High-income Countries Worldwide Research Articles

The Impact of Electronic Health Record Interoperability on Safety and Quality of Care in High-Income Countries: Systematic Review.

BackgroundElectronic health records (EHRs) and poor system interoperability are well-known issues in the use of health information technologies in most high-income countries worldwide. Despite the abundance of literature exploring their relationship, their practical implications on patient safety and quality of care remain unclear.ObjectiveThis study aimed to examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income health care settings.MethodsA systematic search was conducted using 4 web-based medical journal repositories and grey literature sources. The publications included were published in English between 2010 and 2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by 3 researchers in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias assessments were performed using the Risk of Bias in Non-randomized Studies of Interventions and the Cochrane Risk of Bias 2 tools. The findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for health care quality.ResultsA total of 12 studies met the inclusion criteria to be included in our review. The findings were categorized into 6 common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost savings. EHR interoperability positively influenced medication safety, reduced patient safety events, and reduced costs. Improvements in time saving and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty because of the heterogeneity in the outcome measures used and notable variation in study quality.ConclusionsThe benefits of EHR interoperability on the quality and safety of care remain unclear and reflect extensive heterogeneity in the interventions, designs, and outcome measures used. The establishment of common health information technology research outcome measures would support higher-quality research on the topic. Future research efforts should focus on both the positive and negative impacts of interoperable EHR interventions and explore patient perspectives, given the growing trend for patient involvement and stewardship over their own electronic clinical data.Trial RegistrationPROSPERO CRD42020209285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209285International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2020-044941

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Prioritising models of healthcare service delivery for a more sustainable health system: a Delphi study of Australian health policy, clinical practice and management, academic and consumer stakeholders.

Objectives Healthcare expenditure is growing at an unsustainable rate in developed countries. A recent scoping review identified several alternative healthcare delivery models with the potential to improve health system sustainability. Our objective was to obtain input and consensus from an expert Delphi panel about which alternative models they considered most promising for increasing value in healthcare delivery in Australia and to contribute to shaping a research agenda in the field. Methods The panel first reviewed a list of 84 models obtained through the preceding scoping review and contributed additional ideas in an open round. In a subsequent scoring round, the panel rated the priority of each model in terms of its potential to improve health care sustainability in Australia. Consensus was assumed when ≥50% of the panel rated a model as (very) high priority (consensus on high priority) or as not a priority or low priority (consensus on low priority). Results Eighty-two of 149 invited participants (55%) representing all Australian states/territories and wide expertise completed round one; 71 completed round two. Consensus on high priority was achieved for 59 alternative models; 14 were rated as (very) high priority by ≥70% of the panel. Top priorities included improving medical service provision in aged care facilities, providing single-point-access multidisciplinary care for people with chronic conditions and providing tailored early discharge and hospital at home instead of in-patient care. No consensus was reached on 47 models, but no model was deemed low priority. Conclusions Input from an expert stakeholder panel identified healthcare delivery models not previously synthesised in systematic reviews that are a priority to investigate. Strong consensus exists among stakeholders regarding which models require the most urgent attention in terms of (cost-)effectiveness research. These findings contribute to shaping a research agenda on healthcare delivery models and where stakeholder engagement in Australia is likely to be high. What is known about the topic? Healthcare expenditure is growing at an unsustainable rate in high-income countries worldwide. A recent scoping review of systematic reviews identified a substantial body of evidence about the effects of a wide range of models of healthcare service delivery that can inform health system improvements. Given the large number of systematic reviews available on numerous models of care, a method for gaining consensus on the models of highest priority for implementation (where evidence demonstrates this will lead to beneficial effects and resource savings) or for further research (where evidence about effects is uncertain) in the Australian context is warranted. What does this paper add? This paper describes a method for reaching consensus on high-priority alternative models of service delivery in Australia. Stakeholders with leadership roles in health policy and government organisations, hospital and primary care networks, academic institutions and consumer advocacy organisations were asked to identify and rate alternative models based on their knowledge of the healthcare system. We reached consensus among ≥70% of stakeholders that improving medical care in residential aged care facilities, providing single-point-access multidisciplinary care for patients with a range of chronic conditions and providing early discharge and hospital at home instead of in-patient stay for people with a range of conditions are of highest priority for further investigation. What are the implications for practitioners? Decision makers seeking to optimise the efficiency and sustainability of healthcare service delivery in Australia could consider the alternative models rated as high priority by the expert stakeholder panel in this Delphi study. These models reflect the most promising alternatives for increasing value in the delivery of health care in Australia based on stakeholders' knowledge of the health system. Although they indicate areas where stakeholder engagement is likely to be high, further research is needed to demonstrate the effectiveness and cost-effectiveness of some of these models.

AN EVALUATION METHODOLOGY FOR MEASURING THE LONG-TERM IMPACT OF FAMILY STRENGTHENING AND ALTERNATIVE CHILD CARE SERVICES: THE CASE OF SOS CHILDREN’S VILLAGES

Until recently, SOS Children’s Villages International, like many organisations in the social sector, lacked a rigorous and systematic approach to gauging the long-term impact of their services. With this in mind, SOS Children’s Villages International developed a social impact evaluation methodology in 2014 to measure the long-term effects of its services on children and their families and communities, as well as the social return on investment. This evaluation methodology has been tested and applied to similar service types across 15 low-, middle-, and high-income countries worldwide. The findings are regularly consolidated, in order to derive trends and learnings for the global organisation and to inform strategy and policy. The present article will discuss the evaluation methodology and the related limitations. Conclusions regarding the validity of the methodology will be offered in terms of the measurement of social service impact and the way forward.

An analysis of the strategic plan development processes of major public organisations funding health research in nine high-income countries worldwide

BackgroundThere have been claims that health research is not satisfactorily addressing healthcare challenges. A specific area of concern is the adequacy of the mechanisms used to plan investments in health research. However, the way organisations within countries devise research agendas has not been systematically reviewed. This study seeks to understand the legal basis, the actors and the processes involved in setting research agendas in major public health research funding organisations.MethodsWe reviewed information relating to the formulation of strategic plans by 11 public funders in nine high-income countries worldwide. Information was collected from official websites and strategic plan documents in English, French, Italian and Spanish between January 2019 and December 2019, by means of a conceptual framework and information abstraction form.ResultsWe found that the formulation of a strategic plan is a common and well-established practice in shaping research agendas across international settings. Most of the organisations studied are legally required to present a multi-year strategic plan. In some cases, legal provisions may set rules for actors and processes and may establish areas of research and/or types of research to be funded. Commonly, the decision-making process involves both internal and external stakeholders, with the latter being generally government officials and experts, and few examples of the participation of civil society. The process also varies across organisations depending on whether there is a formal requirement to align to strategic priorities developed by an overarching entity at national level. We also found that, while actors and their interactions were traceable, information, sources of information, criteria and the mechanisms/tools used to shape decisions were made less explicit.ConclusionsA complex picture emerges in which multiple interactive entities appear to shape research plans. Given the complexity of the influences of different parties and factors, the governance of the health research sector would benefit from a traceable and standardised knowledge-based process of health research strategic planning. This would provide an opportunity to demonstrate responsible budget stewardship and, more importantly, to make efforts to remain responsive to healthcare challenges, research gaps and opportunities.

Surgical Site Infection in a 1000-Bed Tertiary-Care Teaching Hospital in New Delhi, India

Background: Surgical site infection (SSI) includes infections occurring after 48 hours of any surgery and accounts for most of the healthcare-associated infections (HAIs) in surgical centers. Surgical site infections can result in pain, discomfort, prolonged hospital stay, increased exposure to antimicrobials, and consequentially, increased healthcare costs. Objectives: The study intended to characterize the incidence, etiology, and emerging resistance of SSI in a 1000-bed tertiary-care teaching hospital in New Delhi. Methods: The ambispective study was conducted in a 1000-bed tertiary-care teaching hospital in New Delhi. Clinical, laboratory, and environmental surveillance and screening of health care providers (HCPs) were conducted using the National Healthcare Safety Network (NHSN) definitions and methods given by the US Centers for Disease Control and Prevention (CDC). Results: With 3,541 patients admitted to the Gynecology and Obstetrics Ward and General Surgical Ward of the hospital, the total episodes of SSI were 80 (2.26%). The mean rates of superficial, deep, and organ space SSI were 46.25%, 47.5%, and 6.25%, respectively. The most common organisms isolated were Acinetobacter baumannii (23.75%), Pseudomonas aeruginosa (17.5%), Escherichia coli (15%), and Staphylococcus aureus (12.5%). Conclusions: The rate of SSI in our study was comparable to the unadjusted rates in India, lower-middle, upper-middle, and high-income countries worldwide. Patients with pre-existing medical illness, prolonged operation time, and wound contamination are strongly predisposed to surgical site infection.

ESTADO DE LA VALORIZACIÓN DE BIORRESIDUOS DE ORIGEN RESIDENCIAL EN GRANDES CENTROS URBANOS

In the current study a literature review of household biowaste valorization in large urban centers of developing countries in Latin America and the Caribbean, as well as high-income countries worldwide, was performed. From the analysis of scientific and technical literature of official entities of the two evaluated contexts, 70 large urban centers (37 from Latin America and the Caribbean and 33 from high-income countries), from a total of 34 countries, were studied. The results indicated that household biowaste valorization is established in at least 27 large urban centers, three of them in Latin America and the Caribbean and 24 in high-income countries of North America, Europe, Asia and Oceania. In these, the implementation of 14 type-systems was identified. Although there are differences between the evaluated contexts, the most used treatment methods are composting and anaerobic digestion. Other methods used are thermal processing for animal food production and mechanical biological treatment with composting and with anaerobic digestion. It was evidenced that the implemented systems produce compost (mainly used in gardening and agriculture), electric power, heat, vehicular fuel and animal feed. Finally, despite the relevance of the household biowaste stream in Latin America and the Caribbean large urban centers, and the benefits of its recovery, the results of this study showed the predominance of household biowaste landfilling in this context. In consequence, it is recommended to establish the household biowaste as a priority fraction whose valorization should be the primary aim of management systems.

Trauma on Farms in the Republic of Ireland

BackgroundFarming is the most dangerous occupation in high-income countries worldwide. However, there is a lack of descriptive literature in this area. Injuries on farms are increasing, at a time when the cohort of trauma patients generally has become older and more medically complex. Farmers continue to work late in life when other industry workers would be retired. This study describes major trauma occurring on farms in the Republic of Ireland, the demographics of patients and treatments they received. MethodsData was gathered from the National Office of Clinical Audit Major Trauma Audit (MTA) 2014 to 2016. Patients were included and excluded based on Trauma Audit and Research Network(TARN) inclusion criteria. ResultsThere were 430 patients included in this study. The median age was 54.5 years (range 1-93). There were 6.3%(n=27) paediatric patients, and 27%(n=116) over 65-year olds. Patients had predominantly low Charlson Comorbidity Index scores (median 0). Patients >65 years had more comorbidities (p<0.001). The median ISS was 9(IQR 9-17). The most common mechanism of injury was blow from animal (n=126,29%) followed by low fall (n=115,27%). Summer was the most common season of injury (n=128,30%) and most patients presented to a hospital between 8am-12am(n=412,96%). There were 11 patients (2.6%) who died after arrival to hospital – most commonly due to head injury (n=5,45%).The median length of stay was six days; older patients stayed longer than younger patients (6 vs 12 days,p<0.001). The most common body area injured was limbs (n=139,32%), followed by chest (n=89,21%), spine (n=67,16%) and head injuries (n=64,15%). There were 84 patients (19.5%) who underwent operative intervention, and 77(18%) required intensive care unit (ICU) admission. Farm trauma patients were more likely to arrive by helicopter than other MTA patients. ConclusionsA substantial proportion of trauma on Irish farms involves older men who have co-morbidities and complexity of medical need. Farm trauma occurs in rural and remote locations with longer journey times to trauma centres and trauma units–this has implications for trauma care education and mode of EMS transport. Older patients who suffer trauma on farms require longer hospital stays and may not return to independent living.

Trends in incidence of anal cancer in Austria, 1983-2016.

SummaryBackgroundRecent reports have noted increasing rates of anal cancer among high-income countries worldwide; however, little is known about these trends in Austria.MethodsData on anal cancer from 1983 to 2016 were obtained from Statistics Austria. All tumors (n = 3567) were classified into anal squamous cell carcinomas (ASCC), anal adenocarcinomas (AADC), and others (unspecified carcinoma and other specific carcinoma). Anal cancer incidence rates were calculated in 5‑year cycles and incidence average annual percentage change (AAPC) to evaluate trends by sex, histology and age group.ResultsThe incidence rate of anal cancer was higher among females than males (relative risk, RR = 1.66, 95% confidence interval, CI: 1.55–1.79, p < 0.0001). From 1983 through 2016, incident anal cancer increased significantly (0.92 per 100,000 person-years to 1.85 per 100,000 person-years, AAPC = 1.93, 95% CI: 1.52 to 2.34, p < 0.0001), particularly among those 40–69 years old. From 1983 through 2016, the increasing anal cancer incidence was primarily driven by ASCC (0.47–1.20 per 100,000 person-years, AAPC = 2.23, 95% CI: 1.58 to 2.88, p < 0.0001) and others (other than ASCC and AADC, AAPC = 1.78, 95% CI: 1.01–2.55), yet stable in AADC (AAPC = 0.88, 95% CI: −0.48–2.25).ConclusionsDespite being a rare cancer in Austria, the increase in anal cancer incidence rate from 1983 to 2016 was substantial, particularly in ASCC. The observed rising trends reflect the need to investigate associated risk factors that have increased over time to inform preventive measures.Electronic supplementary materialThe online version of this article (10.1007/s00508-020-01622-z) contains supplementary material, which is available to authorized users.

Psychosis and urbanicity: a review of the recent literature from epidemiology to neurourbanism.

Purpose of reviewEpidemiological studies associate city living with an elevated psychosis risk. Urban (social/economic) stress and exposure to environmental toxins, pollution or disease agents have been proposed to underlie this association. This review provides an update on the recent evidence (May 2017 – November 2018).Recent findingsOf 647 screened studies, 17 on: urbanicity–psychosis associations in worldwide high, middle and low-income countries; explanatory mechanisms, including nature exposure, social and economic stressors and genetic risk; urbanicity effects on the brain and coping; and urbanicity and resources, were included. The reviewed evidence revealed complex patterns of urbanicity–psychosis associations with considerable international variation within Europe and between low, middle and high-income countries worldwide. Social and economic stressors (e.g. migration, ethnic density and economic deprivation), nature exposure and access to resources could only explain part of the urbanicity effects. Risk factors differed between countries and between affective and non-affective psychosis.SummaryUrbanicity–psychosis associations are heterogeneous and driven by multiple risk and protective factors that seem to act differently in different ethnic groups and countries. Interdisciplinary research combining approaches, for example from experimental neuroscience and epidemiology, are needed to unravel specific urban mechanisms that increase or decrease psychosis risk.

Juvenile delinquency, welfare, justice and therapeutic interventions: a global perspective.

This review considers juvenile delinquency and justice from an international perspective. Youth crime is a growing concern. Many young offenders are also victims with complex needs, leading to a public health approach that requires a balance of welfare and justice models. However, around the world there are variable and inadequate legal frameworks and a lack of a specialist workforce. The UK and other high-income countries worldwide have established forensic child and adolescent psychiatry, a multifaceted discipline incorporating legal, psychiatric and developmental fields. Its adoption of an evidence-based therapeutic intervention philosophy has been associated with greater reductions in recidivism compared with punitive approaches prevalent in some countries worldwide, and it is therefore a superior approach to dealing with the problem of juvenile delinquency.

Physical activity, self-efficacy, and quality of life in older Czech adults.

Despite efforts to expand global physical activity (PA) surveillance data to include both low- and high-income countries worldwide, our understanding of the relationship between PA and quality of life (QOL) in older adults from culturally diverse backgrounds is limited. We tested McAuley's social-cognitive model of the PA-QOL relationship in the cultural context of the Czech Republic, a post-communist central European country. A total of 546 older Czech adults (mean age 68years) completed a battery of questionnaires assessing indicators of PA, self-efficacy, health status, and global QOL. A structural equation model was used to test the relationship between PA and QOL. The model hypothesized an indirect relationship between PA and QOL: PA predicted self-efficacy, which in turn predicted global QOL through mental and physical health status. The analyses indicated an acceptable fit of the proposed model, albeit with different emphases than those of studies from Western countries. Above all, we observed a stronger effect of PA on self-efficacy and a weaker mediating effect of health status on the PA-QOL relationship. Our findings supported the validity of McAuley's PA-QOL social-cognitive model for a non-Western cultural context. However, it seems that self-efficacy and health status may influence the PA-QOL relationship in this population in a manner different from that proposed in McAuley's model.

From Endothelial Progenitor Cells to Tissue Engineering: How Far have we Come?

Cardiovascular disease has become the leading cause of death in high income countries worldwide and the available treatment is not able to provide a complete recovery. Tissue engineering offers a possibility to construct autologous vein replacements for surgery. In this review we summarize approaches leading to artificial vascular graft construction. We discuss biomaterials currently in use, various drug delivery systems and the most appropriate cell cultures for vein engineering. Despite the progress in biomaterials and drug delivery systems, generating a suitable tissue microenvironment and selection of the appropriate cell population for graft seeding remains a major challenge. Here we focus on endothelial progenitor stem cells as the most suitable cell type for vascular graft construction. We discuss its sources, isolation techniques and differentiation procedures.

Tuberculosis and migration: a review

In the past decade, the number of new cases of tuberculosis worldwide has barely declined and national tuberculosis control and elimination programmes in many high-income countries worldwide are increasingly challenged to address the problem of disease in foreign-born residents and migrant workers. Routine immigration medical screening, either before or after arrival in the recipient country, is designed to avoid the admission of migrants who pose a public health threat. Screening measures, however, have changed with time largely based on respect for individuals' rights. This paper reviews the measures that are being used by countries to screen immigrants and improve their health well-being, and presents cases studies from two Eastern Mediterranean Region countries.