Ongoing Data Monitoring Research Articles

Improve Advance Care Planning: A Brief Report Discussing Goals of Care Interventions to Improve Communication Among Health Care Teams and Patients Maximizing the Use of the Electronic Health Record Tools.

Introduction: A key element of advance care planning (ACP) is the goals of care (GOC) conversation between the provider and the patient. The value of meaningful GOC conversations for the patient, provider, and health care institution is well documented. However, if the GOC documentation is buried in the medical record, not well defined, or poorly documented, that value is squandered. The Improvement Process: Interventions were implemented with oncology physicians and nurse practitioners (NPs). These included education, system reform including improving the ease and consistency of documentation of ACP, and regular feedback. Results: Participants reported increased confidence in communication skills about GOC conversations postworkshops. Data results for the tracked metrics, health care power of attorney, code status, and GOC, all showed improvement. Conclusion: Physicians and NPs recognized the importance of GOC conversations as part of ACP. Considerable progress was made by focusing on GOC conversations, maximizing information technology, participating in coaching, and ongoing data monitoring.

Environmental effects from petroleum product transportation spillage in Nigeria: a critical review.

Nigeria has struggled to meet sustainable development goals (SDGs) on environmental sustainability, transportation, and petroleum product distribution for decades, endangering human and ecological health. Petroleum product spills contaminate soil, water, and air, harming humans, aquatic life, and biodiversity. The oil and gas industry contributes to environmental sustainability and scientific and technological advancement through its supply chain activities in the transport and logistics sectors. This paper reviewed the effects of petroleum product transportation at three accident hotspots on Nigeria highway, where traffic and accident records are alarming due to the road axis connecting the southern and northern regions of the country. The preliminary data was statistically analysed to optimise the review process and reduce risk factors through ongoing data monitoring. Studies on Nigeria's petroleum product transportation spills and environmental impacts between the years 2013 and 2023 were critically analysed to generate updated information. The searches include Scopus, PubMed, and Google Scholar. Five hundred and forty peer-reviewed studies were analysed, and recommendations were established through the conclusions. The findings show that petroleum product transport causes heavy metal deposition in the environment as heavy metals damage aquatic life and build up in the food chain, posing a health risk to humans. The study revealed that petroleum product spills have far-reaching environmental repercussions and, therefore, recommended that petroleum product spills must be mitigated immediately. Furthermore, the study revealed that better spill response and stricter legislation are needed to reduce spills, while remediation is necessary to lessen the effects of spills on environmental and human health.

Prior COVID-19 and Venous Thromboembolism Risk in Total Joint Arthroplasty in Patients Over 65 Years of Age

BackgroundThe COVID-19 pandemic has been associated with increased risks of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). However, there is limited literature investigating prothrombotic states and complications after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We investigated (1) trends in VTE, PE, and DVT rates post-THA and TKA from 2016 to 2019 compared to 2020 to 2021 and (2) associations between prior COVID-19 diagnosis and VTE, PE, and DVT. MethodsA national dataset was queried for elective THA and TKA cases from 2016 to 2021. We first assessed trends in 90-day VTE prevalence between 2016 to 2019 and 2020 to 2021. Second, we investigated associations between previous COVID-19 and 90-day VTE with regression models. ResultsFrom 2016 to 2021, a total of 2,422,051 cases had an annual decreasing VTE prevalence from 2.2 to 1.9% (THA) and 2.5 to 2.2% (TKA). This was evident for both PE and DVT (all trend tests P < .001). After adjusting for covariates (including vaccination status), prior COVID-19 was associated with significantly increased odds of developing VTE in TKA patients (odds ratio 1.2, 95% confidence interval 1.1 to 1.4, P = .007), but not DVT or PE (P > .05). There were no significant associations between prior COVID-19 and VTE, DVT, or PE after THA (P > .05). ConclusionsOur study suggests that a previous diagnosis of COVID-19 is associated with increased odds of VTE, but not DVT or PE, in TKA patients. Ongoing data monitoring is needed given our effect estimates, emerging COVID-19 variants, and evolving vaccination rates.

Design, Development, and Deployment of a Web-Based Registry for Cardiovascular Intensive Care Unit (CVICU)

Introduction: The cardiovascular intensive care unit (CVICU) registry provides physicians with tools for monitoring, managing, and following up on patients. The CVICU registry provides researchers with the ability to analyze and evaluate integrated data patients. Our goal with this study is to explain the design, development, and deployment of a comprehensive, integrated, qualified cardiovascular intensive care unit registry, as well as to characterize individuals admitted to CVICUs.Material and Methods: From June 2012, a cohort study of ICU admissions for adults (≥18 years) in a teaching hospital’s CVICU began. The study includes retrospective collection of existing data from paper records and hospital information systems (HIS) and ongoing prospective collection using the proposed CVICU registry portal.Results: Between June 2013 and June 2022, 2587 admissions were included, among which 1041 (40.2%) were women, 1546 (59.8%) were man, and the median age was 58 ranging from 18 to 93 years and their mean (SD) age was 56.8 (13) years. About 11.1% of the patients died in the CVICU. The primary indications for CVICU care included mechanical ventilation (29.7%), weaning time (??%), readmission (4.9%), cardiovascular (17.4%), myocardial infarction (1.7%), diabetes (9.3%), hypertension (14.3%). Of these, about 73% had coronary artery bypass grafting (CABG), 15% valve surgery and the remains has other cardiovascular surgeries. About 39% experienced an on-pump surgery. In addition, patients had 6.4 hours weaning time after operation. The overall CVICU length of stay (LOS) rate was 3.6 days and mean predicted by APACHE IV, APACHE II, SOFA, and SAPS II were 5.67, 3.03, 4, and 4 days, respectively.Conclusion: The use of registries equipped physicians and researchers with an integrated data pool to manage and evaluate information. Appropriate patient registries allow effective decision-making for appropriate interventions, resource allocation, and ongoing data monitoring and analysis. Ultimately, this leads to the optimal outcomes for patients. This registry aims to generate valuable knowledge about cardiovascular ICU patients in Iran and to collect accurate and qualified data.

The outcome and challenges of application of pressure ulcer prevention project in king Fahad Hospital Jeddah – 2023

Background: A pressure ulcer (PU), also known as bedsore, pressure injury, or decubitus ulcer, is a localized injury brought on by sustained pressure applied to the skin and underlying soft tissue over an extended length of time. &#x0D; Aim: This study aimed to identify the outcome and challenges of the application of pressure ulcer prevention project.&#x0D; Methodology: This is a retrospective hospital-based study, which monitored the pressure ulcer prevention project's (PUPP) results from 2019 to 2021 for 3 years. Data on 21400 patients were gathered from several departments of a hospital in the northern region of Saudi Arabia. The project's main goals were the installation of a wound care team, hospital staff education, ongoing data monitoring, and follow-up visits for inpatient units.&#x0D; Results: This current study showed that the pressure ulcer prevention project was successful showing a statistically significant reduction of hospital-acquired pressure ulcers (HAPUs) from 1.97% in 2018 to 1.4% in 2019 to 0.53% in 2020 to 0.14% in 2021. &#x0D; Conclusion: The research concluded the percentage of cases of pressure ulcers was successfully decreased by the PUPP. The project can be expanded and carried out in additional hospitals.

The Outcome and Challenges of Application of Pressure Ulcer Prevention Project in King Fahad Hospital Jeddah – 2023

BACKGROUND: A pressure ulcer (PU), also known as bedsore, pressure injury, or decubitus ulcer, is a localized injury brought on by sustained pressure applied to the skin and underlying soft tissue over an extended length of time. This study aimed to identify the outcome and challenges of the application of pressure ulcer prevention project focus to clarify the findings of the application of the project, to highlight the challenges met by the team who apply the project, to know the prevalence state during the application period, and to identify the adherence of nurses to their role. Through Improved nursing education, improve adherence to a policy of pressure ulcer prevention, being sure all equipment is in adequate working condition, Monitoring high-risk patients.&#x0D; &#x0D; METHODOLOGY: This is a retrospective hospital-based study, which monitored the pressure ulcer prevention project&amp;rsquo;s (PUPP) results from 2019 to 2021 for 3 years. Data on 21400 patients were gathered from several departments of a hospital in the west region of Saudi Arabia. The project&amp;rsquo;s main goals were the installation of a wound care team, hospital staff education, ongoing data monitoring, and follow-up visits for inpatient units.&#x0D; &#x0D; RESULTS: This current study showed that the pressure ulcer prevention project was successful showing a statistically significant reduction of hospital-acquired pressure ulcers (HAPUs) from 1.97% in 2018 to 1.4% in 2019 to 0.53% in 2020 to 0.14% in 2021. &#x0D; &#x0D; CONCLUSION: The research concluded the percentage of cases of pressure ulcers was successfully decreased by the PUPP. The project can be expanded and carried out in additional hospitals.

Comments on Experience With Establishing a Robotic Donor Hepatectomy Program for Pediatric Liver Transplantation.

Comments on Experience With Establishing a Robotic Donor Hepatectomy Program for Pediatric Liver Transplantation.

The association between ethnicity, socioeconomic deprivation and receipt of hospital-based palliative care for people with Covid-19: A dual centre service evaluation

Background: People from ethnic minority groups and deprived socioeconomic backgrounds have worse outcomes from COVID-19. Aim: To examine associations between ethnicity and deprivation with timing of palliative care referral for inpatients with COVID-19. Design: Service evaluation of consecutive patients with COVID-19 referred to palliative care. Sociodemographic (including age, sex, Index of Multiple Deprivation, ethnicity coded as White/non-White) and clinical variables were described. The primary outcome was timing of referral to palliative care. Associations between ethnicity and socioeconomic deprivation with the primary outcome were explored using multivariable regression. Setting/participants: Patients with COVID-19 referred to a hospital palliative care service across two London hospitals February–May 2020. Results: A total of 334 patients were included. 119 (36%) were from a non-White ethnic group; most commonly Black British (77, 23%) and Asian British (26, 8%). A longer time between admission and palliative care referral was associated with male gender (IRR 1.23, 95% CI 1.14–1.34) and lower levels of socioeconomic deprivation (IRR 1.61, 95% CI 1.36–1.90) but not ethnicity (IRR = 0.96, 95% CI 0.87–1.06). Conclusions: This large service evaluation showed no evidence that patients from ethnic minority or more deprived socioeconomic groups had longer time to palliative care referral. Ongoing data monitoring is essential for equitable service delivery.

Managing hypertension in rural Uganda: Realities and strategies 10 years of experience at a district hospital chronic disease clinic.

The literature on the global burden of noncommunicable diseases (NCDs) contrasts a spiraling epidemic centered in low-income countries with low levels of awareness, risk factor control, infrastructure, personnel and funding. There are few data-based reports of broad and interconnected strategies to address these challenges where they hit hardest. Kisoro district in Southwest Uganda is rural, remote, over-populated and poor, the majority of its population working as subsistence farmers. This paper describes the 10-year experience of a tri-partite collaboration between Kisoro District Hospital, a New York teaching hospital, and a US-based NGO delivering hypertension services to the district. Using data from patient and pharmacy registers and a random sample of charts reviewed manually, we describe both common and often-overlooked barriers to quality care (clinic overcrowding, drug stockouts, provider shortages, visit non-adherence, and uninformative medical records) and strategies adopted to address these barriers (locally-adapted treatment guidelines, patient-clinic-pharmacy cost sharing, appointment systems, workforce development, patient-provider continuity initiatives, and ongoing data monitoring). We find that: 1) although following CVD risk-based treatment guidelines could safely allocate scarce medications to the highest-risk patients first, national guidelines emphasizing treatment at blood pressures over 140/90 mmHg ignore the reality of “stockouts” and conflict with this goal; 2) often-overlooked barriers to quality care such as poor quality medical records, clinic disorganization and local employment practices are surmountable; 3) cost-sharing initiatives partially fill the gap during stockouts of government supplied medications, but still may be insufficient for the poorest patients; 4) frequent prolonged lapses in care may be the norm for most known hypertensives in rural SSA, and 5) ongoing data monitoring can identify local barriers to quality care and provide the impetus to ameliorate them. We anticipate that our 10-year experience adapting to the complex challenges of hypertension management and a granular description of the solutions we devised will be of benefit to others managing chronic disease in similar rural African communities.

Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations.

Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations.

Challenges in Implementing Hospice Clinical Trials: Preserving Scientific Integrity While Facing Change

Background/AimsNumerous changes can occur between the original design plans for clinical trials, the submission of funding proposals, and the implementation of the clinical trial. In the hospice setting, environmental changes can present significant obstacles, which require changes to the original plan designs, recruitment, and staffing. The purpose of the study was to share lessons and problem-solving strategies that can assist in future hospice trials. MethodsThis study uses one hospice clinical trial as an exemplar to demonstrate challenges for clinical trial research in this setting. Using preliminary data collected during the first months of a trial, the research team details the many ways their current protocol reflects changes from the originally proposed plans. Experiences are used as an exemplar to address the following questions: 1) How do research environments change between the initial submission of a funding proposal and the eventual award? 2) How can investigators maintain the integrity of the research and accommodate unexpected changes in the research environment? ResultsThe changing environment within the hospice setting required design, sampling, and recruitment changes within the first year. The decision-making process resulted in a stronger design with greater generalization. As a result of necessary protocol changes, the study results are positioned to be translational following the study conclusion. ConclusionResearchers would do well to review their protocol and statistics early in a clinical trial. They should be prepared for adjustments to accommodate market and environmental changes outside their control. Ongoing data monitoring, specifically related to recruitment, is advised.

Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study

Objective To quantify the change in prescribing of antibiotic prophylaxis before invasive dental procedures for patients at risk of infective endocarditis, and any concurrent change in the incidence of infective...

Information management.

The desire and requirements for information across the continuum of the enterprise are evident, because outcome measures, quality report cards, and financial pressures effect health care contracting. The real or perceived obstacles to having a comprehensive information management solution (the price tag, the compatibility of hardware and software, multiple locations, ownership of the information, and confidentiality) are so daunting that many are loathe to press ahead. The introduction of modern information technology into the AEC requires a systematic stepwise approach working with trusted partners and stable standards. Intelligent investment in these systems results in a more efficient and effective operating environment based on ongoing data monitoring.