Changes In Practice Research Articles

Change from semi-rigid to soft collars for prehospital management of trauma patients: An observational study.

Protection of the cervical spine is recommended following multisystem injury. In 2021, Ambulance Victoria changed clinical practice guidelines to apply soft collars instead of semi-rigid collars for suspected cervical spine injury. The aim of this study was to describe associated changes in imaging practices and diagnoses of pressure sores, hospital acquired pneumonia, and spinal cord injury. A retrospective pre- and postintervention study was conducted including all consecutive patients that presented to an adult major trauma center in Melbourne, Australia with a cervical collar placed by emergency medical services over two 3-month periods. There were 1762 patients included. A computed tomography (CT) of the cervical spine was performed in 795 (88.4%) patients in the semi-rigid collar period and 810 (93.8%) in the soft collar period (p=0.001). Soft collars were associated with higher rates of clearance of the cervical spine in the emergency department (ED) (odds ratio [OR] 4.14; 95% confidence interval [CI]: 3.36-5.09). There were no differences in diagnosis of pressure sores (0.11%vs. 0.23%, p=0.97) or hospital acquired pneumonia (2.0%vs. 2.7%; p=0.44) or cervical spinal cord injury (0.45%vs. 0.81%; p=0.50). Following a change from prehospital semi-rigid collars to soft collars, more patients were investigated with a CT scan and more frequent clearance of the cervical spine occurred in the ED. There were no differences in the rates of spinal cord injuries, pressure sores or hospital acquired pneumonia, but the study was underpowered to detect significant differences. The practice of soft collars for prehospital care of patients with suspected neck injury requires ongoing surveillance.

Negotiating between the accountability and the innovation mandates: evidence from Italian schools

ABSTRACT In Italy, the National Evaluation System (SNV), encompassing both internal and external accountability components, is designed not only to hold school actors accountable but also to stimulate innovation and change in pedagogical practices. Nevertheless, existing literature presents inconclusive and contradictory findings regarding the effects and the relationship between school performance-based accountability (PBA) and educational innovation. Utilizing sensemaking and filtering theories, this paper analyses the negotiation of PBA and innovation mandates in Italian schools, emphasizing how school actors interpret, filter, and adapt the policy expectations to their organizational and educational practices. Special attention is given to the influence of local school contexts and performative pressures on this process. The primary data collection method involves interviews with school leadership teams and teachers analysed through an ideal type case analysis. Findings reveal diverse school responses to the double mandates of PBA and innovation. Varied logics of school enactment within the contemporary policy context are identified, influenced by teacher attitudes towards PBA and schools’ socio-economic conditions. Innovation is evident in both advantaged and disadvantaged school contexts, albeit with distinct applications and interpretations. Overall, the adaptation of PBA prerogatives in schools to foster innovation and change is neither uniform nor direct, although external pressures impact educational practices across contexts. Beyond socio-economic factors and administrative and marketing accountability pressures, additional intervening elements include school leadership and staff cohesion as well as school infrastructure and material resources.

Occurrence and identification of lungworms in Iranian wild boars

This study represents the first investigation into the occurrence and identification of Metastrongylus spp. in wild boars (Sus scrofa) in Iran, utilizing both molecular and morphological methods. Thirteen wild boars from Kerman Province were examined, with 92.3% found to be infected with at least one species of Metastrongylus. Mixed infections were observed in 38.46% of the animals. Morphological and molecular analyses confirmed the presence of M. pudendotectus and M. salmi, with prevalence rates of 76.9% and 53.9%, respectively. Histopathological examination revealed transverse and longitudinal sections of Metastrongylus parasites within the airways, causing partial to complete obstruction, interstitial pneumonia, and inflammatory responses. The study also highlights the public health significance of these parasites. The higher prevalence observed compared to earlier studies suggests changes in environmental conditions, host dynamics, or agricultural practices as possible factors, warranting further investigation. The findings underscore the need for comprehensive surveillance and control measures to mitigate the risk of zoonotic transmission, particularly in regions with significant wild and domestic swine populations. This study contributes to the understanding of Metastrongylus spp. distribution and their pathological impact, emphasizing the ecological importance of wild boars and the necessity for continued monitoring and research to prevent and control infections in both animal and human populations.

Strengthening open disclosure in maternity services in the English NHS: the DISCERN realist evaluation study.

There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved. To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for service improvement. A three-phased, qualitative study using realist methodology. Phase 1: two literature reviews: scoping review of post-2013 NHS policy and realist synthesis of initial programme theories for improvement; an interview study with national stakeholders in NHS maternity safety and families. Phase 2: in-depth ethnographic case studies within three NHS maternity services in England. Phase 3: interpretive forums with study participants. A patient and public involvement strategy underpinned all study phases. National recruitment (study phases 1 and 3); three English maternity services (study phase 2). We completed n = 142 interviews, including 27 with families; 93 hours of ethnographic observations, including 52 service and family meetings over 9 months; and interpretive forums with approximately 69 people, including 11 families. The policy review identified a shift from viewing injured families as passive recipients to active contributors of post-incident learning, but a lack of actionable guidance for improving family involvement. The realist synthesis found weak evidence of the effectiveness of open disclosure interventions in the international maternity literature, but some improvements with organisation-wide interventions. Recent evidence was predominantly from the United Kingdom. The research identified and explored five key mechanisms for open disclosure: meaningful acknowledgement of harm; involvement of those affected in reviews/investigations; support for families' own sense-making; psychological safely of skilled clinicians (doctors and midwives); and knowing that improvements to care have happened. The need for each family to make sense of the incident in their own terms is noted. The selective initiatives of some clinicians to be more open with some families is identified. The challenges of an adversarial medicolegal landscape and limited support for meeting incentivised targets is evidenced. Research was conducted after the pandemic, with exceptional pressure on services. Case-study ethnography was of three higher performing services: generalisation from case-study findings is limited. No observations of Health Safety Investigation Branch investigations were possible without researcher access. Family recruitment did not reflect population diversity with limited representation of non-white families, families with disabilities and other socially marginalised groups and disadvantaged groups. We identify the need for service-wide systems to ensure that injured families are positioned at the centre of post-incident events, ensure appropriate training and post-incident care of clinicians, and foster ongoing engagement with families beyond the individual efforts made by some clinicians for some families. The need for legislative revisions to promote openness with families across NHS organisations, and wider changes in organisational family engagement practices, is indicated. Examination of how far the study's findings apply to different English maternity services, and a wider rethinking of how family diversity can be encouraged in maternity services research. This study is registered as PROSPERO CRD42020164061. The study has been assessed following RAMESES realist guidelines. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information.

The EU Corporate Sustainability Due Diligence Directive: Real Change or More of the Same?

The implementation of mandatory corporate due diligence has been a growing trend in recent years. Viewed as having the potential to prevent corporate abuse, mandatory due diligence can be presented as the mechanism to substantially improve responsible corporate behaviour in practice. In 2022, the European Commission proposed a Corporate Sustainability Due Diligence Directive (CSDDD). The proposal presents obligations for companies regarding any actual or potential adverse human rights and environmental impacts, as well as liability for violation of such obligations. It aims to streamline due diligence obligations across Member States and create a level playing field. Since then, the Council of the EU and the European Parliament have agreed their negotiating positions. This paper explores the proposed CSDDD, including amendments, and analyses the challenges and prospects for mandatory due diligence. It explores whether the CSDDD could result in a genuine transformation of corporate practices to prevent corporate harms, or whether developments are similar to the incremental changes already seen over the years. It is argued that while the CSDDD could be another step in the right direction, significantly more needs to be done to prioritise rights holders above corporations and demonstrate a real change in responsible business practices.

Trends in Mental Disorders in Children and Adolescents Receiving Treatment in the State Mental Health System

To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States. Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client-Level Data 2013-2021 (total number of records= 13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic, and service strata focusing on community-based programs. The analyses revealed increases in the proportion of anxiety disorders from 9.6% in 2013 to 19.2% in 2021 (adjusted odds ratio [AOR] 2.17, 95% CI 1.85-2.55, p< .001), trauma- and stressor-related disorders from 22.7% to 27.4% (AOR 1.31, 95% CI 1.09-1.57, p= .004), and depressive disorders from 13.4% to 17.0% (AOR 1.20, 95% CI 1.03-1.41, p= .04). During this same period, the proportion of bipolar disorders declined almost 8-fold from 10.0% to 1.3% (AOR 0.07, 95% CI 0.06-0.09, p< .001). The proportion of conduct disorder and oppositional defiant disorder also declined from 9.7% to 4.4% (AOR 0.42, 95% CI 0.32-0.55, p< .001) and from 11.1% to 7.8% (AOR 0.79, 95% CI 0.65-0.98, p= .03), respectively. Trends varied across sex, age, and racial/ethnic strata. The composition of childhood psychiatric diagnoses in patients within publicly funded mental health treatment settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.

Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments

BackgroundRural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice. MethodsThis embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework. ResultsThe survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention. ConclusionBarriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.

Narrative review on the evolving role of HER2/neu targeting in uterine serous cancers.

Serous endometrial cancers (ECs) are an aggressive histotype of ECs which are disproportionately responsible for 40% of cancer-specific mortality rates despite constituting only 5-10% of all uterine cancers in incidence. In recent times, it has become increasingly evident that about 20-40% of uterine serous cancers (USCs) have molecular alterations in ERBB2 pathway with human epidermal growth factor receptor 2 (HER2/neu) amplification or overexpression. We summarise the evidence on genetic and molecular alterations in HER2/neu pathway in USC with a focus on testing criteria, targeting agents and resistance mechanisms. We conducted a database search of PubMed/Medline up to 28th February 2023 for articles published in the English language using pre-defined search terms. One hundred and seventy-one relevant articles were subsequently reviewed for eligibility and inclusion in the review. The Cancer Genome Atlas (TCGA) classification is a significant development in the molecular profiling of ECs with a positive impact on the treatment of these tumors including USCs. Testing criteria for HER2/neu in USC with immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) has evolved in more than a decade with progress made towards EC specific testing guidelines. The findings of a recent phase III study have led to the development of practice changing guidelines towards improving patient outcomes. Molecular aberration in the HER2/neu pathway contributes to the aggressive behaviour of USC. Considering the clinical benefit conferred by HER2/neu targeted therapy, HER2/neu testing is recommended for all cases of serous EC in advanced and recurrent settings. Trastuzumab in combination with platinum and taxanes based chemotherapy is the recommended treatment option for patients with advanced or recurrent serous cancers who test positive to HER2/neu. Clinical trials on targeted therapy are ongoing and future research should focus on selection of patients who will derive the most benefit from such therapy.

Preventing pediatric accidental decannulation events: A quality improvement initiative

ObjectiveTo describe a quality improvement (QI) method to decrease pediatric accidental decannulation (AD) in the early postoperative period for children under age 3. MethodsA retrospective chart review was conducted on children under age 3 who underwent tracheostomy at Duke University Health System from August 1, 2013 to May 1, 2023 (n = 104). A root cause analysis was used to assess factors associated with AD following pediatric tracheostomy. Based on the factors identified by the research team, retrospective data was collected before (8/1/13 - 1/31/22) and after (2/1/22 - 5/1/23) a single practice change was implemented: using twill neck ties, rather than foam neck ties, to secure newly-placed tracheostomy tubes. Twill ties were applied intraoperatively as a visual cue to signal a recent tracheostomy for the interdisciplinary care team. The primary outcome in the pre-intervention and post-intervention period was measured as 30-day incidence of AD per 10 tracheostomy cases. ResultsPrior to the intervention, a total of 11 ADs occurred in 9 patients across 93 pediatric tracheostomies (1.18 AD per 10 cases). Afterward, 0 ADs occurred across 11 pediatric tracheostomies (0 AD per 10 cases). ConclusionThis data suggests that the twill tie intervention may prevent AD and the associated morbidity. With the twill tie initiative, we describe 11 ADs and associated risk factors and present a QI intervention that may help prevent AD and improve patient safety in the early postoperative period.

Strategies to Reduce Alternate Level of Care

What Is the Issue? Alternate level of care (ALC) is when a patient is occupying a bed in a hospital and does not require the intensity of resources or services provided in that hospital. ALC is a persistent barrier to providing efficient health care in Canada, as it is in most health systems worldwide (where ALC is referred to as delayed discharge). Older adults (aged 65 years or older) who require placement in residential care are the largest subgroup of the ALC patient population. Analyzing ALC use data can inform decision-makers about data trends and which jurisdictions have reduced ALC times. By understanding the strategies, policies, or other interventions that have been used to reduce ALC in Canada, and which have been successful at minimizing ALC, decision-makers can consider which strategies to implement in their health jurisdictions. What Did We Do? We analyzed Canadian Institute for Health Information data related to ALC and average length of ALC in older adults in the provinces and territories of Canada. We conducted an environmental scan of the academic and grey literature to: identify strategies to address ALC in older adults in Canada identify strategies that have been effective in reducing ALC in older adults in Canada. What Did We Find? In 2022 to 2023, Canada (excluding Quebec) had 15 ALC hospitalizations per 1,000 population, 369 total ALC days per 1,000 population, and a mean of 25 ALC days per hospitalization in patients aged 65 and older awaiting admission to residential care or elsewhere. While there were variations across jurisdictions, the trends in ALC over time for adults aged 55 years and older were relatively consistent. Patients with more ALC days were aged 75 years and older, had lower incomes, and were admitted to the hospital as urgent. We identified 19 strategies that addressed ALC in older adults in Canada. These included input, throughput, and system-level interventions, which we categorized as live information sharing, recommended initiatives, tools and guidelines, practice changes, and infrastructure and finance. We identified 4 studies that reported a favourable effect of a throughput or system-level strategy compared to no strategy or standard care on ALC hospitalizations, length of stay, or discharge to home. Two throughput strategies may be effective: The Subacute Care for the Frail Elderly (SAFE) Unit improved ALC length of stay (LOS), hospital LOS, and discharge to home. The Transitional Care Unit improved discharge to home. Two system-level strategies may be effective: Home First improved ALC hospitalizations, ALC LOS, and discharge to home. Behavioural Supports Ontario improved ALC hospitalizations and ALC LOS. What Does This Mean? We found common themes in our environmental scan that decision-makers may incorporate into strategies for addressing ALC in older adults waiting for residential care, including the provision of integrated care, promotion of age-friendly care, early identification of patients at risk of ALC, sharing of tools and resources, transitional care, and inclusion of families and caregivers in care planning. This report may serve as the first step for future systematic reviews or other evidence syntheses with a broader scope. Future research might investigate the factors that contribute to ALC and interventions to address those factors.

Antimicrobial Photodynamic Therapy: Novel Concept for Foodborne Pathogens

Changes in agricultural practices, individual diversity, the considerable size of the global food trade, immigrant and tourist circulation, with microorganism transformations have led to the formation of microorganisms that are resistant to chemicals and implementations used, especially antibiotics. Antimicrobial photodynamic therapy (aPDT) is an approach based on the interaction of a natural/synthetic photosensitizer, a suitable light source, and molecular oxygen, and the cytotoxic effect of reactive oxygen species resulting from this interaction on the target microorganism. The benefits of this method, which has found its place in medical terms by treating oral biofilms, superficial lesions, and chronic sinusitis, are limited by problems of low cell/tissue penetration, poor selectivity, non-thermal effect, and off-target damage. Despite similar practical problems in food science, developing technology is expected to encourage new studies on pathogen inactivation in food matrices, reducing the microbial load to safe levels, extending shelf life, and preventing quality loss.

21st Century-Teacher Reinforcement Techniques and The Application of a Learner-Centered Approach in the Intermediate Grades

This study aimed to determine the relationship between reinforcement and learner-centered approach. Sixty-one intermediate-grade teachers (grades four, five, and six) from First City Providential College, Marangal Elementary School, and Benito Nieto Elementary School participated in the study. The tools used to measure reinforcement techniques and learner-centered approaches are the reinforcement techniques questionnaire and the effective role of applying a learner-centered approach questionnaire. Quantitative data were analyzed using Pearson’s r correlation if there was a statistically significant relationship between the two variables and simple regression analysis. The study revealed that there is a significant negative relationship between reinforcement and a learner-centered approach, as it implies that as one variable increases, the other tends to decrease, and vice versa. The result revealed that most teachers are using negative reinforcement, which does not entirely contribute to learner-centered teaching. The researcher designed a “Learner-Centered Educational Framework” that contributes through a systematic application of a learner-centered process that provides structure, guidance, and a common notion of key concepts and practices to be applied to various expertise in educational settings intended to be flexible to accommodate changes in educational practices, societal needs, and educational research.

Supporting Carers to Coregulate With Children in Care: Learnings From Action Research With Caseworkers

ABSTRACTTrauma negatively impacts on the ability of children in out‐of‐home care to experience safety in their relationships. Trauma rearousal can continue to occur even when children are living in a safe and stable setting due to environmental triggers. Carers who are emotionally regulated themselves can model and support emotional regulation (known as coregulation) when their child becomes dysregulated. To do this, carers need agencies to provide trauma‐informed and therapeutic models of care, so they in turn can offer an emotionally secure experience for their child. This article reports on participatory action research with caseworkers from two nongovernment and one government organisation who supported foster and kinship carers to coregulate with children in long‐term care. Reflective practice meetings were held over an eight‐month period to capture the perspectives and experiences of 16 caseworkers who trialled practice changes for coregulation. An inductive analysis approach was used to elicit themes. Findings revealed a three‐phase process took place for caseworkers and carers to (1) acknowledge the presence of trauma and stress, (2) become aware of their own emotional capacity and (3) apply coregulation strategies. This process was possible when organisations promoted trauma awareness and relational safety, thereby creating a ‘holding environment’ for their caseworkers and allowing coregulation to be experienced by carers and their children.

Reframing goals and strategies for delivering humanized obstetric care in Brazil

Introduction: Despite the long-lasting efforts to promote the quality of obstetric care, Brazil requires robust changes in the care practices throughout the prenatal-labour-postpartum continuum. The ongoing National Program for the Humanization of Prenatal and Childbirth (PHPN) efforts address the fight against obstetric violence (OV), the improvement in the quality of obstetric care, but its implementation has faced obstacles and difficulties, such as responding to cultural values and operating with a weak infrastructure. This research explored Brazilian health and social service professionals’ perceptions of the PHPN’s recommendations regarding innovation, policy and practice changes necessary to respect women’s human rights to receive a high quality, dignifying obstetric care. Methods: An online multi-site survey in which data were collected (Jun 2019-Mar 2020) from health professionals working in the public health system in Brazil. Data analysis used descriptive statistics and thematic analysis. Analytical themes were Perceptions of Program effectiveness to minimize obstetric violence and Program’s gaps, inadequacies and needed changes. Results: Respondents (n=369) disclosed their perceptions about the Program’s nature, utility, and gaps towards an improved implementation. Key issues were rooted in the outdated university education, reduced accountability, and governance in services’ management; unfavourable work conditions and climate; professional power-imbalance; population’s lack of information about the Program; underutilization of obstetric nurses’ and midwives’ skills; neglect of professional development; no denunciation &amp; re-education, and culture of quality improvement. Conclusions: Firmness, hope and determination will be needed to transform society’s culture of silence about OV, awakening the public awareness and mobilizing to enhance collective health and political literacy to ensure professional accountability while protecting women and newborns. There is a need for a realignment of work processes, an investment in professional education, and education within women’s social networks for women to become partners in the active process of improvement of quality of obstetric care.

Is the Medical Oncology Workforce in Canada in Jeopardy? Findings from the Canadian Association of Medical Oncologists' COVID-19 Impact Survey Series.

The COVID-19 (C19) pandemic introduced challenges in all areas of the Canadian healthcare system. Along with adaptations to clinical care environments, there was increasing concern about physician burnout during this time. The Canadian Association of Medical Oncologists (CAMO) has examined the effects of the pandemic on the medical oncology (MO) workforce. A series of four multiple choice web-based surveys distributed to MOs who were identified using the Royal College of Physicians and Surgeons directory and CAMO membership in May 2020 (S1), July 2020 (S2), December 2020 (S3), and March 2022 (S4). Descriptive analyses were performed for each survey, and a Chi-square test (α = 0.05) was used to assess factors associated with planned change in practice in S4. The majority of respondents work in a comprehensive cancer center S1/S2/S3/S4 (87%/86%81%/88%) and have been in practice >10 years (56%/61%/50%/64%). The most commonly reported personal challenges were physical (60%) and mental (60%) wellness. In S4, 47% of MOs reported dissatisfaction with their current work-life balance. In total, 83% reported that their workload has increased since the beginning of C19, and 51% of MOs reported their future career plans have been impacted by C19. In total, 56% of respondents are considering retiring or reducing total working hours in the next 5 years. Since the onset of the C19 pandemic, there are concerns identified with wellness, increasing workload, and job dissatisfaction among MOs, associated with experienced staff who have >10 years in practice. As rates of cancer prevalence rise and treatments become more complex, it is crucial to address the concerns raised in these surveys to ensure that we have a stable MO workforce in the future.

Temporal trends of exposure to the herbicide glyphosate in the United States (2013–2018): Data from the National Health and Nutrition Examination Survey

Glyphosate, the most widely used herbicide in the United States, is applied to control broadleaf weeds and grasses. Public concern is mounting over how pesticides affect human and environmental health. Glyphosate toxicity in animals is known, but human carcinogenicity is controversial, and limited epidemiologic evidence suggests associations between exposure and respiratory diseases (e.g., asthma) and adverse child neurodevelopment. Understanding the extent of the general U.S. population exposure to glyphosate is important. To examine temporal trends in exposure to glyphosate, we determined urinary concentrations of glyphosate among U.S. children and adults from three cycles of the National Health and Nutrition Examination Survey (NHANES) conducted 2013–2018. Most of the population (70.0%–81.7%, depending on cycle) was exposed, including children as young as 3 years of age. Concentrations decreased from 2013 to 2018 by 38%; the decline was smaller in younger age groups. The downward trend likely reflects changes in glyphosate use resulting, at least in part, from changes in agricultural practices, regulatory actions, and shifts in public awareness regarding glyphosate toxicity. Continuing glyphosate biomonitoring will help understand how changes in use and actions to restrict applications of this common pesticide affect human exposures.

What could improve surgical data system at health facilities with high surgical volume in Ethiopia?

BackgroundThe effective management of surgical and anesthesia care relies on quality data and its readily availability for both patient-centered decision-making and facility-level improvement efforts. Recognizing this critical need, the Strengthening Systems for Improved Surgical Outcomes (SSISO) project addressed surgical care data management and information use practices across 23 health facilities from October 2019 to September 2022. This study aimed to evaluate the effectiveness of SSISO interventions in enhancing practices related to surgical data capture, reporting, analysis, and visualization.MethodsThis study employed a mixed method, pre- post intervention evaluation design to assess changes in data management and utilization practices at intervention facilities. The intervention packages included capacity building trainings, monthly mentorship visits facilitated by a hub-and-spoke approach, provision of data capture tools, and reinforcement of performance review teams. Data collection occurred at baseline (February – April 2020) and endline (April – June 2022). The evaluation focused on the availability and appropriate use of data capture tools, as well as changes in performance review practices. Appropriate use of registers was defined as filling all the necessary data onto the registers, and this was verified by completeness of selected key data elements in the registers.ResultsThe proportion of health facilities with Operation Room (OR) scheduling, referral, and surgical site infection registers significantly increased by 34.8%, 56.5% and 87%, respectively, at project endline compared to baseline. Availability of OR and Anesthesia registers remained high throughout the project, at 91.3% and 95.6%, respectively. Furthermore, the appropriate use of these registers improved, with statistically significant increases observed for OR scheduling registers (34.8% increase). Increases were also noted for OR register (9.5% increase) and anesthesia register (4.5% increase), although not statistically significant. Assessing the prior three months reports, the report submissions to the Ministry of Health/Regional Health Bureau (MOH/RHB) rose from 85 to 100%, reflecting complete reporting at endline period. Additionally, the proportion of surgical teams analyzing and displaying data for informed decision-making significantly increased from 30.4% at baseline to 60.8% at endline period.ConclusionThe implemented interventions positively impacted surgical data management and utilization practice at intervention facilities. These positive changes were likely attributable to capacity building trainings and regular mentorship visits via hub-and-spoke approach. Hence, we recommend further investigation into the effectiveness of similar intervention packages in improving surgical data management, data analysis and visualization practices in low- and middle-income country settings.

The evaluation of health, disability and aged care-sector engagement with resources designed to support optimisation of the allied health assistant workforce: a qualitative study

BackgroundAllied health assistants (AHAs) support allied health professionals (AHPs) to meet workforce demands in modern healthcare systems. In an Australian context historically, AHAs have been sub-optimally utilised. Prior research has identified that AHAs and AHPs working in health, disability and aged care sectors, and the Vocational Education and Training (VET) industry, may benefit from access to resources to support the optimisation of the AHA workforce. As a part of a Victorian department of health funded project, several resources were developed in line with workforce recommendations for use in each of the above sectors. Recommendations and resources covered the broad areas of pre-employment training, workforce planning and governance, consumer-centred therapy and supports, recruitment and induction and workplace training and development. This study aimed to evaluate the engagement with these newly designed resources to support optimisation of AHAs in the Victorian context.MethodsSemi-structured interviews were conducted to evaluate engagement with resources, from the perspective of AHAs, AHPs and allied health leaders (AHLs) in the health, aged care or disability sectors, and educators and managers of allied health assistance training. Thematic analysis was conducted using team-based framework analysis.ResultsThematic framework analysis of the interview data identified four themes; Why participants accessed the resources; How participants engaged with the resources; What (if any) changes in practice occurred as a result of engaging with the resources in a participant’s local context, How did participants envision the resources being utilised for AHA workforce optimisation in the future. Responses were mapped to the AHA workforce career pathway at the career preparation, career development and career trajectory tiers.ConclusionsAppetite for AHA workforce development and optimal utilisation is evident across Victoria, Australia. Readily accessible resources that inform AHA role and scope of practice, delegation practice, or improve the ability for an AHA to state their own development needs, were identified as useful by participants. The potential for these resources to assist in the optimal utilisation and development of AHA workforces across the career continuum differs according to the role, sector and geographical location of the resource user. Further study is needed to investigate the transferability of these resources to national and global contexts.

Outcomes and safety of atezolizumab plus bevacizumab in the treatment of hepatocellular carcinoma: treatment prognosis and comparison with tyrosine kinase inhibitors in a French multicenter matched real-life study.

The combination of atezolizumab plus bevacizumab (Atz/Bev) has radically changed the treatment strategy for advanced hepatocellular carcinoma (HCC) but raises questions. Our objectives were to determine survival outcomes and safety in a real-life multicenter French cohort, to investigate the on-treatment prognostic value of the bioinflammatory RECA score, and to perform a matched comparison with patients who previously received tyrosine kinase inhibitors (TKIs). A retrospective analysis of 109 consecutive patients enrolled from September 2020 to January 2023 and a post matched comparison with a TKI cohort ( n = 79) by the propensity score matching method. The Atz/Bev population was mainly nonviral disease patients (69%) with Child-Pugh grade A (90%), performance status 0/1 (90%), and Barcelona Clinic Liver Cancer stage B (38%) or stage C (62%) classification. After a median follow-up of 6.5 months (3.6-11.7), overall survival (OS) was 13.0 (5.1-28.7) months. OS was independently associated with metastasis, increased alkaline phosphatase, and serum bilirubin levels. Treatment-related adverse events were reported in 78% of patients, mostly grade 1 or 2. The RECA score clearly revealed two different prognosis groups after three cycles. No difference in OS was observed after matching between sequential treatment with TKIs and Atz/Bev. This real-life study highlights the importance of liver function when using Atz/Bev combination and the necessity of identifying predictive markers of response to HCC therapies. Our findings suggest a change in practices, with a marked proportion of intermediate stages, and support the on-treatment prognostic value of an inflammatory score.

Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study.

Sugammadex is a neuromuscular blockade (NMB) reversal agent introduced in the United States in 2016, which allows the reversal of deep NMB, not possible with neostigmine. Few data describe associated practice changes, if any, in NMB medication use that may have resulted from its availability. We hypothesized that after institutional introduction, use of NMB agents increased. Furthermore, as NMB medication is typically used when the airway has been secured with an endotracheal tube (ETT), we speculated that ETT use may have also increased over the same time period as a result of sugammadex availability. This was a single-center cross-sectional study of patients ages 2 to 17 years undergoing general anesthesia for surgical cases where anesthesia providers often have discretion over NMB medication use or whether to use an ETT versus a laryngeal mask airway (LMA), comparing the time periods 2014 to 2016 (presugammadex) to 2017 to 2019 (early sugammadex) and 2020 to 2022 (established sugammadex). Outcomes included use of (1) any nondepolarizing NMB medication during the case and (2) an ETT versus LMA. We used generalized linear mixed models to examine changes in practice patterns over time. We also examined whether patient age group and in-room provider (resident versus certified registered nurse anesthetist [CRNA]) were associated with increased NMB medication or ETT use. There were 25,638 eligible anesthetics. Patient and surgical characteristics were similar across time periods. In adjusted analyses, the odds of NMB medication use increased from 2017 to 2019 (odds ratio [OR], 1.55, 95% confidence interval [CI], 1.38-1.75) and 2020 to 2022 (OR, 5.62, 95% CI, 4.96-6.37) relative to 2014 to 2016, and were higher in older children (age 6-11 years vs 2-5 years OR, 1.81, 95% CI, 1.63-2.01; age 12-17 years vs 2-5 years OR, 7.01, 95% CI, 6.19-7.92) and when the primary in-room provider was a resident rather than a CRNA (OR, 1.24, 95% CI, 1.12-1.37). The odds of ETT use declined 2017 to 2019 (OR, 0.69, 95% CI, 0.63-0.75) and 2020 to 2022 (OR, 0.71, 95% CI, 0.65-0.78), more so in older children (age 6-11 years vs 2-5 years OR, 0.45, 95% CI, 0.42-0.49; age 12-17 years vs 2-5 years OR, 0.28, 95% CI, 0.25-0.31). Resident presence at induction was associated with increased odds of ETT use (OR, 1.50, 95% CI, 1.38-1.62). The decision to use NMB medication as part of an anesthetic plan increased substantially after sugammadex became available, particularly in older children and cases staffed by residents. ETT use declined over the study period.