Healthcare Research Research Articles

Use of machine learning to identify prognostic variables for outcomes in chronic low back pain treatment: a retrospective analysis

ABSTRACT Objectives Most patients seen in physical therapy (PT) clinics for low back pain (LBP) are treated for chronic low back pain (CLBP), yet PT interventions suggest minimal effectiveness. The Cochrane Back Review Group proposed ‘Holy Grail’ questions, one being: ‘What are the most important (preventable) predictors of chronicity’ for patients with LBP? Subsequently, prognostic factors influencing outcomes for CLBP have been described, however results remain conflicting due to methodological weaknesses. Methods This retrospective observational cohort study examined prognostic risk factors for PT outcomes in CLBP treatment using a sub-type of AI. Bootstrap random forest supervised machine learning analysis was employed to identify the outcomes-associated variables. Results The top variables identified as predictive were: FOTO™ predicted functional status (FS) change score; FOTO™ predicted number of visits; initial FS score, age; history of jogging/walking, obesity, and previous treatments; provider education level; medication use; gender. Conclusion This article presents how AI can be used to predict risk prognostic factors in healthcare research. Improving predictive accuracy helps clinicians predict outcomes and determine most appropriate plans of care and may impact research attrition rates.

Decoding the Digital Pulse: Bibliometric Analysis of 25 Years in Digital Health Research Through the Journal of Medical Internet Research.

As the digital health landscape continues to evolve, analyzing the progress and direction of the field can yield valuable insights. The Journal of Medical Internet Research (JMIR) has been at the forefront of disseminating digital health research since 1999. A comprehensive network analysis of JMIR publications can help illuminate the evolution and trends in digital medicine over the past 25 years. This study aims to conduct a detailed network analysis of JMIR's publications to uncover the growth patterns, dominant themes, and potential future trajectories in digital health research. We retrieved 8068 JMIR papers from PubMed using the Biopython library. Keyword metrics were assessed using accuracy, recall, and F1-scores to evaluate the effectiveness of keyword identification from Claude 3 Opus and Gemini 1.5 Pro in addition to 2 conventional natural language processing methods using key bidirectional encoder representations from transformers. Future trends for 2024-2026 were predicted using Claude 3 Opus, Google's Time Series Foundation Model, autoregressive integrated moving average, exponential smoothing, and Prophet. Network visualization techniques were used to represent and analyze the complex relationships between collaborating countries, paper types, and keyword co-occurrence. JMIR's publication volume showed consistent growth, with a peak in 2020. The United States dominated country contributions, with China showing a notable increase in recent years. Keyword analysis from 1999 to 2023 showed significant thematic shifts, from an early internet and digital health focus to the dominance of COVID-19 and advanced technologies such as machine learning. Predictions for 2024-2026 suggest an increased focus on artificial intelligence, digital health, and mental health. Network analysis of JMIR publications provides a macroscopic view of the evolution of the digital health field. The journal's trajectory reflects broader technological advances and shifting research priorities, including the impact of the COVID-19 pandemic. The predicted trends underscore the growing importance of computational technology in future health care research and practice. The findings from JMIR provide a glimpse into the future of digital medicine, suggesting a robust integration of artificial intelligence and continued emphasis on mental health in the postpandemic era.

Supporting diversity in clinical trials: the equitable breakthroughs in medicine site maturity model.

Among the most powerful barriers to broader inclusion of diverse participants in clinical trials are social determinants of health, trustworthiness of health care providers and research institutions, and competing pressures on potential participants. Nevertheless, current tools to assess organizational capabilities for clinical trial diversity focus primarily on trial infrastructure, rely solely on quantitative self-reported data, and lack meaningful assessment of capabilities related to community engagement. The Equitable Breakthroughs in Medicine (EQBMED) initiative developed a holistic, collaborative, site-driven formative model and accompanyingassessment to catalog sites' current capabilities and identify opportunities for growth in both conducting industry-sponsored clinical trials and enriching diversity of those trials. The model builds upon prior work and reflects unification of two historically distinct components-research operations and community engagement-since sustainable clinical trial diversity efforts must overcome these silos. Here we present the methodology we used to develop the model and accompanyingassessment, describe how findings can support clinical trial diversity efforts, and report findings from early field testing at three U.S. sites. The first three sites were diverse in size (e.g., < 250-1K beds), with varying levels of clinical trial capabilities and community engagement. The maturity assessment laid the foundation for sites to identify and prioritize key areas to advance clinical trial diversity capabilities, and each has made tangible progress. In parallel to completing the assessment with these early sites to understand their maturity and set actionable goals, we also collected their feedback on content validity (e.g., clarity, comprehensiveness, terminology) and feasibility (e.g., ability to collect needed information and data, time required). We describe refinements made to improve the assessment and streamline the process. The EQBMED program will deploy the assessment across various site types (e.g., FQHCs, safety net hospitals) and make further refinements as warranted. Strategic investment in clinical trial diversity requires structured assessment of site maturity as a starting point for collaborative action. We propose the EQBMED maturity model as a first step toward informing efforts to increase representation of diverse populations in clinical research.

Smart Medicine: The Role of Artificial Intelligence and Machine Learning in Next-Generation Healthcare Innovation

The paper focuses on big data and healthcare pharmaceuticals, which pose both great promise and challenge as they can contribute to well-being and deliver innovation and knowledge to next-generation healthcare products. This paper provides an overview of the benefits that machine learning and big data technology contribute to healthcare systems. Realities such as patient and healthcare professional demands, the number of diseases, insufficient drugs, regulations, legal and ethical guideline restrictions, modus operandi, and technology development take place in the healthcare sector. In addition, big data opportunities and challenges for healthcare companies, research, and healthcare infrastructure are discussed. Finally, a vision of health innovation through personalized medicines as well as smart medicine is presented as a step closer to patients through regulatory, legal, and ethical guidelines, applications, and opportunities that need to be regulated and resolved.

Update from d-uo: what can healthcare research contribute to renal cell carcinoma?

Renal cell carcinoma (RCC) accounts for about 13.5% of all urological tumors. Healthcare research analyzes whether treatment recommendations from controlled studies or guidelines are being implemented in routine care. Aprerequisite for the assessment and scientific study of the quality of care in the treatment of urological tumors is standardized documentation. This article illustrates healthcare research in RCC by presenting current data from the prospective of the VERSUS study (VERSorgUngsStudie) by d‑uo (Deutsche Uro-Onkologen). The VERSUS study is anoninterventional, prospective, multicentric study for the documentation and descriptive statistical analysis of the diagnosis, treatment, and aftercare of uro-oncological patients. Of 25,065 patients currently included in the VERSUS study, 1976 have a diagnosis of RCC. Data regarding stage distribution, reason leading to initial diagnosis, distribution of symptomatic vs. asymptomatic patients as well as surgical margins from surgical treatment of RCC are presented. Despite providing interesting results, the VERSUS study remains limited with regard to the depth of the data, since it relies on the same dataset as the German cancer registry. In order to provide more comprehensive healthcare research, organ-related cancer registries like the Urothelial Cancer National Registry (UroNAT) and the Prostate Cancer National Registry (ProNAT) by d‑uo are necessary. These national cancer registries by d‑uo are unique in that they comprise all tumor stages. The Renal Cancer National Registry (ReNAT) by d‑uo is in preparation and will be avaluable contribution to quality assurance of oncological care in Germany.

Panchakarma fitness form for clinical practice and research in Ayurveda

Background: The Panchakarma Fitness Form is an essential tool in Ayurveda, used to assess a patient’s suitability for specific Panchakarma treatments. By evaluating Dashavidha Pareeksha, Sama-Nirama Pareeksha, assessment of Agni, assessment of Koshta, examination of vital parameters, medical history, and other relevant factors, this form ensures that treatment decisions are informed, ethical, and patient-centered. Objectives: To develop and implement a Panchakarma Fitness Form for evaluating patient fitness for Panchakarma therapies and to assess its effectiveness in enhancing treatment safety, personalization, and compliance with clinical and ethical standards over a five-year period. Methods: A comprehensive Panchakarma Fitness Form was designed, incorporating sections on classical advocation on fitness for different Panchakarma therapies, medical history, clinical examination of patient, allergies, medication, and lifestyle factors. The form was used in both routine healthcare and clinical research settings, with a particular emphasis on its role in screening for study eligibility. The implementation of the Panchakarma Fitness Form enhanced patient safety by identifying contraindications and optimizing treatment decisions. This form contributed to improved treatment efficacy by tailoring therapies to individual health conditions and supporting personalized care. In clinical research settings, the form facilitated participant selection, improving study integrity and data reliability. Conclusions: The Panchakarma Fitness Form is a valuable tool that supports safe, effective, and personalized Ayurvedic treatment. By systematically assessing patient readiness, it reduces risks, enhances treatment outcomes, and aids in legal and ethical compliance in both clinical practice and research. This form sets a standard for quality and safety in Ayurveda, supporting patient-centered and informed healthcare.

Online public response to emergency department diagnostic error report: A qualitative study.

The 2022 study on diagnostic error in the emergency department (ED) published by the Agency for Healthcare Research and Quality (AHRQ) reported that one in every 18 ED patients is misdiagnosed. The report was methodologically critiqued by emergency physicians and researchers. However, little is known about public perception of error in the ED. We sought to characterize public response to AHRQ's publication. A search was conducted for online news articles published December 2022 reporting the AHRQ study and containing "public comment" sections. Verbatim comments and relevant characteristics were collected. Three coders completed content analysis and resolved any differences. Descriptive statistics and themes are reported. Fifteen online articles were reviewed; three had public comment sections (New York Times, DailyMail, and Boston Globe). There were 553 unique user comments; 293 were original comments (53%) and 260 were replies to comments (47%). The 260 replies were in response to 113 original comments, with the remaining original comments having 0 replies (n = 180). Of the 202 commenters who identified a personal role in a health care encounter, 70 (35%) identified as patients and 68 (34%) identified as physicians. Comments centered on seven major themes: (1) negative personal experiences, (2) reframing study conclusions, (3) sense of decline in training standards, (4) internal stressors impeding ED diagnostic accuracy, (5) external stressors impeding ED diagnostic accuracy, (6) suggested solutions, and (7) role of the ED in diagnosis. The news coverage of AHRQ's report provided individuals a platform to share their perspectives. Many comments reflected a nuanced understanding of the role of emergency care and the stressors of the ED environment. Despite questions about the report's accuracy, there were many individuals who shared personal negative experiences suggesting that the public may feel directly impacted by error in the ED.

Symmetry and Complexity in Gene Association Networks Using the Generalized Correlation Coefficient

High-dimensional gene expression data cause challenges for traditional statistical tools, particularly when dealing with non-linear relationships and outliers. The present study addresses these challenges by employing a generalized correlation coefficient (GCC) that incorporates a flexibility parameter, allowing it to adapt to varying levels of symmetry and asymmetry in the data distribution. This adaptability is crucial for analyzing gene association networks, where the GCC demonstrates advantages over traditional measures such as Kendall, Pearson, and Spearman coefficients. We introduce two novel adaptations of this metric, enhancing its precision and broadening its applicability in the context of complex gene interactions. By applying the GCC to relevance networks, we show how different levels of the flexibility parameter reveal distinct patterns in gene interactions, capturing both linear and non-linear relationships. The maximum likelihood and Spearman-based estimators of the GCC offer a refined approach for disentangling the complexity of biological networks, with potential implications for precision medicine. Our methodology provides a powerful tool for constructing and interpreting relevance networks in biomedicine, supporting advancements in the understanding of biological interactions and healthcare research.

NCOG-17. THE COMBAT PROJECT - CORE POST OPERATIVE MORBIDITY SET FOR PAEDIATRIC BRAIN TUMOURS

Abstract BACKGROUND Brain tumours are associated with high morbidity both from the tumour and the medical and surgical interventions used to treat them. Post operative morbidity reporting following surgery for paediatric brain tumours is poor due to the lack of a common language when reporting harms. One solution is to develop a core outcome set to stipulate the minimum post operative adverse outcomes that should be reported. The COMBAT (Core Post Operative Morbidity Set for Paediatric Brain Tumours) Project will develop a core outcome set that can be applied to post operative paediatric brain tumour patients to harmonise how adverse outcomes are measured and reported, enabling comparison between different trials, studies and clinical services. We aim to generate interest in The COMBAT Project and invite participation in the project from healthcare professionals and researchers experienced in paediatric neuro-oncology for the consensus process. METHODS AND ANALYSIS We will engage with national and international stakeholders including patients and their carers, healthcare professionals and researchers. A systematic review will identify harms reported in post operative paediatric brain tumour patients and how they are measured. Qualitative interviews with patients and carers will identify any harms of importance to them. A Delphi survey will be created from the harms identified. A consensus meeting will be held to finalise the core outcome set. The final core outcome set will be published and disseminated to encourage uptake. DISCUSSION There is a clear need for a common language to harmonise measurement and reporting of harms following surgery for paediatric brain tumour patients. This project will define post operative adverse outcomes that are of critical importance to key stakeholders. It will be used to standardise surgical morbidity outcome measurement and reporting in trials, studies and clinical practice and will inform future research in this field.

Telehealth Research Strategies in a Post COVID-19 Era: A Roadmap for the Coming Decade.

An Agency for Healthcare Research and Quality-funded Think Tank, held at Michigan State University, brought together a wide range of subject matter experts in telemedicine, telehealth, digital health, digital access, and health care. The authors of this article represented a group focused on the research needs, constructs, and strategies in the post-COVID era. While telemedicine and telehealth grew exponentially during the pandemic, the challenges that have been with us for decades, while ameliorated to some extent, remain. To showcase the State of Michigan as a model, the authors reviewed challenges and opportunities related to telehealth and telemedicine usage and categorized them into seven areas of highest priority. Based on a review of the literature and consultation in the fields of telehealth, telemedicine, and digital access, we identified seven key categories where research would be most effective going forward. These categories include research into the impact of telehealth on clinical services, telehealth's use in administrative activities, education and training for health care providers and patients, telehealth policy implications at state and federal levels, the impact of future technology and innovation on telehealth services, patient characteristics and their experiences, and the ethical aspects of telehealth in the future. We have formulated this overview of our findings to act as a roadmap for future telehealth research. We recommend that ongoing studies should explore each of the seven categories identified above. The search for solutions to overcome the challenges within these topics must not be constrained to research that has been conducted recently; many of these challenges have faced telehealth researchers for decades, and numerous solutions have been proposed over the years. Some of these proposals should be explored once again in light of technological and societal advances. The findings from these studies should be shared in ways and through venues that can make them accessible outside the spheres of academic research, but also by practitioners, policymakers, and patients. Third, research into telehealth in all its incarnations must be prioritized, and leadership is needed to ensure these areas of study are continued to be spotlighted after the noise of the COVID-19 pandemic grows quiet.

Responsive service design and workforce strengthening: Recommendations to improve aged care for Aboriginal and Torres Strait Islander peoples.

This study aimed to develop innovative and practical strategies and recommendations for aged care policy and practice that support the needs of Aboriginal and Torres Strait Islander peoples. A research symposium was held in June 2023 on Kaurna Country at the South Australian Health and Medical Research Institute. The symposium brought together 70 attendees including aged care consumers, Federal and State Government representatives, advocacy services, health, aged care and social service providers, and health and aged care researchers. Two roundtable sessions titled 'Responsive Service Design' and 'Workforce Strengthening' were conducted following a World Café approach. Data were analysed thematically. This paper proposes recommendations relating to innovation and improvement within aged care policy and practice. Recommendations for responsive service design and workforce strengthening include the following: (1) promote genuine engagement and involvement, (2) establish partnerships between sectors, (3) ensure compliance, (4) innovative communication and feedback pathways, (5) holistic approaches to well-being, (6) prioritise cultural safety and (7) flexible recruitment and retention strategies. Working together and building partnerships between diverse stakeholders including community members, workforce, service providers and policymakers is required for sustainable and meaningful innovation within the aged care sector. Our recommendations, driven by community needs, provide an opportunity to ensure the innovation and implementation of ongoing aged care reforms meet the needs and expectations of Aboriginal and Torres Strait Islander peoples.

Development and Validation of the Midwifery Interventions Classification for a Salutogenic Approach to Maternity Care: A Delphi Study

Background/Objectives: This study aims to develop and validate a Midwifery Interventions Classification (MIC), which is an evidence-based, standardized taxonomy and classification of core midwifery interventions based on a salutogenic perspective for maternity care. Methods: This study described the consensus process up to the results regarding the validation of the MIC through a two-round Delphi survey involving three panels of stakeholders: Midwives, Healthcare Researchers, and Maternity Service Users. Results: The resulting MIC comprises 135 core midwifery interventions classified into Direct Midwifery care (n = 101 interventions), Indirect Midwifery Care (n = 52 interventions), and Community Midwifery Care (n = 13 interventions), reaching an overall consensus rate among experts equal to 87%. These interventions were, therefore, adapted specifically for the Italian midwifery care context, with potential for international transferability, implementation, and scalability. Conclusions: The MIC is pivotal to boosting quality improvement, education, and comparable data collection for research, sustaining midwives’ role in promoting optimal health for women, newborns, and families at large.

Children and adolescents’ experiences of mandatory SARS-CoV-2 testing in schools: a cross-sectional survey

BackgroundPublic health measures during the COVID-19 pandemic had dramatic consequences for children and adolescents. However, policy-makers and healthcare researchers did not give sufficient weight to children’s perspectives. One common public...

Health services research in acute pain medicine : Where do we come from in Germany?

Up to the early 2000s the need for optimization in the treatment of acute pain in hospitals was highlighted. Only afew successes were achieved in the optimization process. As the acute pain care in Germany remained persistently unsatisfactory, the first health services research projects in pain medicine were initiated. These were intended to achieve improvements in patient care. To illustrate the beginnings of health services research in the field of pain medicine in Germany the research projects "Pain-free hospital" and "Action alliance pain-free City of Münster" as well as the certification initiative Certkom are described. An analysis of the current state of pain care for patients and interdisciplinary pain management, the derivation of optimization measures, their implementation and subsequent evaluation were carried out in all the projects presented in the sense of acomplex intervention. All the projects could achieve improvements in patient care through asystematic survey of the current situation, targeted planning and the introduction of optimization measures. Corresponding evaluations could demonstrate these results. The systematic approach in the projects with the collation of scientific data in real-life care has achieved optimization in acute pain management. The foundations were laid for further healthcare research in pain treatment in Germany; however, the projects also revealed limitations in the inclusion of vulnerable patient groups.

Modern Approaches for Improved Healthcare Access and Efficiency: A Critical Analysis

The rapid advancement of technology and the evolving needs of healthcare systems have spurred the development of innovative approaches aimed at improving healthcare access and efficiency. This article critically analyzes modern methods, including telemedicine, artificial intelligence (AI), electronic health records (EHR), and integrated care models, exploring their effectiveness, challenges, and impact on stakeholders. Through a balanced examination of case studies, this study highlights both successful implementations and areas of concern, such as disparities in digital accessibility, data security, and system interoperability. The findings underscore the transformative potential of these approaches while calling attention to the regulatory and ethical considerations that accompany them. Recommendations for future strategies emphasize policy development, technology enhancements, and global collaboration to ensure equitable and efficient healthcare access. This analysis offers healthcare practitioners, policymakers, and researchers insights into optimizing these modern solutions while mitigating risks, ultimately fostering a more resilient and inclusive healthcare system.

Identifying and analyzing variables in musculoskeletal healthcare research

This review intends to help the students and researchers to organize, write, and analyze to make a quality research paper and to know the importance of variables in healthcare clinicians/researchers. Variables are fundamental components of the research question, serving as properties that distinguish members of groups or sets. They explain the different aspects of the sample that is under study. Variables are capable of having multiple values. Variables vary from subject to subject in the sample. A variable is a fundamental concept in research, representing a concept, image, or perception that can take different measurable values. Research design (RD) involves comparing independent groups or conditions, exploring predictive relationships, experimental studies for causal links, and comparative studies with multiple independent variables (IVs) or dependent variables (DVs). Variables play a crucial role in research and are broadly classified into causal relationships, study design, and units of measurement. IV is predictors that influence outcomes known as DV. Extraneous variables are unrelated but impactful. Moderating variables alter the relationship between IV and DV. Intervening variables or confounding variables (CVs) can complicate the cause-and-effect relationships. Active variables are manipulated, while attribute variables, inherent traits such as age, cannot be controlled. Even tests are based on variables. This review provides a comprehensive guide for students and young researchers to understand the role of variables and RD in conducting quality research papers, emphasizing the importance of operationalizing variables, controlling for CVs, and selecting appropriate RDs.

Am I attached? A patient-partnered approach to creating infographics about attachment to primary care in Ontario, Canada

BackgroundHaving a primary care provider is associated with better care experiences and lower care costs. In 2021, INSPIRE-PHC released Primary Care Data Reports - publicly available summaries of administrative billing data about how populations in each of Ontario’s 60 health teams use primary care services. Given the characterization of Canadian primary care systems as ‘in crisis’, publicly available data about primary care at the regional level presented a significant opportunity for knowledge mobilization. An understandable resource could ground the public conversation about primary care access in data. Recognizing the role that lived experience plays in ensuring the public understands research findings, a partnership between patient advisors, Ontario Health Team representatives, researchers, and trainees was established to co-produce public-facing infographics based on primary care data.MethodsEvidence-based guidelines for public health infographic creation and elements of transformative action research guided a six-meeting process to engage up to 14 patient advisors, three Ontario Health Team staff and two primary care trainees. Patient advisors were affiliated with a provincial patient-oriented primary health care research group or a Hamilton-based Ontario Health Team. Ninety-minute meetings were conducted virtually, and notes were shared with attendees to ensure they accurately reflected the conversation. Two consultations with Ontario Health Team-affiliated primary care providers provided direction and ensured project outputs aligned with local priorities.ResultsProject partners shared feedback on draft infographics, audience identification, priority elements from Primary Care Data Reports to include in the infographics, and aesthetic features (e.g., headings, colour scheme, charts). Project partners felt the most important metrics to convey to the public were those that simultaneously reinforced the benefits of primary care on individual health outcomes and health system costs.ConclusionsPatient engagement in research is becoming widespread, but co-developing knowledge products with patient and health system partners is less common. Our approach to engaging patients prevented both oversimplification and unnecessary complexity in a public-facing visual about attachment to primary care.

Hospital COVID-19 Burden and Adverse Event Rates

The COVID-19 pandemic introduced stresses on hospitals due to the surge in demand for care and to staffing shortages. The implications of these stresses for patient safety are not well understood. To assess whether hospital COVID-19 burden was associated with the rate of in-hospital adverse effects (AEs). This cohort study used data from the Agency for Healthcare Research and Quality's Quality and Safety Review System, a surveillance system that tracks the frequency of AEs among selected hospital admissions across the US. The study sample included randomly selected Medicare patient admissions to acute care hospitals in the US between September 1, 2020, and June 30, 2022. The main outcome was the association between frequency of AEs and hospital-specific weekly COVID-19 burden. Observed and risk-adjusted rates of AEs per 1000 admissions were stratified by the weekly hospital-specific COVID-19 burden (daily mean number of COVID-19 inpatients per 100 hospital beds each week), presented as less than the 25th percentile (lowest burden), 25th to 75th percentile (intermediate burden), and greater than the 75th percentile (highest burden). Risk adjustment variables included patient and hospital characteristics. The study included 40 737 Medicare hospital admissions (4114 patients [10.1%] with COVID-19 and 36 623 [89.9%] without); mean (SD) patient age was 73.8 (12.1) years, 53.8% were female, and the median number of Elixhauser comorbidities was 4 (IQR, 2-5). There were 59.1 (95% CI, 54.5-64.0) AEs per 1000 admissions during weeks with the lowest, 77.0 (95% CI, 73.3-80.9) AEs per 1000 admissions during weeks with intermediate, and 97.4 (95% CI, 91.6-103.7) AEs per 1000 admissions during weeks with the highest COVID-19 burden. Among patients without COVID-19, there were 55.7 (95% CI, 51.1-60.8) AEs per 1000 admissions during weeks with the lowest, 74.0 (95% CI, 70.2-78.1) AEs per 1000 admissions during weeks with intermediate, and 79.3 (95% CI, 73.7-85.3) AEs per 1000 admissions during weeks with the highest COVID-19 burden. A similar pattern was seen among patients with COVID-19. After risk adjustment, the relative risk (RR) for AEs among patients admitted during weeks with high compared with low COVID-19 burden for all patients was 1.23 (95% CI, 1.09-1.39; P < .001), with similar results seen in the cohorts with (RR, 1.33; 95% CI, 1.03-1.71; P = .03) and without (RR, 1.23; 95% CI, 1.08-1.39; P = .002) COVID-19 individually. In this cohort study of hospital admissions among Medicare patients during the COVID-19 pandemic, greater hospital COVID-19 burden was associated with an increased risk of in-hospital AEs among both patients with and without COVID-19. These results illustrate the need for greater hospital resilience and surge capacity to prevent declines in patient safety during surges in demand.

American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis.

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates.

Recovery environments in places of daily living: a scoping review and conceptual analysis

BackgroundOwing to advances in medical technology and the promotion of at-home medical care, patients are more frequently being treated in their places of daily living after discharge from acute care hospitals. As medical care and lifestyle are closely linked, the quality of life of the patient and their families therefore depends on the adequate preparation of the recovery environment. Hence, modifying this environment to ensure that the patient’s lifestyle and medical care are complementary is often vital. This study aimed to clarify the concept of recovery environments in places of daily living.MethodsThe literature search and selection of articles were based on a scoping review conducted in Scopus and PubMed, while data extraction and analysis were based on conceptual analysis. Thirty-two articles met the inclusion criteria.ResultsOur analysis of these articles allowed us to classify four types of recovery environments in places of daily living: physical environments appropriate to the health status of the recovering patient, collaborative environments in which intra-family roles are empowered, community environments in which recovering patients are accepted, and service environments in which the required services can be accessed. We also noted the main roles of medical professionals for building relationships with patients: providing decision-making support in places of daily living, creating an environment that empowers patients and their families, and modifying the service environment.ConclusionsFor patients, the main aims of recovery environments in places of daily living are to make them physically comfortable, maintain their identity, and improve their quality of life. Although this study is only a first step towards conceptualizing recovery environments in places of daily living and the final results are tentative, we are nonetheless confident that it will be important for advancing the field of home healthcare research.