Evidence-based Assessment Tools Research Articles

Write here write now. What can we learn from the writing goals of people with aphasia?

ABSTRACT Background People with aphasia commonly have difficulties with producing written language (dysgraphia). Greater understanding of people with aphasia’s rehabilitation goals for writing can inform development of evidence-based assessment and management tools. Aims This qualitative study aimed to explore the nature of writing goals of people with aphasia who attended an intensive speech and language therapy (SLT) centre. Methods and Procedures Qualitative data was obtained from five years-worth of client SLT reports from an intensive aphasia centre. Using qualitative content analysis, a deductive coding framework was used to identify any description of writing goals; coding incorporated iterative refinement and agreement among authors. Themes were then constructed to reflect clients’ goals to inform writing assessment and therapies. Outcomes and Results Qualitative analysis focused on content describing 66 goals on writing from 87 reports. There were two dominant interrelated themes: Supporting Communication (33 goals) and Technology (25 goals). Technology included subthemes on Emailing, Texting, Social Media, and Assistive Technology. Two smaller themes were Impairment Focused (4 goals), where goals did not have a clear functional direction, and Other (4 goals), where goals targeted specific writing activities, e.g. crosswords. Conclusions These thematic findings demonstrate the varied real-life goals for writing among attendees at an aphasia centre. They highlight the nature of relatively early-stage rehabilitation goals for individuals with aphasia, focusing on supporting communication and returning to valued activities. The results provide a context within which we can scrutinise the adequacy of current clinical tools to support goal setting, assess functional writing and design interventions for acquired writing difficulties. Further guidance is needed on assessment of writing as a supportive communication strategy and therapy towards improving this skill. There are also gaps in supporting the personal goals of people with aphasia who wish to produce written language via technology or in online environments. Future research should recognise these priorities and work together with people with aphasia, clinicians, and technology specialists to address an area of clinical need.

The use of e-mental health tools in the perinatal context

SUMMARY E-mental health tools are a promising solution to reducing the high prevalence of perinatal mood and anxiety disorders and addressing barriers faced by women seeking professional help. This article summarises the main e-health tools used in perinatal mental healthcare, including examples of evidence-based tools for assessment, prevention and treatment of such disorders. We also highlight the main characteristics of the development process of e-mental health tools, which are based on cognitive–behavioural therapy, as well as the ethical concerns to be considered with their use and integration in healthcare systems.

The Equitable Benefit Approach to guide the assessment of medical and psychosocial factors in liver transplant candidacy.

Lack of available organs poses a significant challenge in meeting the needs of patients with life-threatening liver disease who could benefit from liver transplantation (LT). Psychosocial vulnerability markers have been linked to post-transplant outcomes, raising questions about their use in patient selection. However, their incorporation into selection criteria raises concerns about health equity and potential discrimination. As a result, there is a pressing need to refine fair allocation systems that consider both clinical and psychosocial factors to ensure equitable access and optimize post-transplant outcomes. The Equitable Benefit Approach (EBA) proposed in this paper by the multidisciplinary group of clinical experts in LT from the Italian Society for the Study of the Liver seeks to address these concerns. It presents four procedural principles, the two allocative principles usually applied in transplantation (urgency and utility) and introduces a new one, the principle of health equity. The EBA aims to prioritize patients with the highest transplant benefit while addressing health inequalities. It emphasizes evidence-based decision-making and standardized assessment tools to reliably evaluate psychosocial risk factors. Implementing the EBA involves a multi-step process, including stakeholder engagement, prospective studies to validate its efficacy, development of institutional policies and algorithms, and ongoing monitoring and revision. By following these steps, health care providers can ensure that LT allocation decisions are transparent and responsive to evolving clinical and social contexts. Ultimately, the EBA should offer a comprehensive framework for fair patient selection in LT, considering both biomedical and psychosocial aspects.

GAPS phase II: development and pilot results of the global assessment in pediatric surgery, an evidence-based pediatric surgical capacity assessment tool for low-resource settings.

Pediatric surgical care in low- and middle-income countries is often hindered by systemic gaps in healthcare resources, infrastructure, training, and organization. This study aims to develop and validate the Global Assessment of Pediatric Surgery (GAPS) to appraise pediatric surgical capacity and discriminate between levels of care across diverse healthcare settings. The GAPS Version 1 was constructed through a synthesis of existing assessment tools and expert panel consultation. The resultant GAPS Version 2 underwent international pilot testing. Construct validation categorized institutions into providing basic or advanced surgical care. GAPS was further refined to Version 3 to include only questions with a > 75% response rate and those that significantly discriminated between basic or advanced surgical settings. GAPS Version 1 included 139 items, which, after expert panel feedback, was expanded to 168 items in Version 2. Pilot testing, in 65 institutions, yielded a high response rate. Of the 168 questions in GAPS Version 2, 64 significantly discriminated between basic and advanced surgical care. The refined GAPS Version 3 tool comprises 64 questions on: human resources (9), material resources (39), outcomes (3), accessibility (3), and education (10). The GAPS Version 3 tool presents a validated instrument for evaluating pediatric surgical capabilities in low-resource settings.

Enhancing the Preanesthesia Evaluation: Consensus Development of the Cannabis Use and Behaviors Assessment Tool (CUBAT)

PurposeThis project aimed to develop an evidence-based preanesthesia cannabis use assessment tool to acquire complete and accurate patient history and develop a best-informed, individualized anesthesia and analgesia care plan. DesignModified Delphi. MethodsUsing an evidence synthesis and multistage, modified Delphi process, eight experts from across the United States developed a consensus-based tool to aid in developing a best-informed, individualized plan for anesthesia and analgesia care. FindingsTwo survey rounds integrated informed evidence-based tool revisions. The final tool included instructions for use, a glossary of terms, and seven key assessment items aimed at gathering the most influential information regarding cannabis use. ConclusionsThe Cannabis Use and Behaviors Assessment Tool is a first-of-its-kind tool providing an essential framework for preanesthesia cannabis use assessment.

Development and Validation of a Composite Skin Quality Scale.

The increasing demand for skin quality interventions in aesthetic medicine underscores the necessity for objective, evidence-based assessment tools that may be used to evaluate novel interventions or devices. To develop and validate a 5-point photonumeric rating scale for assessing overall skin quality, including radiance, color evenness, and smoothness. The IBSA (Institut Biochimique SA) Composite Skin Quality Scale was developed and underwent live validation with 88 real-world patients, chosen to encompass a broad spectrum of skin qualities and Fitzpatrick skin types. Scale validation was performed by board-certified plastic surgeons and dermatologists over 2 rounds, 2 weeks apart. Reliability was assessed through intrarater and interrater agreements, utilizing weighted kappa statistics and intraclass correlation coefficient (ICC). The scale's ability to discern a clinically relevant 1-grade difference was evaluated with 72 photo pairs. Combined intrarater reliability results showed weighted kappa values of 0.812 (right side) and 0.815 (left side) and an ICC of 0.903 for both sides, indicating an almost perfect agreement. Interrater reliability ranged from substantial to almost perfect, with kappa coefficients between 0.654 and 0.853 and ICCs between 0.657 and 0.855 across all rater pairs in both rounds. The ability to detect a clinically relevant 1-point difference using the scale was established. Integrating various key aspects of skin quality, the IBSA Composite Skin Quality Scale is a clinically relevant and highly reliable tool, suitable for skin assessment in clinical studies of new aesthetic technologies and products.

Prevalence, Attributes, and Risk Factors of QT-Interval-Prolonging Drugs and Potential Drug-Drug Interactions in Cancer Patients: A Prospective Study in a Tertiary Care Hospital.

Introduction Cancer chemotherapy regimens include multiple classes of adjuvant drugs as supportive therapy. Because of the concurrent intake of other drugs (like antiemetics, antidepressants, analgesics, and antimicrobials), there is a heightened risk for possible QT interval prolongation. There is a dearth of evidence in the literature regarding the usage of QT-prolonging anticancer drugs and associated risk factors that have the propensity to prolong QT interval. The purpose was to explore the extent of the use of QT-interval-prolonging drugs and potential QT-prolonging drug-drug interactions (QT-DDIs) in cancer patients attending OPD in a tertiary-care hospital. Methods This was a hospital-based, cross-sectional, observational study. Risk stratification of QT-prolonging drugs for torsades de pointes (TdP) was done by the Arizona Center for Education and Research on Therapeutics (AzCERT)/CredibleMeds-lists, and potential QT-DDIs were determined with four online DDI-checker-software. Results In 1331 cancer patients, the overall prevalence of potential QT-prolonging drug utilization was 97.3%. Ondansetron, pantoprazole, domperidone, and olanzapine were the most frequent QT-prolonging drugs in cancer patients. The top six antineoplastics with potential QT-prolongingand torsadogenic actions were capecitabine, oxaliplatin, imatinib, bortezomib, 5-fluorouracil, and bendamustine. Evidence-based pragmatic QTc interval prolongation risk assessment tools are imperative for cancer patients. Conclusion This study revealed a high prevalence of QT-prolonging drugs and QT-DDIs among cancer patients who are treated with anticancer and non-anticancer drugs. As a result, it's critical to take precautions, stay vigilant, and avoid QT-prolongingin clinical situations. Evidence-based pragmatic QTc interval prolongation risk assessment tools are needed for cancer patients.

An assessment of severity of acute bronchiolitis using bronchiolitis severity score and its relation to serum sodium level in children attending Alexandria University Hospital

Background Acute viral bronchiolitis is a significant cause of respiratory morbidity globally. Acute bronchiolitis is a clinical diagnosis based on the clinical judgment of the treating physician. Consequently, management strategies for acute bronchiolitis have great variability. Therefore, valid objective, evidence-based assessment tools were needed to help assess the severity of the illness, therefore reducing variation in management plans and standardizing care. Aim The present work aims to assess the validity of the use of bronchiolitis severity score (BSS) and serum sodium level in predicting the severity of acute bronchiolitis and the relation between them in children attending Alexandria University Children’s Hospital. Patients and methods The study was a comparative cross-sectional study of 131 children clinically diagnosed with acute bronchiolitis, from 1 month to 2 years of age, who presented to the Emergency Department of Alexandria University Children’s Hospital. Measurement of each patient’s BSS and serum sodium level was done on presentation in triage. Admitted and nonadmitted patients were followed up. Longer length of hospital stay and Pediatric Intensive Care Unit (PICU) admission were considered indicators of increased severity of the disease and worse outcomes. Results There was a male predominance and the median age of the studied patients was 3 months. On the basis of BSS, acute bronchiolitis was classified as mild in 19 (14.5%) cases, moderate in 79 (60.3%), and severe in 33 (25.2%). Hyponatremia at presentation was present in 20 (15.2%) cases. Increased severity, as determined by BSS, was statistically significantly associated with higher rates of admissions, longer hospital stays, and increased incidence of PICU hospitalization. There was no statistically significant difference between the hyponatremic status and increased hospital stay or the incidence of PICU admission. By univariate analysis, length of hospital stay and incidence of PICU admission was significantly affected by BSS and by hyponatremia. By multivariate analysis, the only parameter that was significant was BSS. In predicting a longer hospital stay in admitted patients, BSS showed a sensitivity (Se)=77.78%, specificity (Sp)=100%, positive predictive value (PPV)=100%, and negative predictive value (NPV)=42.9 while hyponatremia showed a Se=20.83%, Sp=91.67%, PPV=93.75%, and NPV=16.18. In predicting the need for PICU admission in studied cases, BSS showed a Se=69.23%, Sp=94.92%, PPV=60%, and NPV=96.6 and Se=38.46%, while hyponatremia showed Sp=87.29%, PPV=25%, and NPV=92.79. Conclusion BSS could be used as a valuable tool for assessing the severity of acute bronchiolitis. The presence of hyponatremia on initial presentation, although occasionally observed, cannot be used as a predictor of disease severity, but it could be used as a prognostic factor of a more severe disease course.

Predictive value of a novel digital risk calculator to determine early patient outcomes after major surgery: a proof-of-concept pilot study

BackgroundA structured risk assessment of patients with validated and evidence-based tools can help to identify modifiable factors before major surgeries. The Protego Maxima trial investigated the value of a new digitized risk assessment tool that combines tools which can be easily used and implemented in the clinical workflow by doctors and qualified medical staff. The hypothesis was that the structured assessment and risk-grouping is predictive of short-term surgical quality reflected by complications and overall survival.MethodsThe Protego Maxima Trial was a prospective cohort analysis of patients undergoing major surgery (visceral, thoracic, urology, vascular and gynecologic surgeries) as key inclusion criterion and the absence of an acute or acute on chronically decompensated pulmo-cardiovascular decompensation. Patients were risk-scored with the software (The Prehab App) that includes a battery of evidence-based risk assessment tools that allow a structured risk assessment. The data were grouped to predefined high and low risk groups and aggregate and individual scores. The primary outcome was to validate the predictive value of the RAI score and the TUG for overall survival in the high and low risk groups. Secondary outcomes were surgical outcomes at 90-days after surgery (overall survival, Clavien-Dindo (CD) 1–5 (all complications), and CD 3–5 (major complications)). The study was carried out in accordance with the DIN ISO 14,155, and the medical device regulation (MDR) at Frankfurt University Hospital between March 2022 and January 2023.ResultsIn total 267 patients were included in the intention to treat analysis. The mean age was 62.1 ± 12.4 years. Patients with a RAI score > 25 and/or a timed up and go (TUG) > 8 s had a higher risk for mortality at 90 days after surgery. The low-risk group predicted beneficial outcome and the high-risk group predicted adverse outcome in the ROC analysis (Area Under the Curve Receiver Operator Characteristics: AUROC > 0.800; p = 0.01). Risk groups (high vs. low) showed significant differences for 90-day survival (99.4% vs. 95.5%; p = 0.04) and major complications (16.4% vs. 32.4%; p < 0.001).ConclusionThe proof-of-concept trial showed that a risk assessment with ‘The Prehab App’ may be viable to estimate the preoperative risk for mortality and major complications before major surgeries. The overall performance in this initial set of data indicated a certain reliability of the scoring and risk grouping, especially of the RAI score and the TUG. A larger data set will be required to proof the generalizability of the risk scoring to every subgroup and may be fostered by artificial intelligence approaches.Trial registrationEthics number: 2021-483-MDR/MPDG-zuständig monocentric; The Federal Institute for Pharmaceuticals and Medical Devices/BfArM, reference number: 94.1.04-5660-13655; Eudamed: CIV-21-07-0307311; German Clinical Trial Registry: DRKS 00026985.

Pain Management in Cognitively Impaired Older Adults.

Pain identification and management in cognitively impaired older adults, especially those with major neurocognitive disorder, are challenging because of communication barriers and health care providers who are unaccustomed to the patient's baseline behavioral and psychological conditions. Appropriately distinguishing pain-associated behaviors separate from dementia, utilizing effective assessment tools, and administering proper interventions and medications to treat pain promptly for this population need to be considered. Nurses play critical roles in implementing various evidence-based assessment tools to assess pain and choosing appropriate pain management interventions by training and supporting other nurses to use these assessment tools and develop their critical assessment skills to quickly identify pain and evaluate pain management interventions.

Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension.

Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients. DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.

Quality Improvement Project to improve access to early screening and physiotherapy for infants at high risk of neurodevelopmental disorders

ABSTRACT Purpose and Setting Recent international guidelines for Early Diagnosis of Cerebral Palsy (CP) recommend the use of specific evidence-based tools and early therapy intervention for preterm infants at high risk of cerebral palsy. Referrals for physiotherapy and diagnoses of CP in high-risk infants discharged from the Neonatal Intensive Care Unit (NICU) at the Chelsea and Westminster NHS trust were recorded as occurring later than guidance recommends. A quality improvement project was initiated aiming to enhance identification of CP, increase provision of early physiotherapy and achieve this within the current physiotherapy staffing establishment. Methods A quality improvement project was implemented. Physiotherapists received training in using evidence-based assessment tools and early intervention. A new pathway was developed including a schedule of screening assessments and physiotherapy for high-risk infants on discharge from the NICU. This included a 14-month pilot of a new physiotherapy outpatient screening clinic. Results Following the pilot, age of referral for physiotherapy reduced from a mean of 11.84 to 4.25 months. All babies were assessed using recommended evidence-based tools including the Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination and General Movements. Previously only the Alberta Infant Motor Scales were used. Parent feedback demonstrated that the parents felt supported, valued the relationship with physiotherapists and felt confident to carry out activities suggested by physiotherapists. Conclusion and Recommendations The new physiotherapy screening clinic was effective in increasing access to early physiotherapy and evidence based diagnostic assessments and was achieved within current staffing levels. A business case is being considered to increase physiotherapy provision so intervention can be provided consistently at the planned frequency. It is suggested that other Trusts may also find this model of intervention effective.

Navigating the digital world: development of an evidence-based digital literacy program and assessment tool for youth

The rapid expansion of digital connectivity has provided youth with wide-ranging access to digital platforms for communication, entertainment, and education. In light of this profound shift, there have been growing concerns about online safety, data privacy, and cybersecurity. A critical factor influencing the ability of youth to responsibly navigate digital platforms is digital literacy. While digital literacy programs have been implemented in various regions worldwide, significant disparities remain not only in overall digital literacy levels, but also the assessment of digital literacy initiatives. To address these challenges, an environmental scan and literature review were conducted to identify existing digital literacy programs in Canada developed specifically for youth, as well as digital literacy assessment tools, respectively. The search encompassed peer-reviewed articles, organizational curricula, and assessment measures indexed in various databases and organization websites. The environmental scan identified 15 programs targeting key components of digital literacy such as data safety, cyberbullying, and digital media. The literature review identified 12 digital literacy assessment tools. Based on the findings, data were synthesized from shortlisted programs and assessment tools to inform the development of both a new digital literacy program and assessment tool to complement the youth-focused program. The new program focuses on four key components: (1) digital fluency, (2) digital privacy and safety, (3) ethics and empathy, and (4) consumer awareness. A 15-item assessment tool was also developed consisting of 4–5 questions specific to each program component. Given the growing importance of digital competencies, a youth-focused program and assessment tool are crucial for understanding and addressing digital literacy among this vulnerable cohort. This program's adaptability allows for customization across sociodemographic target groups, including culturally diverse and geographically remote communities—an aspect that has the potential to enhance digital literacy across settings. Implementing digital literacy programs can better prepare youth for an increasingly digital world, while minimizing potential risks associated with technology use.

Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients

BackgroundCentral to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AimsThe purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DesignThe Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SettingsOn a six-bed adult inpatient Palliative Care Unit (PCU). Participants/SubjectsNonverbal palliative care patients. MethodsEvidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. ResultsNurses’ attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. ConclusionsMOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.

Development of a novel primate welfare assessment tool for research macaques.

Primates are important species for biomedical research and ensuring their good welfare is critical for research translatability and ethical responsibility. Systematic animal welfare assessments can support continuous programme improvements and build institutional awareness of areas requiring more attention. A multi-facility, collaborative project aimed to develop and implement a novel primate welfare assessment tool (PWAT) for use with research macaques. PWAT development involved: establishing an internal focus group of primate subject matter experts, identifying animal welfare categories and descriptors based on literature review, developing a preliminary tool, beta-testing the tool to ensure practicality and final consensus on descriptors, finalising the tool in a database with semi-automated data analysis, and delivering the tool to 13 sites across four countries. The tool uses input- and outcome-based measures from six categories: physical, behavioural, training, environmental, procedural, and culture of care. The final tool has 133 descriptors weighted based upon welfare impact, and is split into three forms for ease of use (room level, site level, and personnel interviews). The PWAT was trialled across facilities in March and September 2022 for benchmarking current macaque behavioural management programmes. The tool successfully distinguished strengths and challenges at the facility level and across sites. Following this benchmarking, the tool is being applied semi-annually to assess and monitor progress in behavioural management programmes. The development process of the PWAT demonstrates that evidence-based assessment tools can be developed through collaboration and consensus building, which are important for uptake and applicability, and ultimately for promoting global improvements in research macaque welfare.

Coach Mentorship Using the Adult-Oriented Sport Coaching Survey

The Adult-Oriented Sport Coaching Survey (AOSCS) is an evidence-based assessment tool for coaches that stimulates self-reflection and learning of adult-oriented coaching practices. The AOSCS, comprised of 22 items that form five coaching themes, was used in this mixed-methods case study by a coach of adult skiers, who sought facilitation and mentorship from a coach developer to apply the AOSCS to strategically improve his coaching across a season. A pragmatic paradigm was adopted for this mixed-methods qualitatively dominant, sequential study. The coach and his skiers (n = 10) completed the AOSCS at three points in time (pre-, mid-, and postseason). At each point, the coach journaled prior to debriefing with the coach developer for 20–50 min. Through reflexive thematic and correlation analyses, eight adult-oriented coaching practices were identified as strong points of integration. The findings indicated that working with the coach developer enabled the coach’s reflection of the AOSCS scores to refine, strategize, and align coaching with his adult skiers’ perceptions for adult-oriented coaching. This study outlined the facilitation of reflection on AOSCS scores can be used advantageously across a season to promote more deliberate coach learning and practice.

Pengembangan Instrumen Deteksi Kemunduran Bio, Psiko, Sosio, Spiritual pada Pasien Lanjut Usia

This research aims to develop an instrument that detects bio, psycho, social, and spiritual decline in elderly hospital patients by using theoretical concepts in nursing care. The research method uses cross-sectional, with validity and reliability tests using the Product Moment correlation test. The research results show that the bio, psycho, social, and spiritual deterioration detection instrument consists of 26 questions with high validity and reliability. This instrument has been based on various concepts that focus on the individual's bio, psychological, social, and spiritual needs. In conclusion, this instrument is easy to use and is an evidence-based nursing assessment tool.&#x0D; Keywords: Bio-Psycho-Socio-Spiritual Decline; Elderly Patients

Towards evidence-based human resource development for South African local government

Background: The effective management of human resources is crucial for the sustainability of municipalities. However, as evidenced by poor service delivery, municipalities are not measuring human resource development. There is no known assessment tool or system to measure the performance of human resource development in South African municipalities.Aim: This study investigated the human resource development challenges experienced in municipalities and recommends, among other things, an evidence-based assessment tool that will improve human resource development implementation.Setting: Participants included line managers, human resource development professionals, employees, and councillors from randomly sampled local, district and metropolitan municipalities in South Africa.Method: An exploratory sequential mixed-methods design was used. Quantitative data were collected using questionnaires from 111 respondents. Qualitative data were collected from respondents given an opportunity to elaborate on their responses to statements in the questionnaire.Results: The results of the study show that municipalities are not effectively implementing human resource development, which compromises service delivery and municipal performance. They also suggest that municipalities are not effectively implementing the adopted Integrated Municipal Framework for Human Resource Development.Conclusion: The study concludes that there is an urgent need for local government to prioritise the management of human resource development. An evidence-based assessment tool will ensure that human resource development governance gaps are addressed in municipalities.Contribution: This study adds to the debate on the management of human resource development in South African local government by providing a context-specific analysis of implementing and managing human resource development and by recommending improvement strategies.

An evidence-based quality assessment tool for ovarian cancer care delivery.

384 Background: Ovarian cancer is the fifth leading cause of cancer death among women in the United States (US). Optimizing care for patients with ovarian cancer using a systematic, guideline-concordant approach improves outcomes. However, notable gaps persist for most patients with ovarian cancer in the US. Beginning in 2018, the Association of Community Cancer Centers (ACCC) implemented a quality improvement (QI) initiative in community and academic cancer centers to address care gaps. From this work, our expert steering committee published a quality document to inform evidence based ovarian cancer care delivery. Methods: In Phase II of this project we used the quality document to inform a qualitative baseline self-assessment and development of four six-month QI initiatives at cancer centers in the US. Based on this work, we developed a quality assessment tool to aid cancer centers in performing QI needs-assessments using the ovarian cancer quality document. The assessment tool applies evidence-based care recommendations in key areas identified by our multidisciplinary steering committee comprised of experts in ovarian cancer care. Results: The assessment tool includes a series of program-level questions and addresses seven key domains: 1. Care coordination and patient education, 2. Prevention and screening, 3. Diagnosis and initial management, 4. Treatment planning, 5. Disease surveillance, 6. Equity in care, and 7. Quality of life. Each domain has between two and seven key recommendations identified. Sites rate themselves on a four-point scale (1-unsatisfactory, 2-needs improvement, 3-acceptable, 4-good) for each key recommendation. Each key recommendation is given equal weight, and a combined score from 0-100 is calculated for each of the seven domains. The tool includes a macro-enabled spreadsheet that makes necessary calculations and provides an overall score, domain-specific sub-scores, and a list of key recommendations that received low ratings. The tool is to be used by clinical sites to self-assess the quality of ovarian cancer care currently provided at their cancer program and serves as a needs assessment. It is recommended that the site team performs the self-assessment in the context of a facilitated half-day multidisciplinary team meeting. After the self-assessment, sites are encouraged to develop QI initiatives to address the gaps identified using the format and structure we have previously described. Conclusions: The QI Assessment tool provides an important resource for cancer centers to conduct needs assessments in key areas of ovarian cancer care. The needs assessment can be used to inform the implementation of program-specific QI initiatives to elevate quality care delivery.

Neonatal early-onset sepsis calculator: Impact on antibiotic use in a level II neonatal unit in Western Australia

BackgroundOveruse of empirical intravenous antibiotics in neonates in high-income countries (HICs) is well documented. The Kaiser Permanente neonatal early-onset sepsis (EOS) calculator is an evidence-based sepsis risk assessment tool that has demonstrated potential to reduce antibiotic usage in this population. The incidence of early-onset sepsis in most HICs is 0.4–0.8 per 1000 live births. The objective was to evaluate the calculator's impact on antibiotic rates and length of stay in a regional level II Special Care Nursery. MethodsA single-centre retrospective cohort study compared antibiotic administration rates in the first 72 h in neonates ≥35 weeks gestation born during two 6-month periods in 2019 (pre-EOS calculator) and 2021 (post-EOS calculator). Electronic and paper case records were accessed to capture data. Continuous data were summarised using mean and standard deviation, and categorical data were summarized using frequency distributions. There were 951 (2019) and 1129 (2021) infants born during the study periods. ResultsFollowing implementation of the calculator, antibiotic exposure decreased from 13.7% to 4.7% of all neonates without reported negative outcomes. Mean length of stay for neonates born across the two periods decreased from 2.38 to 2.13 days. Indications for antibiotic use shifted more towards clinical condition and away from obstetric risk factors. There were no culture-proven cases of sepsis or readmissions with EOS in either period. ConclusionImplementation of the EOS calculator significantly reduced exposure to antibiotics, without adverse outcomes.