiology and internal medicine wards to further evolve the organization's practice model. Data from the electronic data-capture system were retrospectively analyzed for a 5-year period (January 2016 to December 2020). A total of 94 201 interventions were recorded in the AIM High system (average 362 interventions per week or 26 interventions per pharmacist per week). Of these, 15 661 (16.6%) cited the anticoagulation standard (average 60 anticoagulation interventions per week or 4 anticoagulant interventions per pharmacist per week). For the cardiology and internal medicine wards, 4183 of 11 888 (35.2%) and 9034 of 54 843 (16.5%) interventions cited the anticoagulation standard, respectively. The top 4 types of anticoagulation interventions were dose changed (n = 4372 or 27.9%), drug started or restarted (n = 3867 or 24.7%), patient education (n = 3094 or 19.8%), and drug discontinued (n = 2944 or 18.8%). Dedicated ward-based clinical pharmacists were following clinical practice standards incorporating the majority of cpKPIs to complete anticoagulation interventions. The types of anticoagulation interventions evolved over time and were influenced by the patient population.

Tailoring Upper-Limb Robot-Aided Orthopedic Rehabilitation on Patients' Psychophysiological State.

Physical therapy keeps exploiting more and more the capabilities of the robot of adapting the treatments to patients' needs. This paper aims at presenting a psychophysiological-aware control strategy for upper limb robot-aided orthopedic rehabilitation. The main features are the capability of i) generating point-to-point trajectories inside an adaptable workspace, ii) providing assistance in guiding the patients' limbs in accomplishing the assigned task allowing them to freely move with a certain degree of spatial and temporal autonomy and iii) tuning the control parameters according to the patients' kinematics performance and psychophysiological state. The implemented control strategy is validated in a real clinical setting on eight orthopedic patients undergoing twenty daily robot-aided rehabilitation sessions. The psychophysiological-aware control strategy evidenced a positive impact on the enrolled participants since they are effectively conducted in a calmer condition with respect to the patients who did not receive the psychophysiological adaptation. Moreover, clinical performance indicators suggest that the proposed tailored control strategy improves motor functions.

ESHRE certification of ART centres for good laboratory and clinical practice.

ESHRE certification of ART centres for good laboratory and clinical practice.

Clinical performance indicators for monitoring the management of cutaneous melanoma: a population-based perspective.

The prognosis of cutaneous malignant melanoma (CMM) is based on disease progression. The highly heterogeneous clinical-pathological characteristics of CMM necessitate standardized diagnostic and therapeutic interventions tailored to cancer’s stage. This study utilizes clinical performance indicators to assess the quality of CMM care in Veneto (Northeast Italy). This population-based study focuses on all incidences of CMMs registered by the Veneto Cancer Registry in 2015 (1279 patients) and 2017 (1368 patients). An interdisciplinary panel of experts formulated a set of quality-monitoring indicators for diagnostic, therapeutic, and end-of-life clinical interventions for CMM. The quality of clinical care for patients was assessed by comparing the reference thresholds established by experts to the actual values obtained in clinical practice. The prevalence of stage I-CMM decreased significantly from 2015 to 2017 (from 71.8 to 62.4%; P < 0.001), and almost all the pathology reports mentioned the number of nodes dissected during a lymphadenectomy. More than 90% of advanced CMMs were promptly tested for molecular BRAF status, but the proportion of patients given targeted therapies fell short of the desired threshold (61.1%). The proportion of stage I–IIA CMM patients who inappropriately underwent computerized tomography/MRI/PET dropped from 17.4 to 3.3% (P < 0.001). Less than 2% of patients received medical or surgical anticancer therapies in the month preceding their death. In the investigated regional context, CMM care exhibited both strengths and weaknesses. The evaluated clinical indicators shed essential insight on the clinical procedures requiring corrective action. It is crucial to monitor clinical care indicators to improve care for cancer patients and promote the sustainability of the healthcare system.

Clinical outcomes and performance indicators of patients with kidney failure and acute kidney injuries in ASEAN countries.

This review article reports clinical outcomes and performance indicators of patients with kidney failure (KF) and acute kidney injuries (AKI) in Association of South East Asian Nations (ASEAN) countries. Association of South East Asian Nations data, segregated by income status, from national registries and literature were collated, compared and benchmarked against international references. The national incidence and prevalence of treated KF ranged from 172 to 479 per million population (pmp) and 36-2255 pmp, respectively. Brunei (79%), Malaysia (66%) and Singapore (66%) had world-leading proportions of diabetes-related KF. Hemodialysis (HD), Peritoneal Dialysis (PD) and transplant accounted for 68-100%, 0-27% and 0-18% of all KF replacement therapy, respectively. Transplant patient survival was superior with 90%-93% at 5 years and 71%-90% at 10 years, compared to PD (44%-54%) and HD (53-64%) at 5 years. Higher-income countries were able to achieve good anemia control, HD and PD adequacy targets, while usage of arteriovenous fistula in HD varied from 70% to 85%. Acute Kidney Injury rates ranged from 24.2% to 49.2% of high-dependency admissions. Lower incidences of PD peritonitis and HD catheter-related Bloodstream Infections; and PD-favouring quality-of-life were evident in higher-income countries. Association of South East Asian Nations has a challenging burden of kidney disease, with extremely high incidence, prevalence, DM-related KF and AKI rates. The magnitude of the prevailing problem calls for the creation of a regional society under the auspices of ASEAN with a shared perspective of universal, equitable and charitable access to quality renal care; consistent with the founding premises and healthcare initiatives of ASEAN.