Evidence-based Process Research Articles

Abstract 331: Area Specific Differences for Quality of Care and Outcomes in Ischemic Stroke in China

Background: Former studies suggest differences in stroke care associated with race, age or gender. We sought to find whether such disparities existed in different areas in patients hospitalized with stroke among hospitals participating in the China Stroke Center Association. Methods: In-hospital mortality and 4 stroke performance measures among 660,225 patients admitted with ischemic stroke in the Eastern, Central and Western regions of China in the China Stroke Center Association between 2015 and 2019. Results: After adjustment for both demographics and diseases history variables, western patients had lower odds relative of receiving intravenous thrombolysis (Eastern: OR, 1.78; 95%CI, 1.72 to 1.84; Central: OR, 1.55; 95%CI, 1.50 to 1.60), early antithrombotics (Eastern: OR, 1.95; 95%CI, 1.90 to 1.99; Central: OR, 1.86; 95%CI, 1.81 to 1.90), dysphagia screening (Eastern: OR, 1.03; 95%CI, 1.01 to 1.04; Central: OR, 0.83; 95%CI, 0.81 to 0.84) and NIHSS (Eastern: OR, 1.18; 95%CI, 1.16 to 1.20; Central: OR, 1.50; 95%CI, 1.48 to 1.53). However, the in-hospital death was higher in eastern and central regions (Eastern: OR, 0.48; 95%CI, 0.43 to 0.54; Central: OR, 0.51; 95%CI, 0.45 to 0.57). Conclusions: Western patients with stroke received fewer evidence-based care processes than central or eastern patients. Quality of care improvement in stroke should be focused on the west. The high mortality of the east and central probably resulted in that better hospitals in these areas received more severe patients substantially.

Standardization of Phyllanthus niruri and Sonchus arvensis as Components of Scientific Jamu

Saintifikasi Jamu, or the scientific investigation of Jamu, is an evidence-based process to ensure the safety and efficacy of herbal medicine through health service research. Jamu has been empirically explored as a composition of various crude drugs, hence called as Scientific Jamu. Phyllanthus niruri and Sonchus arvensis are two of the 30 medicinal plants processed into Scientific Jamu. Components of the Scientific Jamu are standardized to ensure that these materials meet the predefined quality. This study was aimed to determine the specific parameters (macroscopic, microscopic, total flavonoid content, water-soluble extract content, and ethanol-soluble extract content) and non-specific parameters (loss on drying, total ash content, and acid insoluble ash content) of Phyllanthus niruri and Sonchus arvensis collected from Batu, Tawangmangu, and Bogor. The methods of the determination referred to the Indonesian Herbal Pharmacopoeia 1st Edition (2008). The results showed that Phyllanthus niruri and Sonchus arvensis from the three places did not meet the standard requirement.

Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents.

The aim of this systematic review was to locate and analyze United States state crisis standards of care (CSC) documents to determine their prevalence and quality. Following PRISMA guidelines, Google search for "allocation of scarce resources" and "crisis standards of care (CSC)" for each state. We analyzed the plans based on the 2009 Institute of Medicine (IOM) report, which provided guidance for establishing CSC for use in disaster situations, as well as the 2014 CHEST consensus statement's 11 core topic areas. The search yielded 42 state documents, and we excluded 11 that were not CSC plans. Of the 31 included plans, 13 plans were written for an "all hazards" approach, while 18 were pandemic influenza specific. Eighteen had strong ethical grounding. Twenty-one plans had integrated and ongoing community and provider engagement, education, and communication. Twenty-two had assurances regarding legal authority and environment. Sixteen plans had clear indicators, triggers, and lines of responsibility. Finally, 28 had evidence-based clinical processes and operations. Five plans contained all 5 IOM elements: Arizona, Colorado, Minnesota, Nevada, and Vermont. Colorado and Minnesota have all hazards documents and processes for both adult and pediatric populations and could be considered exemplars for other states.

Zero Harm During Transition in Care From the Emergency Department to Medical/Surgical Units.

Health care-related errors are the third leading cause of death in the United States. When evidence-based processes are applied, harm related to health care errors can reach zero. The purpose was to achieve zero preventable harm to patients during transitions in care from the emergency department (ED) to medical/surgical (Med/Surg) areas. A performance improvement process was used to drive the evidence-based design to eliminate harm in transitions from the ED to Med/Surg units. Once initial design was complete, small tests of change were deployed until zero harm was achieved. Zero harm during transitions from the ED to Med/Surg areas was achieved. The use of formal performance improvement systems, tools, and evidence-based practices allows organizations to achieve and sustain zero harm during these transitions in care. This transitions project met multiple objectives. In addition, throughput efficiencies were realized.

The Association of ICU Acuity With Adherence to ICU Evidence-Based Processes of Care

Admission to high-acuity ICUs has been associated with improved outcomes compared with outcomes in low-acuity ICUs, although the mechanism for these findings is unclear. The goal of this study was to determine if high-acuity ICUs more effectively implement evidence-based processes of care that have been associated with improved clinical outcomes. This retrospective cohort study was performed in adult ICU patients admitted to 322 ICUs in 199 hospitals in the Philips ICU telemedicine database between 2010 and 2015. The primary exposure was ICU acuity, defined as the mean Acute Physiology and Chronic Health Evaluation IVa score of all admitted patients in a calendar year, stratified into quartiles. Multivariable logistic regression was used to examine relations of ICU acuity with adherence to evidence-based VTE and stress ulcer prophylaxis, and with the avoidance of potentially harmful events. These events included hypoglycemia, sustained hyperglycemia, and liberal transfusion practices (defined as RBC transfusions prescribed for nonbleeding patients with preceding hemoglobin levels≥ 7 g/dL). Among 1,058,510 ICU admissions, adherence to VTE and stress ulcer prophylaxis was high across acuity levels. In adjusted analyses, those admitted to low-acuity ICUs compared with the highest acuity ICUs were more likely to experience hypoglycemic events (adjusted OR [aOR], 1.12; 95%CI, 1.04-1.19), sustained hyperglycemia (aOR, 1.07; 95%CI, 1.04-1.10), and liberal transfusion practices (aOR, 1.55; 95%CI, 1.33-1.82). High-acuity ICUs were associated with better adherence to several evidence-based practices, which may be a marker of high-quality care. Future research should investigate how high-acuity ICUs approach ICU organization to identify targets for improving the quality of critical care across all ICU acuity levels.

Multiple fault localization of software programs: A systematic literature review

Multiple fault localization (MFL) is the act of identifying the locations of multiple faults (more than one fault) in a faulty software program. This is known to be more complicated, tedious, and costly in comparison to the traditional practice of presuming that a software contains a single fault. Due to the increasing interest in MFL by the research community, a broad spectrum of MFL debugging approaches and solutions have been proposed and developed. The aim of this study is to systematically review existing research on MFL in the software fault localization (SFL) domain. This study also aims to identify, categorize, and synthesize relevant studies in the research domain. Consequently, using an evidence-based systematic methodology , we identified 55 studies relevant to four research questions. The methodology provides a systematic selection and evaluation process with rigorous and repeatable evidence-based studies selection process. The result of the systematic review shows that research on MFL is gaining momentum with stable growth in the last 5 years. Three prominent MFL debugging approaches were identified, i.e. One-bug-at-a-time debugging approach (OBA), parallel debugging approach, and multiple-bug-at-a-time debugging approach (MBA), with OBA debugging approach being utilized the most. The study concludes with some identified research challenges and suggestions for future research. Although MFL is becoming of grave concern, existing solutions in the field are less mature. Studies utilizing real faults in their experiments are scarce. Concrete solutions to reduce MFL debugging time and cost by adopting an approach such as MBA debugging approach are also less, which require more attention from the research community.

177 Evidence-Based Monitoring and Surveillance Process to Assist with Dialysis Vascular Access Maturation and CV Catheter Reduction

177 Evidence-Based Monitoring and Surveillance Process to Assist with Dialysis Vascular Access Maturation and CV Catheter Reduction

Towards standardisation of evidence-based clinical care process specifications.

There is a strong push towards standardisation of treatment approaches, care processes and documentation of clinical practice. However, confusion persists regarding terminology and description of many clinical care process specifications which this research seeks to resolve by developing a taxonomic characterisation of clinical care process specifications. Literature on clinical care process specifications was analysed, creating the starting point for identifying common characteristics and how each is constructed and used in the clinical setting. A taxonomy for clinical care process specifications is presented. The De Bleser approach to limited clinical care process specifications characterisation was extended and each clinical care process specification is successfully characterised in terms of purpose, core elements and relationship to the other clinical care process specification types. A case study on the diagnosis and treatment of Type 2 Diabetes in the United Kingdom was used to evaluate the taxonomy and demonstrate how the characterisation framework applies. Standardising clinical care process specifications ensures that the format and content are consistent with expectations, can be read more quickly and high-quality information can be recorded about the patient. Standardisation also enables computer interpretability, which is important in integrating Learning Health Systems into the modern clinical environment. The approach presented allows terminologies for clinical care process specifications that were widely used interchangeably to be easily distinguished, thus, eliminating the existing confusion.

Digital health technology: factors affecting implementation in nursing homes.

Digital health technology (DHT), which includes digital algorithms and digital records, is transforming the way healthcare services are delivered. In nursing homes, DHT can enhance communication and improve the identification of residents' health risks, but its implementation has so far been inconsistent. Therefore, the LAUNCH (Leadership of digitAl health technology Uptake among Nurses in Care Homes) study was undertaken to identify factors that may affect DHT implementation in these settings. To identify the factors that enable nurses to implement DHT in nursing homes and to co-design a nurse-led stepped process supporting the effective implementation of DHT innovations in nursing homes. An appreciative inquiry methodology was used. A total of 20 interviews with managers, residents and relatives, and nurses from five nursing homes in England were undertaken. The interview questions focused on their understanding of DHT, their experiences of it, and its potential benefits in nursing homes. Data from the interviews were thematically analysed and the emerging themes were used to inform two co-creation workshops, during which participating nurses discussed a practical, evidence-based process for DHT implementation in nursing homes. Three broad themes emerged from the interviews: improving communication; engaging with DHT and retaining humanised care; and introducing DHT and protecting data security. The co-creation workshop participants formulated the LAUNCH process model, a nurse-led, stepped approach supporting DHT implementation in nursing homes. The LAUNCH study identified factors enabling staff in nursing homes to introduce and sustain DHT innovations. Participating nurses co-created a three-step process for the effective implementation of DHT innovations in nursing homes, which have the potential to release staff time, improve quality of care, and have positive effects on staff recruitment and retention.

The efficacy of Enhanced Recovery after Surgery (ERAS) for elderly patients with intertrochanteric fractures who received surgery: study protocol for a randomized, blinded, controlled trial

BackgroundIntertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promotes repair of injured tissues and eliminates traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation and provide reliable evidence-based data for applying the program to clinical practice.Methods/designWe will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time to get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home, and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment.DiscussionAlthough an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway.Trial registrationRegistered on 12 October 2019. Trial number is ChiCTR1900026487.

Safety and Health Innovation in Preschools: A Total Worker Health Pilot Project.

The primary objective of this study was to evaluate quality of work life in early childhood education (ECE) centers and implement a total worker health (TWH) pilot project with a small sample of ECE teachers. An evidence-based strategic planning process to make policy, system, and environmental (PSE) changes related to TWH was implemented with six ECE centers. A pre-post design with mixed-methods was used to evaluate the impact. Baseline findings suggest that there are significant disparities related to quality of work life among ECE teachers compared with the national population. After implementation of the pilot project, ECE centers averaged 4.7 PSE changes. Qualitative data informed facilitators and barriers to implementation of TWH-related changes. This pilot project reflects an evidence-based participatory approach to assessing and improving the well-being of ECE teachers.

807 Implementation of an Evidence-based Wound Care Process at a Regional Burn Center Reduces Hospital Acquired Infections

Abstract Introduction Central line associated blood stream infection (CLABSI) rates in burn patients exceeds the national average. The purpose of this study was to determine if implementation of an evidence-based process for wound care and central line management reduce infections. Methods A protocol for central line and wound care was developed in conjunction with another burn center with lower CLABSI rates and a care bundle, based on colorectal surgical literature. The new protocol required hand to elbow washing prior to wound care, separating the dirty and clean steps of the wound care process, changing protective gear when going from dirty to clean and performing the Hospital Acquired Infection (HAI) bundle elements separate from wound care. CLABSI and Ventilator Associated Pneumonia (VAP) rates were then compared with the previous year. Results Following implementation of the new wound care guidelines, the number of CLABSIs declined from 10 in 2017 to 2 in 2018 and 1 so far in 2019 (through August 2019). The median number of CLABSIs per 1000 days was 0 (range of 0 to 11) before the bundle and 0 (range of 0 to 4.2) after implementation of the bundle. Using the Wilcox rank sum test, there was no significant difference (p=0.09) between the CLABSI rate per 1000 device days between the time period before the bundle implementation and after the bundle implementation, however this may be due to the small sample size. Although the CLABSI rate did not show a statistically significant decrease, the proportion of positive blood cultures decreased by 50% after implementation of the bundle. The number of VAPs declined from 8 in 2017 to 6 in 2018 and so far in 2019 no VAPs have been reported (through August 2019). There was no difference in device days between groups. Conclusions Creating a wound care process that clearly defines and separates clean and dirty steps, similar to colorectal surgical bundles in the reduction of Surgical Site Infection, reduced CLABSI and HAI rates in a clinically significant, if not statistically significant way in the Burn Intensive Care Unit. Further study is needed to increase the power of this study to possibly detect statistically significant differences. Applicability of Research to Practice Implementation of an evidence-based, standardized practice for wound care improved infection rates at one regional burn center. It would be beneficial for this process to be replicated at other centers to further test correlation with infection reduction.

Evidence-based Reasoning Processes in Education: A Model to Support Interventionist Practice

The Evidence-based Reasoning model is a systematic inquiry into student learning to determine what interventions are required in classroom contexts. The four step process includes noticing students who need additional support in their learning, the use of assessment data to establish an evidence-base, and subsequent interpretation that leads to decision making. The reasoning process is supported by collaborative practice models both within and beyond the teaching profession. The evaluation of interventions is integral in determining the impact that interventions have on student learning.

Compliance With Evidence-Based Processes of Care After Transitions Between Staff Intensivists.

We sought to evaluate the impact of transitions of care among staff intensivists on the compliance with evidence-based processes of care. Cohort study using data from the Toronto Intensive Care Observational Registry. Seven academic ICUs in Toronto, Ontario. Critically ill mechanically ventilated adult patients. We explored the effects of the weekly transition of care among staff intensivists on compliance with three evidence-based processes of care (spontaneous breathing trials, lung-protective ventilation, and neuromuscular blocking agents). Two practices that are less guided by evidence (early discontinuation of antibiotics and extubation attempts) served as positive controls. We conducted the analysis using generalized estimating equations to account for clustering at the patient level. The cohort consisted of 10,570 patients admitted between June 2014 and August 2018. Compliance varied for each practice (63.6%, 42.5%, and 21.1% for lung-protective ventilation, spontaneous breathing trials, and neuromuscular blockade, respectively). There was no effect of transitions of care on compliance with spontaneous breathing trials (odds ratio, 1.00; 95% CI, 0.95-1.07), lung-protective ventilation (odds ratio, 1.07, 95% CI, 0.90-1.26), or neuromuscular blockade use (odds ratio, 0.95; 95% CI, 0.75-1.20). However, early antibiotic discontinuation was more likely (odds ratio, 1.23; 95% CI, 1.06-1.42) and extubation attempts were less frequent (odds ratio, 0.77; 95% CI, 0.65-0.93) after a transition of care. We observed no significant impact of transitions of care between individual staff physicians on evidence-based processes of care for mechanically ventilated adult patients. However, transitions were associated with a lower likelihood of extubation and higher odds of earlier discontinuation of antibiotics.

Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study

BackgroundPublic health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners’ perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs.MethodsChronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo.ResultsTwenty seven interviews were conducted with practitioners in four states (5–8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM.ConclusionsResults of this study highlight practitioners’ perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.

The Evidence of Effectiveness: Beyond the Methodological Standards

There is growing recognition that policymakers can achieve substantially better results by using an evidence-based approach to solve social problems. Nevertheless, there is still considerable debate as to how best to identify evidence-based information, aggregate and process this information, and then disseminate it to non-technical users. This manuscript discusses the sources of this discord within the context of evidence-based registries and propose ways in which to ameliorate it.

Decision Theory, Relative Plausibility and the Criminal Standard of Proof

The evolution of the understanding of evidence-based proof and decision processes in the law, especially criminal law, and standards of proof in this area, has a long-standing and controversial history. Competing accounts cause the legal scholarship to engage in critical and thoughtful exchanges. Some of the divergent views reflect different methodological perspectives similarly recognized in other fields, such as applied psychology and economy, and the broader interdisciplinary research fields of judgment and decision-making, system analysis and decision science. One such methodological perspective asserts that accounts of juridical proof should provide a description and explanation of how the legal system actually works as a whole. Other—more mathematical and analytical accounts—concentrate on how, ideally, legal decision-making under uncertainty ought to be made in order be considered sensible. This paper focuses on the relative plausibility (RP) account advocated by Professors Allen and Pardo as an example of the former perspective. Its logical structure and argumentative implications are analysed using elements of decision theory, which is the prime representative of the latter, more mathematical approach to legal proof. Using formal diagrammatic schemes to depict the structural relationships between the core elements of the two accounts, it is demonstrated in what sense they can be considered logically related and congruent. The demonstration shows that the principal disagreements among the proponents of the two examined theories derive from differences in (1) the criteria used to judge the adequacy of competing accounts of legal decision-making, and (2) the level of formalization of the bases of decisions in each candidate account. This structural analysis supports the view that adherence to one or the other of the examined perspectives does not imply a contradiction, but reflects the coverage of different aspects of the same overall decision architecture. Using decision-theoretic notions, our analyses also provide a way to explain RP decisions through an explicit criterion, thus providing a reply to the recurrent critique that RP theory lacks specific means to justify its decisional framework.

Abstract P1-15-05: Identifying educational needs and areas for improvement in the management of HR+, HER2- breast cancer using cyclin-dependent kinase 4/6 inhibitors

Abstract Background: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) offer the potential to significantly improve outcomes for women with HR+, HER2- breast cancer. However, given the relative short time period of their availability, appropriate evidence-based uses of CDK4/6i therapies depend on effective education and implementation strategies. In the context of an accredited continuing medical education (CME) and quality improvement (QI) program, we conducted a survey study to identify educational needs and areas for improvement involving CDK4/6i decision-making and clinical management. Methods: Baseline surveys were administered to medical oncologists and clinical staff in 2 large U.S. healthcare systems. The surveys included items for assessing participants’ challenges, barriers, and education/training needs in managing patients with HR+/HER2- breast cancer, specifically focusing on uses of CDK4/6i therapies. In addition to conducting the survey study, at baseline we audited 100 electronic medical records (EMRs) of women with HR+, HER2- breast cancer in each of the 2 systems. The oncology teams then participated in CME/QI activities in which national leaders in breast cancer research and education presented the baseline survey results and EMR-audit feedback, and guided participants in developing targeted action plans to overcome barriers and to close clinical gaps. Results: Survey respondents were 15 medical oncologists, 3 nurses, and 2 QI personnel. Regarding their patients on CDK4/6i therapies, large percentages of the respondents indicated low levels of satisfaction with current CDK4/6i treatment algorithms (40%), scheduling of patient follow-up visits (35%), team-based coordination of care (15%), and protocols for supportive care (15%). The most commonly reported challenges and barriers in managing patients with HR+/HER2- breast cancer were identifying women who would benefit from CDK4/6i therapies (35%), monitoring patients for disease progression (25%), and receiving support from administrative leadership (15%). Regarding facilitators to reducing patient risks of discontinuing CDK4/6i due to toxicity, the most common responses were increasing interprofessional collaboration and care coordination (45%), and providing education about adverse events to patients and caregivers (20%) and to oncology clinical team members (15%). Participants in the CME/QI activities developed action plans that included establishing protocols and EMR tracking mechanisms for monitoring patients using CDK4/6i therapies, tracking pharmacy dispensing of CDK4/6i therapies, and documenting patient characteristics such as staging, menopausal status, and progression to guide individualized treatment decision-making. Conclusions: Concerning the implementation of CDK4/6i therapies, this survey study addresses challenges and variable practices that have been recently reported in the literature. The findings reveal specific education and training needs, along with targeted strategies, that are essential for promoting evidence-based, appropriate decision-making and management processes involving these therapies for women with HR+, HER2- breast cancer. Citation Format: Sara Tolaney, Joyce A. O'Shaughnessy, Rebecca Crawford, Tariqa Ackbarali, Laurence Greene, Jeffrey Carter, Tamar Sapir. Identifying educational needs and areas for improvement in the management of HR+, HER2- breast cancer using cyclin-dependent kinase 4/6 inhibitors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-15-05.

STEPS-T Program Improves Endovascular Treatment Outcomes of Acute Ischemic Stroke; A 6-Year Study.

Background: Early endovascular recanalization of occluded vessels in acute ischemic stroke (AIS) is a major contributor to good clinical outcome. We report the analysis of all AIS patients throughout a 6-year experience following the deployment of a quality initiative aiming at improving care, speed and maintaining quality for AIS treatment.Methods: Using a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2017, workflow/outcomes were recorded. There were no exclusion criteria. During the first year, a quality program employing “digital-object” technology, staff education, and workflow improvement was implemented to reduce time-to-treatment. Using electronic recording, workflow times were collected for onset (TO), CT (TCT), door (TD), angiography-suite (TA), groin puncture (TG), DSA (TDSA), and recanalization (TR). Recanalization time (TG-TR) and workflow intervals were compared at Year 1 and 6.Results: Analysis of 382 patients (aged 71.3 ± 12.9) undergoing mechanical thrombectomy for AIS (206 male and 176 female) was performed. Recanalization time was significantly reduced from 82 min in 2012 to 34 min by 2017 (IQR 52–117 min and 23–49 min), a 59% reduction (P < 0.001). Further, consistent year-over-year reductions in setup time (TA-TG) (44% improvement) and TCT to TA times were observed. During the same period, clinical outcome significantly improved year-over-year as measured with the modified Rankin Scale 0–2 (33, 37, 38, 41, 53, and 58%).Conclusions: Significant improvements were observed following the deployment of a quality initiative enabling iterative evidence-based process improvements, thereby sustaining significant reductions in time-to-treat and improved clinical outcomes for AIS patients.

Summary of the NACI Statement on the Use of Bivalent Factor H Binding Protein Meningococcal Serogroup B (MenB-fHBP) Vaccine for the Prevention of Meningococcal B Disease.

TrumenbaTM, a bivalent, factor-H binding protein meningococcal serogroup B (MenB-fHBP) vaccine was authorized for use in Canada in October 2017 for the prevention of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup B in individuals 10-25 years of age. The National Advisory Committee on Immunization (NACI) provides recommendations regarding the use of meningococcal vaccines to the Public Health Agency of Canada. To summarize NACI recommendations regarding the use of MenB-fHBP vaccine in Canada. The NACI Meningococcal Disease Working Group developed a predefined search strategy to identify all eligible studies, assessed the quality of these studies, and summarized and analyzed the findings. According to the NACI evidence-based process, the working group then proposed recommendations and identified the grade of evidence that supported them. In light of the evidence, the recommendations were then considered and approved by NACI. The two serogroup B meningococcal vaccines currently authorized for use in Canada are not interchangeable as they contain different antigens and there are no published studies on the immunogenicity resulting from a vaccination series combining the two products. Following the review of evidence, NACI recommends that MenB-fHBP vaccine may be considered as an option for use in individuals 10 years of age and older in situations when a serogroup B meningococcal vaccine should be offered: 1) during serogroup B meningococcal disease outbreaks or with the emergence of hyperendemic N. meningitidis strains that are predicted to be susceptible to the vaccine; 2) for individuals who are close contacts with a case of invasive meningococcal disease caused by serogroup B N. meningitidis; 3) for individuals with underlying medical conditions that would put them at higher risk of meningococcal disease than the general population; or 4) for individuals at higher risk of exposure to serogroup B meningococcal isolates than the general population. NACI also recommends that MenB-fHBP vaccine may be considered as an option for individuals 10-25 years of age who are not at higher risk of meningococcal disease than the general population, but who wish to reduce their risk of invasive serogroup B meningococcal disease. NACI recommends immunization against serogroup B IMD for all individuals who are at a higher risk of disease due to an underlying medical condition or an increased risk of exposure. In addition to providing guidance to public health decision-makers (i.e. provinces/territories making decisions for publicly-funded immunization programs), these NACI recommendations provide information to individuals, vaccine providers and organizations about vaccines that may not currently be included in publicly funded immunization programs. NACI continues to recommend against the use of the serogroup B vaccines in routine universal immunization programs in Canada at this time.