Improved Data Capture Research Articles

Classification of Crack Coordinates through Wavelet - Analysis and CNN: Analysis of Data Preparation and Network Structure

For the two-dimensional localization of acoustic emission events (AE), artificial intelligence (AI) was applied. AE events were generated by breaking pencil leads on a granite plate measuring with dimensions of 50 cm × 50 cm × 6 cm. A total of 128 measurements were carried out at each of the 81 positions on the top surface of the granite plate. The recorded signals with 16 channels were processed using continuous wavelet transformation (CWT). The resulting RGB images served as input data for a convolutional neural network (CNN). The transformed images of the measured AE signals were converted into a four-dimensional input by considering them as deeper input, allowing for improved data capture. The result was analysed using a binary classifier according to the one-versus-all method. However, due to limited computational capacity, processing the four-dimensional data posed a challenge, resulting in significant programming effort. The results of this investigation provide insights into the potential of using AI for the localization of AE events.

Enhancing the usability of health data for inequalities research: a UK quality improvement project and code list curation.

Objective and ApproachPrimary care datasets provide a rich source of information for inequalities research; however, the value derived from these depends largely on the comprehensiveness of the code lists used by researchers. To date, no standardised code list for inequalities research has been developed. The aim of this project was to develop a comprehensive code list for groups of interest to inequalities research, namely: people with learning disabilities (LDs), people with severe mental illness (SMI), people from ethnic minority groups, and people who are transgender. Existing code lists were extracted from the Clinical Practice Research Datalink (CPRD) Bibliography (the largest research dataset in the UK), and four UK code list repositories: OpenCodelists, Health Data Research UK, University of Cambridge, and London School of Hygiene and Tropical Medicine. Comprehensive code lists were then curated through collation and removal of duplicates. Results16 code lists were identified for LDs, 18 for SMI, 16 for ethnicity, and 2 for transgender. From these, 661, 733, 346 and 68 unique codes were identified, respectively. Preliminary testing of the curated code lists, in a CPRD dataset, indicated that the number of individuals belonging to these groups was increased by 90% (compared to the original code list). Conclusions and ImplicationsOur findings suggest that the curated code lists improved data capture. These lists now need to be validated by healthcare specialists, before being made publicly available. The inclusion of code-specific definitions will enable international researchers to adapt the code lists to their medical systems.

Strategic Initiatives for Public Service Modernization: The Case of Key Focus Activities (KFAs) in Sarawak, Malaysia

Governments worldwide recognize the necessity of modernizing their public administration systems to adapt to evolving socioeconomic and technological landscapes. In Sarawak, Malaysia, the Key Focus Activities (KFA) is part of the Sarawak Civil Service initiatives to transform and optimize the civil service. The KFA initiative aims to enhance efficiency, effectiveness, and responsiveness by developing, reviewing, improving, and reengineering policies, regulations, processes, systems, and procedures. An analysis of 67 Rakyat KFA project reports evaluated the reliability of data captured and the contribution of KFA projects to Sarawak Government objectives. Findings highlighted the need for improved data capture and user-friendliness of the KFA system. Many KFA projects focused on tactical, isolated achievements rather than broader, inter-agency solutions. To maximize the impact of KFA projects, recommendations were proposed. These include enhancing KFA project report’s clarity, fostering knowledge sharing and inter-agency collaboration, and promoting public participation. The KFA initiative showcases the Sarawak Government's commitment to enhancing its civil service, in line with global trends. By addressing the identified areas for improvement, the initiative can optimize service delivery, resource utilization, and responsiveness to citizen needs. As the transformation journey continues, reevaluating and realigning the KFA initiative is essential to maintain its relevance and effectiveness in fulfilling the Sarawak Government's long-term priorities and strategic goals.

Human papillomavirus-associated cancer incidence by disaggregated Asian American, Native Hawaiian, and other Pacific Islander ethnicity.

Asian Americans and Native Hawaiians and other Pacific Islanders have suboptimal human papillomavirus (HPV) vaccination and cancer screening rates. Asian Americans and NHPIs are often aggregated, masking disparities characterized by varying colonization and immigration patterns and cultural and religious beliefs between populations and ethnicities. We examined the incidence of HPV-associated cancers across disaggregated Asian American and NHPI ethnicities. Using the Surveillance, Epidemiology, and End Results Detailed Asian/Pacific Islander database, we calculated 1990 to 2014 sex-specific, age-standardized HPV-associated cancer incidence of cervical carcinoma, oropharyngeal squamous cell carcinoma (SCC), vulvar SCC, vaginal SCC, anal SCC, and penile SCC by ethnicity: Asian Indian and Pakistani, Chinese, Filipino, Japanese, Kampuchean, Korean, Laotian, Native Hawaiian, other Pacific Islander, and Vietnamese. Trends by calendar period (1990 to 1996, 1997 to 2002, 2003 to 2008, 2009 to 2014) were estimated using Joinpoint regression. The most common HPV-associated cancer was cervical carcinoma in women and oropharyngeal SCC in men. During 1990 to 2014, cervical carcinoma incidence per 100 000 ranged from 4.5 (Asian Indian and Pakistani) to 20.7 (Laotian). Cervical carcinoma incidence only statistically significantly declined for Asian Indian and Pakistani, Filipino, Korean, Laotian, and Vietnamese women (range = 19.9% to 44.1% decline per period). Among men, oropharyngeal SCC incidence per 100 000 ranged from 1.1 (Chinese) to 5.1 (Native Hawaiian). Oropharyngeal SCC incidence only statistically significantly increased (31.0% increase per period) for Japanese men. Heterogeneity across ethnicities were observed for other cancer sites. HPV-associated cancer incidence varied widely between Asian Americans and NHPIs and by ethnicity, underscoring the need for improved data capture of ethnic groups in research and more tailored interventions to better address health disparities between Asian American and NHPI populations.

Building a learning network to accelerate improvement in pancreas cancer care and outcomes: Canopy Cancer Collective.

368 Background: Pancreas cancer (PC) survival is among the lowest of all malignancies. While limited advances in treatment are a major driver of this reality, ample opportunity exists to improve outcomes by reducing care variation, providingcoordinated, comprehensive care, and accelerating research. Learning health networks (LHNs) improve outcomes in pediatric diseases through such mechanisms, yet are not widely implemented in adult care. We aimed to develop, implement, and collect initial outcomes of the first oncology LHN, the Canopy Cancer Collective (CCC). Methods: In 2019, we established CCC to apply to PC the LHN model, including core tenets of continuous quality improvement (QI), data-sharing, empowered interdisciplinary teams and a stakeholder community including individuals with PC, and focus on community-defined improvable “outcomes that matter”. Six care centers were selected to join the LHN, and engaged in a collaborative design process to co-create a set of improvement aims and change ideas. Center team members received training in basic QI methods/tools guided by the IHI Model for Improvement and were coached to apply these to local improvement efforts. LHN infrastructure and technology enabled sharing of new ideas, best practices, and results amongst centers. Eight more centers joined in 2021, and an outcomes database built and implemented. Results generated by this database will inform center-specific and Network-wide improvement efforts and allow the LHN to undertake research. Results: Currently, 14 care centers are active participants in the CCC LHN. Five key outcomes have been defined as key targets, and centers have co-created and tested change ideas organized around key drivers of excellent PC care including proactive, timely care, aligned/prepared multidisciplinary teams, informed, activated patients, and accurate diagnosis and disease classification. 100% of care centers are trained in QI methods and actively testing change ideas. For example, in May 2022, 11 centers reporting on monthly QI activities met on average 4 times to advance QI projects, deploying a mean of 2.9 plan-do-study-act (PDSA) cycles (range, 0-5) focused on key drivers and outcomes, including reduced time to treatment, increased trial enrollment, assessment of patient experience, and improved data capture. Conclusions: Building a sustainable LHN for PC centers is feasible and has set the stage for improving patient and provider outcomes through iterative community-building, continuous improvement, and sharing of data and multidisciplinary best practices. Results lay the foundation for expansion not only in PC, but translation to other complex malignancies that will benefit from transformative, system-based approaches to outcome improvement.

An integrated framework of sensing, machine learning, and augmented reality for aquaculture prawn farm management

The rapid growth of prawn farming on an international scale will play an important role in meeting the protein requirements of an expanding global population. Efficient management of the commercial ponds for healthy production of prawns is the key mantra of success in this industry. It is a necessity to maintain the water quality parameters in these ponds within specific ranges to create an ideal environment of optimal growth of healthy prawns. The current practice of water quality data collection and their usage for decision making on most farms is not efficient and does not take full advantage of the latest technologies. The research presented in this paper aimed at addressing this problem by systematic investigation and development of an integrated framework where (i) modern sensors were investigated for their suitability and deployed for continuous monitoring of the water quality variables in prawn ponds; (ii) novel machine learning models were investigated based on collected data and deployed to accurately forecast pond status over next 24 h. This provides farmers insight into upcoming situations and take necessary measures to avoid catastrophic situations; and (iii) augmented reality-based visualisation methods were investigated for improved data capture process and efficient decision making through real-time interactive interfaces. The paper presents the integrated framework as well as the details of sensing, machine learning, and augmented reality components. We found that (i) YSI EXO2 Multi-Sonde is the best sensor for continuous monitoring of prawn ponds; (ii) ForecastNet (our developed machine learning model) provides best forecasting results with symmetric mean absolute percentage error of 6.1 %, 9.6 %, and 8.5 % for dissolved oxygen, pH, and temperature; and (iii) augmented reality-based interactive interface achieves accuracy as high as 89.2 % for management decisions with at least 41 % less time. The experience of the project as presented in this paper can act as a guide for researchers as well as prawn farmers to take advantage of latest sensors, machine learning algorithms and augmented reality tools.

Implications of COVID-19 for HIV Research: data sources, indicators and longitudinal analyses.

Implications of COVID-19 for HIV Research: data sources, indicators and longitudinal analyses.

Improving the management of hypertension and diabetes: An implementation evaluation of an electronic medical record system in Nairobi County, Kenya

ObjectiveTo evaluate the implementation of a novel electronic medical record (EMR) system for management of non-communicable diseases (NCD) (hypertension (HTN) and diabetes mellitus (DM)) in health facilities in informal settlements in Nairobi. Questions of interest were on the use of, perception of the HCWs, and scalability and sustainability of the EMR system. MethodThe study utilised a descriptive and analytical implementation evaluation through a convergent parallel mixed-methods design in 33 health facilities in the informal settlements in Nairobi County, Kenya. We carried out semi-structured interviews with the county and sub-county health management staff (n = 9), facility in-charges (n = 8), healthcare workers (HCW) (n = 35), and project staff (n = 7). Additionally, quantitative analysis, trend analysis, critical evaluation and costing were done. Qualitative data were analysed thematically using NVIVO while quantitative data were analysed using Excel and Stata software. ResultsThe EMR system significantly improved data capture and management of HTN and DM patients. The system helped clinicians to adhere to treatment and management guidelines and in clinical decision making. Most HCWs had a positive attitude and perceptions about the EMR system, and it was a good initiative for improving the quality and standardisation of care. The data captured made it easier to generate health facility and clinics reports which were essential for planning and decision-making processes. A critical audit of the EMR system features showed adequate general design features (data elements, structure and organisation, ease of use, accessibility, interfaces, confidentiality, access limitation, accuracy and integrity). DiscussionUse of the EMR helped in improving patients care. The technology not only enhanced assurance of patients’ information safety and availability but also supported in clinical decision making and standardisation of care. Successful implementation of the technology is dependent on positive perception and attitude of the HCWs. While the initial cost of setting and managing the EMR is high, future maintenance cost could be lower, making it sustainable in the long run. However, it is vital for future implementors to source for adequate funds to run it to completion if it is to achieve its objective.

Stroke Templates and Trainee Education are Associated With Improved Data Capture in an Academic Hospital.

Effective medical record documentation is required to support accurate capture of diagnoses, patient acuity (case mix index [CMI]), and justify resource utilization for reimbursement. Billing code complexity and a lack of formal documentation education in training programs have created a need for academic medical centers to incorporate training for trainees (residents, fellows, and new nurse practitioners). We hypothesized that standardized stroke note templates, trainee education, and feedback from chart audits would improve documentation accuracy. To improve the accurate/complete capture of expected (E) length of stay (LOS) and CMI by designing/implementing ischemic and hemorrhagic stroke templates containing high-frequency complication and comorbidity diagnoses with the greatest impact on stroke populations, combined with trainee education and chart audits. Descriptive statistics were used for outcomes before/after implementation of the templates. Primary outcomes include ELOS and CMI. Wilcoxon rank-sum test or chi-square test was used for group comparison. The post-template group demonstrated a significant improvement in ELOS from 5.84 to 8.27 days (p < .0001). Case mix index increased (1.73-1.75; p < .0001) in the post-template group. Stroke-specific templates, trainee education, and chart audits were associated with significant improvement in documentation accuracy and an improved business model of stroke care in our hospital.

PDG13 CAN THE PURCHASING PERFORMANCE OF HEALTHCARE INSTITUTIONS BE ASSESSED VIA THE DATA DECLARED FOR REIMBURSEMENT?

French health authorities rely on information reported by healthcare facilities in E-PMSI to assess hospital activity and ensure their reimbursement. Some of these data are restored in open access (ScanSante database) and therefore can be used to improve purchasing performance through benchmark studies. Nevertheless, a previous study suggested obvious misreporting errors regarding expensive drug prices. We aim to explore the confidence that can be placed in these declarative data. This retrospective study assesses open data robustness based on reported annual quantities and spending of expensive drugs reimbursed in addition to the diagnosis related group tariff. We deduced the 2017 average purchasing prices (prices are confidential) for APHP (Paris hospitals, e-PMSI database) and for French hospitals formerly under overall allocation (ex-UOA, ScanSante database) and compared it to the national reimbursement price cap (RPC) (the oldest of the year, if so). The relative price differential (RPD%) should be negative or zero. Then, we compared (as an external validation) APHP monthly declared data in 2018 with accurate market data and with monthly RPC applicable in 2018. Results: APHP and ex-UOA hospitals consumed 216 expensive drugs of the additional list in 2017. Significant errors affected 25% of it (RPD>1%) that indicates data entry mistakes (RPD min: +1,01%; max: +152,2%; average:+7,3%). Reported biases concerned primarily immunosuppressors and antihemorragic agents. In 2018 in APHP, 48% of the declared purchasing price (n=222) were superior to the RPC and 35% were higher than the accurate market prices. Deviations were particularly explained by the price declaration of old contracts, repealed references and declared consumption unit errors. Conclusions: Despite the conservative methodology adopted, our study highlights the poor quality of the declarative data that limit their use. Improved data capture is a major challenge because of the financial consequences for institutions in terms of refunds granted.

Epidemiology of Upper Extremity Vascular Injury in Contemporary Combat

The incidence of wartime upper-extremity vascular injury (UEVI) has been stable for the past century. The objective of this study is to provide a contemporary review of wartime UEVI, including epidemiologic characterization and description of early limb loss. The Department of Defense Trauma Registry (DoDTR) was queried to identify US service members who sustained a battle-related UEVI in Afghanistan between January 2009 and December 2015. Anatomic distribution of injury, mechanism of injury (MOI), associated injuries, early management, and early limb loss were analyzed. Analysis identified 247 casualties who sustained 308 UEVIs. The most common injury was to the vessels distal to the brachial bifurcation (63.3%, n=195), followed by the brachial vessels (27.3%, n=84) and the axillary vessels (9.4%, n=29). The predominant MOIs were penetrating explosive fragments (74.1%, n=183) and gunshot wounds (25.9%, n=64). Associated fractures were identified in 151 (61.1%) casualties and nerve injuries in 133 (53.8%). Angiography was performed in 91 (36.8%) casualties, and endovascular treatment was performed 10 (4%) times. Temporary vascular shunts were placed in 39 (15.8%) casualties. Data on surgical management were available for 171 injuries and included repair (48%, n=82) and ligation (52%, n=89). The early limb loss rate was 12.1% (n=30). For all casualties sustaining early limb loss, the MOI was penetrating fragments from an explosion; the average injury severity score (ISS) was 32.3, and the mortality was 6.7% (n=2). In those without amputation, the ISS and mortality were low at 20 and 4.6% (n=10), respectively. Overall mortality was 4.9% (n=12). The early limb loss rate was increased compared with initial descriptions from Operation Iraqi Freedom. Amputations are associated with a higher ISS. Improved data capture and fidelity, or differing MOIs, may account for this trend. Proficiency with open and endovascular therapy remains a critical focus for combat casualty care.

Abstract WP357: Implementation of Stroke Templates and Enhanced Trainee Education in an Academic Hospital Improved Data Capture of Risk Variables and Reduced Hospital Costs

Background: Effective medical record documentation is required to support accurate capture of diagnoses and reflect true patient acuity (case mix index [CMI]) related to resource utilization for healthcare reimbursement. Increasing complexity and expansion in billing codes combined with the lack of a documentation education component in provider training programs has created a need for academic medical centers to incorporate training for new residents and nurse practitioners. We hypothesized that standardized stroke templates combined with formal education of trainees and feedback from chart audits would improve costs and documentation accuracy (increase expected length of stay (LOS), CMI). Purpose: To design and implement ischemic and hemorrhagic stroke templates with high frequency complication and comorbidity diagnoses that have the greatest impact on stroke populations, combined with trainee education and real-time chart audits, to improve the capture and accuracy of Vizient risk variables (LOS, CMI). Methods: Descriptive statistics were used to analyze outcomes before and after implementation of the templates. The outcomes include expected (E) LOS and observed (O) LOS. The O/E ratio and variance days (O-E) were calculated. Cost avoidance was calculated by multiplying the terminal day total cost by the variance days. The Wilcoxon rank sum test was used to compare groups with significance set at p&lt;0.05. Analyses were performed using SAS 9.4. Results: The post-template group demonstrated significant improvement in all outcomes. The ELOS showed the most improvement contributing to the reduction in the O/E LOS. Cost avoidance increased from $24.49 to $1,897.01 per patient, yielding a net cost avoidance of $1,252,373.02. Conclusions: Stroke-specific templates, combined with trainee education and chart audits, significantly improves the accuracy of documentation and addresses the importance of quality and efficiency in healthcare reform.

Increasing bowel cancer screening participation: integrating population-wide, primary care and more targeted approaches.

Participation in the Australian National Bowel Cancer Screening Program (NBCSP) is suboptimal. Given the program's enormous potential to save lives, Cancer Council Victoria has prioritised increased screening participation as part of its strategic plan. This paper describes the implementation, and evaluation where available, of Cancer Council Victoria programs to increase participation, supported by a mix of own organisation and Victorian state health department funding. Type of programs: At the population level, Cancer Council Victoria has delivered television-led mass media campaigns to motivate age-eligible individuals to complete and return their NBCSP kit. It has also delivered targeted awareness and education programs for underscreened populations including Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse communities, and groups experiencing social disadvantage. Programs involving general practice have also been trialled to improve the knowledge and confidence of general practitioners (GPs) to discuss bowel screening with their patients, and to implement identification, reminder and follow-up systems to improve bowel screening participation. There is strong evidence to support the use of mass media public health campaigns, which have resulted in significant increases in screening kit return rates. Targeted education sessions with underscreened communities have led to increases in knowledge about bowel cancer screening, confidence to do the test and intention to participate in the NBCSP in communities where these sessions have been trialled. Early findings suggest that GP endorsement strategies are welcomed by patients and are an effective way to encourage NBCSP participation. System changes using patient information systems may be more challenging, given the inconsistent entry of NBCSP data. Our work to date demonstrates that there is a strong case for regular, widespread mass media strategies to increase NBCSP participation. There is also evidence to support more tailored, complementary approaches with dedicated education programs for underscreened groups, and active and sustained engagement with underscreened communities and primary care providers to overcome personal, cultural and systems barriers to screening. Improved data capture capabilities are needed to better implement and evaluate the impact of future strategies to improve NBCSP participation.

Geological and bioregional assessments – enabling future tight, shale and deep coal gas development – Cooper Basin case study

The Australian Government’s Geological and Bioregional Assessment (GBA) Program is a series of independent scientific studies conducted by Geoscience Australia and CSIRO, supported by the Bureau of Meteorology and managed by the Department of the Environment and Energy. These studies focus on the Cooper, Isa and Beetaloo GBA regions, all of which include basins which are prospective, but under-explored, for shale, tight and/or deep coal gas. The GBA Program seeks to expedite development in order to bring new gas resources to the east coast gas market within the next 5–10 years through increased understanding of the potential environmental impacts posed by gas development and increasing the efficiency of assessment, monitoring and ongoing regulation, including improved data capture and reporting. This multi-agency program addresses the potential environmental impacts of gas development through geological and environmental baseline assessments and identification of major information gaps (Stage 2), followed by an analysis of the potential impacts on assets, including groundwater, surface water, environmental and cultural assets as well as Commonwealth and State matters of environmental significance (Stage 3). This paper will discuss how integrated conceptual models of the geology and hydrogeology of selected unconventional petroleum resources can be utilised by industry, regulators and other stakeholders. By establishing a baseline assessment for the Cooper Basin, which includes an integrated shale, tight and deep coal prospectivity and groundwater study, future development scenarios can be envisaged and the potential impact on groundwater and other resources contemplated. Similar baseline assessments and conceptual models are being developed for the Isa and Beetaloo GBA regions.

Evaluation of the national policy of single screening and treatment for the prevention of malaria in pregnancy in two districts in Eastern Indonesia: health provider perceptions

BackgroundMalaria in pregnancy has devastating consequences for both the expectant mother and baby. Annually, 88.2 (70%) of the 125.2 million pregnancies in malaria endemic regions occur in the Asia–Pacific region. The control of malaria in pregnancy in most of Asia relies on passive case detection and prevention with long-lasting insecticide-treated nets. Indonesia was the first country in the region to introduce, in 2012, malaria screening at pregnant women’s first antenatal care visit to reduce the burden of malaria in pregnancy. The study assessed health providers’ acceptability and perceptions on the feasibility of implementing the single screening and treatment (SST) strategy in the context of the national programme in two endemic provinces of Indonesia.MethodsQualitative data were collected through in-depth interviews with 86 health providers working in provision of antenatal care (midwives, doctors, laboratory staff, pharmacists, and heads of drug stores), heads of health facilities and District Health Office staff in West Sumba and Mimika districts in East Nusa Tenggara and Papua provinces, respectively.ResultsHealth providers of all cadres were accepting of SST as a preventive strategy, showing a strong preference for microscopy over rapid diagnostic tests (RDTs) as the method of screening. Implementation of the policy was inconsistent in both sites, with least extensive implementation reported in West Sumba compared to Mimika. SST was predominantly implemented at health centre level using microscopy, whereas implementation at community health posts was said to occur in less than half the selected health facilities. Lack of availability of RDTs was cited as the major factor that prevented provision of SST at health posts, however as village midwives cannot prescribe medicines women who test positive are referred to health centres for anti-malarials. Few midwives had received formal training on SST or related topics.ConclusionsThe study findings indicate that SST was an acceptable strategy among health providers, however implementation was inconsistent with variation across different localities within the same district, across levels of facility, and across different cadres within the same health facility. Implementation should be re-invigorated through reorientation and training of health providers, stable supplies of more sensitive RDTs, and improved data capture and reporting.

An overview of the new Geological and Bioregional Assessments Program

As part of the AU$86.3 million ‘Towards a New Energy Future’ package, the Australian Government has committed AU$30.4 million to undertake the Geological and Bioregional Assessments Program. This program aims to encourage sustainable gas development through a series independent scientific studies into the potential environmental impacts of shale and tight gas exploration and production. These studies, conducted by Geoscience Australia and CSIRO, supported by the Bureau of Meteorology and managed by the Department of the Environment and Energy, will focus on three basins (regions) that are prospective, but underexplored for shale and tight gas. The program seeks to encourage exploration to bring new gas resources to the East Coast Gas Market within the next 5–10 years, increase the understanding of the potential environmental impacts posed by gas developments and increase the efficiency of assessment, monitoring and ongoing regulation, including improved data capture and reporting. The Cooper Basin and the Isa Superbasin have been selected for investigation with a third basin expected to be announced by mid-2018. The program will be delivered in three stages over 4 years and will investigate areas prospective for shale and tight gas within these regions. This independent, transparent, science-based approach aims to assist in building community understanding of, and confidence in, the capacity for safe and environmentally sustainable unconventional gas developments.

Where is the evidence? The use of routinely-collected patient data to retain adults on antiretroviral treatment in low and middle income countries–a state of the evidence review

ABSTRACTRetention rates in antiretroviral treatment (ART) in low- and middle-income countries are suboptimal for meeting global "90-90-90" treatment targets. Interventions using routinely collected patient data to follow up with ART defaulters is recommended to improve retention; yet, little is documented on how these data are used in practice. This state of the evidence review summarizes how facilities and programmes use patient data to retain adults on ART in low- and middle-income countries, and what effect, if any, these interventions have on retention. The authors searched peer-reviewed and grey literature in PubMed, POPLINE, OVID, Google Scholar, and select webpages; screened publications for relevance; and applied eligibility criteria to select articles for inclusion. Over 4,000 records were found, of which 19 were eligible. Interventions assessed within the studies were sorted into three categories: patient tracing (18), data reviews (3), and improved data capture systems (9). Nine studies demonstrated increased retention or reduced lost to follow-up; however, the quality of evidence was weak. We recommend that future research investigates how various combinations of these interventions are being implemented and their effectiveness on ART retention across diverse country contexts, taking into account cultural, social and economic barriers and differences in countries' HIV epidemics and health information systems.

The Quality and Utility of Surgical and Anesthetic Data at a Ugandan Regional Referral Hospital

There are little primary data available on the delivery or quality of surgical treatment in rural sub-Saharan African hospitals. To initiate a quality improvement system, we characterized the existing data capture at a Ugandan Regional Referral Hospital. We examined the surgical ward admission (January 2008-December/2011) and operating theater logbooks (January 2010-July 2011) at Mbarara Regional Referral Hospital. There were 6346 admissions recorded over three years. The mean patient age was 31.4±22.3years; 29.8% (n=1888) of admissions were children. Leading causes of admission were general surgical problems (n=3050, 48.1%), trauma (n=2041, 32.2%), oncology (n=718, 11.3%) and congenital condition (n=193, 3.0%). Laparotomy (n=468, 35.3%), incision and drainage (n=188, 14.2%) and hernia repair (n=90, 6.8%) were the most common surgical procedures. Of 1325 operative patients, 994 (75%) had an ASA I-II score. Of patients undergoing 810 procedures booked as non-elective, 583 (72%) had an ASA "E" rating. Records of 41.3% (n-403/975) of patients age 5 years or older undergoing non-obstetric operations were missing from the ward logbook. Missing patients were younger (25 [13,40] versus 30 [18,46] years, p=0.002) and had higher ASA scores (ASA III-V 29.0% versus 18.9%, p<0.001) than patients recorded in the logbbook; there was no diffence in gender (male 62.8% versus 67.0%, p=0.20). The hospital records system measures surgical care, but improved data capture is needed to determine outcomes with sufficient accuracy to guide and record expansion of surgical capacity.

Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study.

The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety indicators.

The current economic burden of illness of osteoporosis in Canada.

We estimate the current burden of illness of osteoporosis in Canada is double ($4.6 billion) our previous estimates ($2.3 billion) due to improved data capture of the multiple encounters and services that accompany a fracture: emergency room, admissions to acute and step-down non-acute institutions, rehabilitation, home-assisted or long-term residency support. We previously estimated the economic burden of illness of osteoporosis-attributable fractures in Canada for the year 2008 to be $2.3 billion in the base case and as much as $3.9 billion. The aim of this study is to update the estimate of the economic burden of illness for osteoporosis-attributable fractures for Canada based on newly available home care and long-term care (LTC) data. Multiple national databases were used for the fiscal-year ending March 31, 2011 (FY 2010/2011) for acute institutional care, emergency visits, day surgery, secondary admissions for rehabilitation, and complex continuing care, as well as national dispensing data for osteoporosis medications. Gaps in national data were supplemented by provincial and community survey data. Osteoporosis-attributable fractures for Canadians age 50+ were identified by ICD-10-CA codes. Costs were expressed in 2014 dollars. In FY 2010/2011, the number of osteoporosis-attributable fractures was 131,443 resulting in 64,884 acute care admissions and 983,074 acute hospital days. Acute care costs were $1.5 billion, an 18% increase since 2008. The cost of LTC was 33.4 times the previous estimate ($31 million versus $1.03 billion) because of improved data capture. The cost for rehabilitation and secondary admissions increased 3.4 fold, while drug costs decreased 19%. The overall cost of osteoporosis was over $4.6 billion, an increase of 83% from the 2008 estimate. Since the 2008 estimate, new Canadian data on home care and LTC are available which provided a better estimate of the burden of osteoporosis in Canada. This suggests that our previous estimates were seriously underestimated.