National Experts Research Articles

Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios.

To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB. Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments. The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. Experts participated in the Delphi rounds and nurses in the pilot test.

Exploring gender disparities in the disease and economic tobacco-attributable burden in Latin America.

Tobacco use has significant health consequences in Latin America, and while studies have examined the overall impact, the gender-specific effects have not been thoroughly researched. Understanding these differences is crucial for effective tobacco control policies. The objective of this study was to explore the differences in tobacco-attributable disease and economic burden between men and women in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru. We used a previously validated economic model to quantify the impact of tobacco-related illnesses, including morbidity, mortality, healthcare costs, productivity losses, informal care expenses, and DALYs, by gender and age. We utilized data from national surveys, records, studies, and expert opinions to populate the model. In 2020, there were 351,000 smoking-attributable deaths. Men accounted for 69% and women 31%. Ecuador and Mexico had the highest male-to-female death ratio, while Peru and Chile had the smallest disparities. 2.3 million tobacco-related disease events occurred, with 65% in men and 35% in women. Ecuador and Mexico had higher disease rates among men, while Peru had a more balanced ratio. Regarding DALYs, men lost 6.3 million due to tobacco, while women lost 3.3 million, primarily from COPD, cardiovascular disease, and cancer. Brazil and Mexico had the highest DALY losses for both genders. Costa Rica had a lower male-to-female tobacco use prevalence ratio but ranked second in deaths, disease events, and DALYs attributed to tobacco. Colombia had a unique pattern with a male-to-female death ratio of 2.08 but a higher ratio for disease events. The health systems spent $22.8 billion to treat tobacco-attributable diseases, with a male-to-female cost ratio 2.15. Ecuador showed the greatest gender cost difference, while Peru had the lowest. Productivity loss due to tobacco was $16.2 billion, with Ecuador and Mexico exhibiting the highest gender disparities and Peru the lowest. Informal care costs amounted to $10.8 billion, with men incurring higher costs in Ecuador, Costa Rica, and Mexico. Tobacco causes significant health and economic burdens in Latin America, with gender-based differences. There is a need for gender-disaggregated data to improve tobacco control policies.

Bleeding assessment in a large cohort of patients with Osteogenesis Imperfecta

BackgroundOsteogenesis Imperfecta (OI) is characterised by bone fragility. Among several features, easy bruising and multiple case reports on haemorrhagic events have been reported. This paper describes the diverse manifestations of bleeding and bruising in a large cohort of 328 OI patients. The aim of this study is to provide insight in the diverse aspects and therapeutic considerations of bleedings in OI.MethodsThis descriptive cohort study was conducted at the National Expert Center for adults with OI in the Netherlands. Bleeding was assessed by the validated self-bleeding assessment tool (Self-BAT) The tool was distributed among 328 adults with different clinically confirmed types of OI.Results195 of 328 invited patients (completion rate 60%) with OI type 1 (n = 144), OI type 3 (n = 17) and OI type 4 (n = 34), aged between 18 and 82 years, completed the tool. Self-BAT scores were above the normal range in 42% of all patients. For males Self-BAT scores were increased in 37% with a mean score of 3.7, ranged between 0 and 18. For females the Self-BAT scores were increased in 44% with a mean of 5.4 and a range of 0–24. No statistical differences in OI subtypes were found.ConclusionsBleeding tendency appears to be a relevant complication in OI patients as this study confirms the presumption of bleeding tendency. There are specific recommendations to clinicians who treat OI patients to consider an assessment of bleeding tendency and use potential interventions to reduce haemorrhagic complications and improve quality of life.

Using PROMIS Methodology to Create Self-Report Measures of Mindfulness and Related Concepts.

Mindfulness meditation is ubiquitous in health care, education, and communities at large. Mindfulness-Based Interventions (MBIs) are the focus of hundreds of NIH-funded trials given the myriad health benefits associated with this practice across multiple populations. Notwithstanding, significant gaps exist in how mindfulness concepts are measured using currently available self-report instruments. Due to the number of available mindfulness measurement tools, each measuring different aspects, it is difficult to determine the extent to which individuals develop comparable mindfulness skills and attitudes and which health benefits can be attributed to which gains in mindfulness. The Patient-Reported Outcomes Measurement Information System (Puerto RicoOMIS®) has established a rigorous instrument development methodology to create brief, precise, and clinically relevant outcomes tools. This is the first of 4 papers representing an NCCIH-funded initiative (R01AT009539), which has applied Puerto RicoOMIS® instrument development methodologies to mindfulness measurement to improve the rigor, relevance, and reproducibility of MBI research results. This introductory paper sets the stage for why improved mindfulness measurement tools are needed and briefly describes the Puerto RicoOMIS® development approach. The second 2 papers highlight results from a national survey, focus groups, and expert interviews to identify and organize relevant mindfulness concepts, domains, and items for eventual item bank creation. The fourth paper reviews the item writing and development process of these new instruments, including results from stakeholder cognitive interviews and a translatability review. Together these papers feature the rigorous development approach, rationale, logic, and significance that supports the development, calibration, and validation of new Puerto RicoOMIS® measures of mindfulness and related concepts.

Adolescent E-Cigarette Expectancies: Measure Development and Preliminary Validity of the Electronic Nicotine Vaping Outcomes Measure for Youth.

Electronic nicotine delivery systems ("e-cigarettes") are the nicotine product most commonly used by adolescents. Research, treatment, and policy could benefit from measures of adolescent e-cigarette beliefs about outcomes of use (ie, expectancies). In the current study, we developed and tested an adolescent electronic nicotine vaping expectancy measure. A focus group with adolescents evaluated potential e-cigarette expectancy items. A panel of national experts assisted in revision of these items. Finally, items were administered to a sample of adolescents 14-17years old (N = 267, Mean age 15.6, SD = 1.1, 50.9% Female, 50.2% Non-Hispanic White, 22.5% Non-Hispanic Black, 14.2% Hispanic) in a large Southeastern metropolitan area in the United States. Exploratory Factor Analysis revealed a four factor solution: Negative Consequences (Cronbach's α = .92); Positive Reinforcement (α = .83); Negative Affect Reduction (α = .95); and Weight Control (α = .89). Subscales were significantly correlated with vaping susceptibility and lifetime vaping. Subscales successfully differentiated susceptible adolescents from confirmed non-susceptible adolescents, with susceptible adolescents reporting more positive expectancies, eg, Positive Reinforcement, M = 5.0, SD = 2.0 vs M = 3.0, SD = 2.1, P < .001, η2 = 0.19, and less negative expectancies, M = 5.5, SD = 2.3 vs M = 6.5, SD = 2.6, P = .001, η2 = 0.04. Similar results were found comparing adolescents who have never vaped nicotine with those who have vaped nicotine. Hierarchical linear regression demonstrated subscales were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. A preliminary version of an adolescent expectancy measure appears reliable and valid based on expert input and pilot testing with adolescents. Promising results were found in the domains of concurrent validity, discriminant validity, and incremental validity. Future research and evaluation efforts will be able to use this tool to further prevention and treatment goals.

Simuliids from Madrid Autonomous Region (Spain): update and new contributions

Simuliidae family in Spain has been studied irregularly: some enclaves have been widely investigated by both national and foreign experts, while others have been merely mentioned or addressed indirectly for various reasons. The Madrid Region in Spain has been recurrently investigated in this respect, yet many geographical areas remain to be studied regarding Simuliidae taxonomy, geographical distribution, and ecology. In this study, a thorough sampling was conducted based on searching for preimaginal stages of larva and pupa attached or fixed to any suitable support in different lotic water systems. The latter were chosen for their favourable conditions for hosting new and valuable information. The collected material was identified based on morphological characteristics. A total of 16 species were identified. The following is an update of the simuliid fauna and its altitudinal ranges from Spain’s central geographical area, including seven new records for the Madrid Region: Prosimulium rufipes (Meigen, 1830); Simulium (Nevermannia) naturale Davies, 1966; Simulium (Nevermannia) quasidecolletum Crosskey, 1988; Simulium (Nevermannia) urbanum Davies, 1966; Simulium (Simulium) trifasciatum Curtis, 1839; Simulium (Simulium) maximum (Knoz, 1961); Simulium (Simulium) variegatum Meigen, 1818. Following the update, the species with the narrowest altitudinal distribution were: S. (N.) naturale and S. (N.) urbanum: 1843-1844 meters (m), while Simulium (Nevermannia) cryophilum (Rubtsov, 1959) and Simulium (Simulium) intermedium Roubaud, 1906 presented the widest distribution: 870-2000 m. In this study, S. (N.) naturale and S. (N.) urbanum also displayed the narrowest altitudinal range, with 1 m, whereas S. (N.) cryophilum presented the broadest, with 603 m. The present study contributes to the knowledge of Spanish blackflies generally and from the Madrid Region in particular, providing new insights into the species composition and their altitudinal distribution. It thus lays the foundations for future works.

Covered versus bare-metal stenting of the mesenteric arteries in patients with chronic mesenteric ischaemia (CoBaGI): a multicentre, patient-blinded and investigator-blinded, randomised controlled trial

Mesenteric artery stenting with a bare-metal stent is the current treatment for atherosclerotic chronic mesenteric ischaemia. Long-term patency of bare-metal stents is unsatisfactory due to in-stent intimal hyperplasia. Use of covered stents might improve long-term patency. We aimed to compare the patency of covered stents and bare-metal stents in patients with chronic mesenteric ischaemia. We conducted a multicentre, patient-blinded and investigator-blinded, randomised controlled trial including patients with chronic mesenteric ischaemia undergoing mesenteric artery stenting. Six centres in the Netherlands participated in this study, including two national chronic mesenteric ischaemia expert centres. Patients aged 18 years or older were eligible for inclusion when an endovascular mesenteric artery revascularisation was scheduled and a consensus diagnosis of chronic mesenteric ischaemia was made by a multidisciplinary team of gastroenterologists, interventional radiologists, and vascular surgeons. Exclusion criteria were stenosis length of 25 mm or greater, stenosis caused by median arcuate ligament syndrome or vasculitis, contraindication for CT angiography, or previous target vessel revascularisation. Digital 1:1 block randomisation with block sizes of four or six and stratification by inclusion centre was used to allocate patients to undergo stenting with bare-metal stents or covered stents at the start of the procedure. Patients, physicians performing follow-up, investigators, and radiologists were masked to treatment allocation. Interventionalists performing the procedure were not masked. The primary study outcome was the primary patency of covered stents and bare-metal stents at 24 months of follow-up, evaluated in the modified intention-to-treat population, in which stents with missing data for the outcome were excluded. Loss of primary patency was defined as the performance of a re-intervention to preserve patency, or 75% or greater luminal surface area reduction of the target vessel. CT angiography was performed at 6 months, 12 months, and 24 months post intervention to assess patency. The study is registered with ClinicalTrials.gov (NCT02428582) and is complete. Between April 6, 2015, and March 11, 2019, 158 eligible patients underwent mesenteric artery stenting procedures, of whom 94 patients (with 128 stents) provided consent and were included in the study. 47 patients (62 stents) were assigned to the covered stents group (median age 69·0 years [IQR 63·0-76·5], 28 [60%] female) and 47 patients (66 stents) were assigned to the bare-metal stents group (median age 70·0 years [63·5-76·5], 33 [70%] female). At 24 months, the primary patency of covered stents (42 [81%] of 52 stents) was superior to that of bare-metal stents (26 [49%] of 53; odds ratio [OR] 4·4 [95% CI 1·8-10·5]; p<0·0001). A procedure-related adverse event occurred in 17 (36%) of 47 patients in the covered stents group versus nine (19%) of 47 in the bare-metal stent group (OR 2·4 [95% CI 0·9-6·3]; p=0·065). Most adverse events were related to the access site, including haematoma (five [11%] in the covered stents group vs six [13%] in the bare-metal stents group), pseudoaneurysm (five [11%] vs two [4%]), radial artery thrombosis (one [2%] vs none), and intravascular closure device (none vs one [2%]). Six (13%) patients in the covered stent group versus one (2%) in the bare-metal stent group had procedure-related adverse events not related to the access site, including stent luxation (three [6%] vs none), major bleeding (two (4%) vs none), mesenteric artery perforation (one [2%] vs one [2%]), mesenteric artery dissection (one [2%] vs one [2%]), and death (one [2%] vs none). The findings of this trial support the use of covered stents for mesenteric artery stenting in patients with chronic mesenteric ischaemia. Atrium Maquet Getinge Group.

The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)

BackgroundThis study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations.MethodsSixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified.A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators.ResultsCare received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators.ConclusionsThis is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.

Assessment of ultra processed foods consumption in Senegal: validation of the Nova-UPF screener

BackgroundUltra-processed foods (UPF), as proposed by the Nova food classification system, are linked to the development of obesity and several non-communicable chronic diseases and deaths from all causes. The Nova-UPF screener developed in Brazil is a simple and quick tool to assess and monitor the consumption of these food products. The aim of this study was to adapt and validate, against the 24-hour dietary recall, this short food-based screener to assess UPF consumption in the Senegalese context.MethodsThe tool adaptation was undertaken using DELPHI methodology with national experts and data from a food market survey. Following the adaptation, sub-categories were renamed, restructured and new ones introduced. The validation study was conducted in the urban area of Dakar in a convenience sample of 301 adults, using as a reference the dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake obtained via 24-hour recall. Association between the Nova-UPF score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants’ classification according to quintiles of Nova-UPF score and quintiles of the dietary share of UPF.ResultsThe results show a linear and positive association (p-value < 0.001) between intervals of the Nova-UPF score and the average dietary share of UPF. There was a near perfect agreement in the distribution of individuals according to score’s quintiles and UPF dietary share quintiles (Pabak index = 0.84).ConclusionThe study concluded that the score provided by the Nova-UPF screener adapted to the Senegalese context is a valid estimate of UPF consumption.

Integrating Hospital-Based Harm Reduction Care-Harnessing the Nursing Model.

Hospitals are risk environments for people who use drugs, and most hospitals are unprepared to deliver substance use disorder (SUD) care, including harm reduction (HR) interventions. HR philosophy clashes with traditional hospital hierarchy and norms, and staff may resist HR interventions due to stigma, fear of enabling substance use, legal and safety concerns. Nurses are central to hospital culture and care and could promote and deliver HR care. Our US hospital has an inter-professional addiction consult service (ACS) that includes medical providers, social workers, and peers. We developed and launched a hospital-based registered nurse-(RN) led HR intervention, including distributing safe-use supplies (eg, syringes). We describe model development and early experience, using an Exploration, Preparation, Implementation, and Sustainment framework. ACS experiences and community HR interventions informed our exploration phase. In the preparation phase we secured funding from Medicaid payers for a 2-year pilot, including full-time RN salary and HR supplies. We elicited buy-in from hospital executive leaders, partly by partnering with nurse champions who described unmet patient care and staff education needs. We consulted hospital lawyers and developed an institution-wide media campaign targeting staff, including in-person booths distributing naloxone and materials promoting international overdose awareness day (eg, "#EndOverdose" buttons). We collaborated with local and national experts to develop the intervention, which includes RN bedside HR education and staff trainings. The Implementation was from September 2022 to March 2023. We trained 459 staff (over 15 trainings) and conducted 209 patient encounters. Generally, patients and staff embraced the HR RN role, including previously controversial safe-use supply distribution. Sustainment efforts include engaging stakeholders in continuous improvement and evaluation efforts. A nurse-led hospital-based HR intervention can expand patient services, support staff, and bridge HR and medical models.

Food environment in Burkina Faso: priority actions recommended to the government using Food-EPI tool.

The food environment is an important factor in the efforts of countries worldwide to achieve a transition to sustainable food systems. The objective of this study is to formulate and prioritize actions to be addressed to the government of Burkina Faso for the creation of a healthy food environment, which will contribute to reducing malnutrition in all its forms and non-communicable diseases. National experts were brought together to identify and prioritize actions to fill the gaps identified through a multi-step assessment process following the methodology of the Healthy Food and Environment Policy Index (Food-EPI). Up to 20 priority policy actions were recommended to the Burkina Faso government. Actions in the policy component focused mainly on regulation of food promotion and marketing, particularly to children, and others in the infrastructure support component focused largely on political leadership, i.e., strong and visible political support from the government to improve the food environment, population nutrition, diet-related non-communicable diseases and their inequalities. The priority actions to be recommended to the government will strengthen advocacy for government decisions to create a healthier food environment in the country.

Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries.

Central and Eastern European (CEE) countries have recently implemented reforms to health care provider payment systems, which include changing payment methods and related systems such as contracting, management information systems, and accountability mechanisms. This study examines factors influencing provider payment reforms implemented since 2010 in Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. A four-stage mixed methods approach was used: developing a theoretical framework and data collection form using existing literature, mapping payment reforms, consulting with national health policy experts, and conducting a comparative analysis. Qualitative analysis included inductive thematic analysis and deductive approaches based on an existing health policy model, distinguishing context, content, process, and actors. We analyzed 27 payment reforms that focus mainly on hospitals and primary health care. We identified 14 major factor themes influencing those reforms. These factors primarily related to the policy process (pilot study, coordination of implementation systems, availability of funds, IT systems, training for providers, reform management) and content (availability of performance indicators, use of clinical guidelines, favorability of the payment system for providers, tariff valuation). Two factors concerned the reform context (political willingness or support, regulatory framework, and bureaucracy) and two were in the actors' dimension (engagement of stakeholders, capacity of stakeholders). This study highlights that the content and manner of implementation (process) of a reform are crucial. Stakeholder involvement and their capacities could influence every dimension of the reform cycle. The nine countries analyzed share similarities in barriers and facilitators, suggesting the potential for cross-country learning.

Implementation and Efficacy of a Large-Scale Radiation Oncology Case-Based Peer-Review Quality Program across a Multinational Cancer Network

PurposeWith expansion of academic cancer center networks across geographically-dispersed sites, ensuring high-quality delivery of care across all network affiliates is essential. We report on the characteristics and efficacy of a radiation oncology peer-review quality assurance (QA) system implemented across a large-scale multinational cancer network. Methods and MaterialsSince 2014, weekly case-based peer-review QA meetings have been standard for network radiation oncologists with radiation oncology faculty at a major academic center. This radiotherapy (RT) QA program involves pre-treatment peer-review of cases by disease site, with disease-site subspecialized main campus faculty members. This virtual QA platform involves direct review of the proposed RT plan as well as supporting data including relevant pathology and imaging studies for each patient. Network RT plans were scored as being concordant or nonconcordant based on national guidelines, institutional recommendations, and/or expert judgment when considering individual patient-specific factors for a given case. Data from January 1, 2014 through December 31, 2019 were aggregated for analysis. ResultsBetween 2014 and 2019, across 8 network centers, a total of 16,601 RT plans underwent peer-review. The network-based peer-review case volume increased over the study period, from 958 cases in 2014 to 4,487 in 2019. A combined global nonconcordance rate of 4.5% was noted, with the highest nonconcordance rates among head-and-neck cases (11.0%). For centers that joined the network during the study period, we observed a significant decrease in the nonconcordance rate over time (3.1% average annual decrease in nonconcordance, p=0.01); among centers that joined the network prior to the study period, nonconcordance rates remained stable over time. ConclusionsThrough a standardized QA platform, network-based multinational peer-review of RT plans can be achieved. Improved concordance rates among newly-added network affiliates over time are noted, suggesting a positive impact of network membership on the quality of delivered cancer care.

The challenge of doing good: promotion of recycling in Almaty through civic community initiatives

Recycling is one of the key components in reduction of carbon emissions and improving environmental conditions, especially in the urban context. In Central Asia, the legislation and infrastructure necessary for waste management is still under development. Thus, the knowledge gap and public awareness campaigns are mostly done at the grassroots level. This paper looks at the case of recycling promotion through civic community initiatives that also have a charitable component in Almaty. It explores the ethical considerations that are being entangled with the introduction of recycling culture in the city and is grounded in the literature on civil society, environmental ethics and social entrepreneurship. The data was collected through semi-structured interviews with organizers of recycling fairs and NGOs working on recycling. The paper reveals that by appealing to the ethical considerations of people to “do good” and contribute to charitable cause, the organizers of the recycling fair also demonstrate the effects of over-consumerism, ways of doing waste management, and educate about reuse and upcycle culture. The single case of Darmarka in Almaty present a limitation of the study. Therefore, a more in-depth research on the organisation of Darmarka events in other cities in Kazakhstan and CIS, as well as on similar initiatives in other Central Asian countries would be beneficial in the future. This is an important contribution in understanding what challenges and opportunities exist in promotion of recycling in Central Asia, that can be useful to national governments, experts, and international organizations working in this area.

Health Experts’ Perspectives on Barriers, Facilitators, and Needs for Improvement of Hospital Care in the Dying Phase

Introduction. Globally, hospitals are an important place in end‐of‐life care and most frequent place of death in Germany (47%), but at the same time, the least preferred one—both for patients and their informal caregivers. As hospital care in the dying phase on non‐palliative care wards has rarely been studied systematically, we assessed the current state of care in the dying phase in hospitals as a first step. Methods. In an online survey, N = 165 national health experts were invited to answer eight open questions on care aspects, facilitators, barriers, and needs for improvement as well as COVID‐19 pandemic specifics regarding hospital care in the dying phase. Sociodemographic data were analysed descriptively, and responses were analysed using qualitative thematic analysis. Results. Of n = 65 experts, 52% work as nursing staff and 30% as physicians. We identified facilitators, barriers, and needs for improvement regarding 11 topics on the following three levels: institutional level (general institutional conditions, hospital culture, and integration of specialist palliative care), team level (attitude towards and dealing with death and dying, competencies, communication, and teamwork) and care level (dying phase, symptom control, patient centredness, and involvement of informal caregivers). Conclusion. Improving care in the dying phase has to overcome barriers on various levels. We assume that rather “small” measures will find their way into clinical routine and contribute to the improvement of hospital care in the dying phase.

Consensus on the preoperative management of patients with chronic moderate to severe shoulder pain to improve postoperative outcomes: Delphi results

BackgroundAn appropriate preoperative management of patients with chronic moderate to severe shoulder pain who are candidates for surgery due to rotator cuff disease or glenohumeral osteoarthritis may improve surgery and patient outcomes, but published evidence in this regard is scarce. Therefore, the availability of recommendations on preoperative interventions based on expert consensus may serve as guidance. MethodsA Delphi study was conducted to develop a preoperative management algorithm based on a national expert consensus. A Delphi questionnaire was developed by a Scientific Committee following a systematic review using PRISMA criteria of the relevant literature published during the last 10 years. It consisted of 48 statements divided into five blocks (I. Assessment/diagnosis of preoperative pain; II. Preoperative function/psychosocial aspects; III. Therapeutic objectives; IV. Treatment; V. Follow-up/referral), and 28 experienced shoulder surgeons from across the country were invited to answer. ResultsAll participants responded to the Delphi questionnaire in the first round and 25 in the second round (89.3% of those invited). Overall, 46/49 final statements reached a consensus, based on which a final preoperative management algorithm was defined by the Scientific Committee. First, surgeons should assess shoulder pain intensity and characteristics, shoulder functionality and psychosocial aspects using specific validated questionnaires. Preoperative therapeutic objectives should include shoulder pain control, depression/nocturnal sleep improvement, opioid consumption adjustment and substance abuse cessation. Postoperative objectives regarding the degree of shoulder pain reduction or improvement in functionality/quality of life should be established in agreement with the patient. Treatment of preoperative chronic moderate to severe shoulder pain should comprise non-pharmacological as well as pharmacological interventions. Follow-up of shoulder pain levels, treatment adherence and mental health status of these patients may be carried out by the surgical team (surgeon and anesthesiologist) together with the Primary Care team. Patients with very intense shoulder pain levels may be referred to the Pain Unit, following specific protocols. ConclusionA preoperative management algorithm for patients with chronic moderate to severe shoulder pain who are candidates for surgery due to rotator cuff disease or glenohumeral osteoarthritis was defined based on a national expert consensus. Main points include a comprehensive patient management starting with an objective assessment of shoulder pain and function, quality of life, establishment of preoperative and postoperative therapeutic targets, prescription of individualized therapeutic interventions and multidisciplinary patient follow-up. Implementation of these recommendations to clinical practice may result in better preoperative shoulder pain management and more successful surgery outcomes and patient satisfaction.

Helping Educational Leaders Mobilize Evidence (HELM): The iterative redesign of the Leadership and Organizational Change for Implementation (LOCI) intervention for use in schools.

Few "intervention agnostic" strategies have been developed that can be applied to the broad array of evidence-based practices (EBPs) in schools. This paper describes two studies that reflect the initial iterative redesign phases of an effective leadership-focused implementation strategy-Leadership and Organizational Change for Implementation (LOCI)-to ensure its acceptability, feasibility, contextual appropriateness, and usability when used in elementary schools. Our redesigned strategy-Helping Educational Leaders Mobilize Evidence (HELM)-is designed to improve principals' use of strategic implementation leadership to support the adoption and high-fidelity delivery of a universal EBP to improve student outcomes. In Study 1, focus groups were conducted (n = 6) with 54 district administrators, principals, and teachers. Stakeholders provided input on the appropriateness of original LOCI components to maximize relevance and utility in schools. Transcripts were coded using conventional content analysis. Key themes referencing low appropriateness were summarized to inform LOCI adaptations. We then held a National Expert Summit (Study 2) with 15 research and practice experts. Participants provided feedback via a nominal group process (NGP; n = 6 groups) and hackathon (n = 4 groups). The research team rated each NGP suggestion for how actionable, impactful/effective, and feasible it was. We also coded hackathon notes for novel ideas or alignment with LOCI components. Study 1 suggestions included modifications to LOCI content and delivery. Study 2's NGP results revealed most recommendations to be actionable, impactful/effective, and feasible. Hackathon results surfaced two novel ideas (distributed leadership teams and leaders' knowledge to support educators EBP use) and several areas of alignment with LOCI components. Use of these iterative methods informed the redesign of LOCI and the development of HELM. Because it was collaboratively constructed, HELM has the potential to be an effective implementation strategy to support the use of universal EBP in schools.

Development of psycho-oncology telehealth guidelines: a modified Delphi consensus study

Abstract Objective: In response to COVID-19, psycho-oncology clinicians moved to a model of telephone and videoconference treatment in Australia. The Psycho-oncology Co-operative Research Group (PoCoG) identified a paucity of evidence available to guide adaptation of therapy for remote delivery. This research aimed to develop consensus for evidence-based guidelines on ways to adapt psychological therapies in psycho-oncology for remote delivery. Methods: A national expert advisory group (N = 11) was convened consisting of psycho-oncology clinicians and clinical researchers. An iterative codesign methodology was used to draft psycho-oncology telehealth guidelines. Australian psycho-oncology clinicians participated in a Delphi consensus process to guide the content included in the guidelines. Content was presented under six domains: (i) screening and outcome measures, (ii) formulation, (iii) safety considerations, (iv) resource adaptation, (v) adaptations to therapy, and (vi) example case studies. Participants rated items based on importance, therapeutic appropriateness, and/or usefulness. Consensus was defined as &gt;80% agreement. Results: Thirty-two psycho-oncology clinicians with telehealth experience participated in three Delphi rounds. Agreement was reached on (i) the importance of including screening and outcome measures (90%) and items (n = 5) related to how best to facilitate this; (ii) the importance of addressing provision of a formulation (100%), although only 2/6 strategies presented to facilitate formulation reached consensus; (iii) the appropriateness of proposed risk assessment and management strategies (84%); (iv) therapeutic appropriateness of simplifying resources (100%), including 3/5 visual optimization strategies; and (v) common behavioral components of therapy (n=5). Conclusions: Providing guidance to psycho-oncology clinicians for integrating telehealth into routine clinical practice must go beyond logistical considerations. These consensus-based guidelines provide support to clinicians for adaptation of psycho-oncology therapy to telehealth and will ensure evidence-based practice.

Team Around the Patient: multi-professional opportunities to support care delivery in hospitals.

Background: Demands on healthcare are outstripping the resources available. Many organisations are struggling to recruit sufficient registered nursing staff to maintain service delivery and are re-evaluating how safe, high quality, sustainable care could be provided. The concept “Team Around the Patient” being piloted in Hywel Dda University Health Board seeks to understand who can provide what care outside of traditional workforce models. The objective of this study is to examine perceptions of key health board stakeholders of the Team Around the Patient model of care and establish research priorities, and to design and test a workforce analysis model to test the implementation of Team Around the Patient. The model will be designed for use in adult, acute inpatient hospital wards.&#x0D; Methods: Before implementing the Team Around the Patient on select adult surgical and medical wards semi structured interviews were undertaken with key health board stakeholders to gather their understandings and perspectives on the concept, and create a working definition. A purposive approach was taken to engage a range of professional opinions including corporate and operational nursing, patient experience, allied health professionals, workforce and operational development. Interview topics included opportunities, quality indicators, barriers and enablers and organisational impacts. Ethical approval was provided by Swansea University and through The Integrated Research Application System (IRAS). Interviews were recorded, transcribed and thematically analysed. &#x0D; Results: In total 15 participants were interviewed. High level findings show support for the concept, with many participants identifying the potential new roles to be included. Key quality indicators such as inpatient falls, medication errors, pressure damage, length of stay, complaints and staff experience were identified as being important measures for this concept. Challenges associated with introducing new roles were mainly associated with workforce culture, delegation and finance. &#x0D; Conclusion: The results indicate overall support for “Team around the Patient” as a model of care which will help to alleviate issues surrounding skill shortages, while introducing more collaborative, inter-professional working. Further research is underway to gain wider perspectives of the concept from national and international experts in the fields of health care, academia and policy makers. The next stage of the research will include observational studies of health care delivery in practice to test the model of workforce analysis. The aim will be to identify opportunities for non-nursing staff groups to support care delivery where a gap in practice, or inefficiencies in the timely delivery of care, has been identified.

Consensus Building Method as a participatory tool of health decision making to counteract medical desertification in Europe.

Medical deserts can be described as isolated or depopulated areas with significant falling numbers of medical practitioners and overall health workforce shortages. The project ‘Action for Health and Equity: Addressing medical Deserts’ (AHEAD) aims to reduce health inequalities by addressing the phenomenon of medical desertification in European context. AHEAD is a consortium of partners from civil society organizations and academic institutions from five countries: Italy, Moldova, the Netherlands, Romania and Serbia. A single stakeholder cannot solve the problem of medical desertification and thus it requires a complex participatory decision making process involving a wide range of stakeholders. AHEAD developed and applied a participatory decision making methodology called consensus building, to address this challenge.&#x0D; We deployed the methodology with the aim of obtaining a general agreement among stakeholders on policy options to counteract and prevent medical deserts in local communities. Our definition of consensus does not necessarily mean that all stakeholders have to agree with each other in every aspect. We created a democratic space where stakeholders could agree to disagree and focus on coming to a consensus on policy options that are contextually relevant and feasible to implement. This methodology is rooted in the idea of equality, quality, legitimacy and acceptability where the policy options are co-created, locally relevant, have increased trust, confidence and are thus more likely to be accepted and implemented.&#x0D; Our consensus building methodology is deployed in three phases in all countries. First, we undertook the activities with homogenous stakeholders from three groups: community members, patient organizations, health providers, health worker organizations, health insurers and local decision makers. The homogenous sessions identify policy options and select representatives for multi-stakeholder sessions to come to consensus on most pressing and feasible policy options, in the second phase. Finally, the representatives of the multistakeholder session meet national level policy makers and experts to come to consensus on most important or appropriate policy options. These sessions are structured in a way to clarify issues, opening out the discussion by exploring stakeholders’ lived experiences, exploring ideas to counteract medical desertification and coming together to find common ground.&#x0D; The deployment of this methodology as a participatory decision making process helped us democratise and make the process more effective for policy making, by the involvement of a wide range of stakeholders. This methodology acted as an intervention in empowering the vulnerable groups who otherwise do not have a voice in the process. It also proved to be a win-win process for both the affected community and the policy makers. The community members get an opportunity to share their concerns and suggest the most feasible and effective policy options to counteract medical desert in their locality. Consequentially, the policy makers get valuable inputs from a wide range of stakeholders including people with lived experiences. The policy options generated through our consensus building methodology will be used to initiate a national policy dialogue in all five countries to bring policy change to counteract medical desert.