Quality Of Outcomes Research Articles

Development and validation of a short clinical risk management implementation (Short CRiMI) questionnaire.

Clinical Risk Management (CRM) is an important instrument to continuously improve safety of health care delivery. In Germany, hospitals are required by law to implement CRM and incidence reporting systems. Since 2010, nation-wide surveys have been conducted periodically to evaluate implementation of CRM in hospitals. The instrument used in these surveys is constantly being updated to reflect previous experiences, as well as to adapt to ongoing trends and developments in CRM practices. The survey instrument used in 2022 consisted of up to 200 items and took up to an hour to complete. In this study, we aimed to develop a short instrument to measure the level of CRM implementation in hospitals, evaluate its psychometric properties, and to offer benchmarking data for health care facilities of different sizes. We used data collected in 2022 as part of KHaSiMiR study, employing a cross-sectional self-reported online survey. The hospital administrations were invited to designate one CRM manager to participate in the study. Out of 1,411 general hospitals invited, 401 responses were collected (response rate of 28%). After removing the cases with excessive missings, we imputed remaining missing values using multiple imputation, and split the resulting sample (n=362) in two halves (i.e., exploratory and testing subsamples). A principal component analysis was applied on the first subsample. We validated the resulting model using confirmatory factor analysis in the testing subsample. We evaluated internal consistency, and tested external validity of the established instrument using correlation analysis with two single-item measures: subjective evaluation of CRM implementation compared to similar organizations and compared to own ideal level. The principal component analysis included 45 items from the full instrument. The analysis resulted in a three-factor model with 26 items. In the confirmatory factor analysis, the model demonstrated acceptable fit with the data according to the commonly used fit indices: Chi2/df=1.36, CFI=0.941, TLI=0.930, RMSEA=0.045 (90% CI=0.032-0.056), SRMR=0.049. Cronbach's alpha of all three factors was good (>0.70). All three factors had statistically significant positive correlations with each other (0.359-0.497) and with the two single items (0.282-0.532). None of the correlations were high enough (>0.7) to indicate multicollinearity. The proposed short clinical risk management implementation (Short CRiMI) questionnaire is psychometrically valid and can be used to rapidly evaluate CRM implementation in hospitals. Further research can provide evidence of its external validity and association with quality and safety outcomes. Benchmarking data can be used to compare the results with the data from the most recent Germany-wide survey.

China’s space sector, firm CSR and patent quality

China’s space sector, firm CSR and patent quality

Acupuncture for Chronic Radiation-Induced Xerostomia in Head and Neck Cancer: A Multicenter Randomized Clinical Trial.

Patients with head and neck cancer who undergo radiotherapy can develop chronic radiation-induced xerostomia. Prior acupuncture studies were single center and rated as having high risk of bias, making it difficult to know the benefits of acupuncture for treating radiation-induced xerostomia. To compare true acupuncture (TA), sham acupuncture (SA), and standard oral hygiene (SOH) for treating radiation-induced xerostomia. A randomized, blinded, 3-arm, placebo-controlled trial was conducted between July 29, 2013, and June 9, 2021. Data analysis was performed from March 9, 2022, through May 17, 2023. Patients reporting grade 2 or 3 radiation-induced xerostomia 12 months or more postradiotherapy for head and neck cancer were recruited from community-based cancer centers across the US that were part of the Wake Forest National Cancer Institute Community Oncology Research Program Research Base. Participants had received bilateral radiotherapy with no history of xerostomia. Participants received SOH and were randomized to TA, SA, or SOH only. Participants in the TA and SA cohorts were treated 2 times per week for 4 weeks. Those experiencing a minor response received another 4 weeks of treatment. Patient-reported outcomes for xerostomia (Xerostomia Questionnaire, primary outcome) and quality of life (Functional Assessment of Cancer Therapy-General) were collected at baseline, 4 (primary time point), 8, 12, and 26 weeks. All analyses were intention to treat. A total of 258 patients (201 men [77.9%]; mean [SD] age, 65.0 [9.16] years), participated from 33 sites across 13 states. Overall, 86 patients were assigned to each study arm. Mean (SD) years from diagnosis was 4.21 (3.74) years, 67.1% (n = 173) had stage IV disease. At week 4, Xerostomia Questionnaire scores revealed significant between-group differences, with lower Xerostomia Questionnaire scores with TA vs SOH (TA: 50.6; SOH: 57.3; difference, -6.67; 95% CI, -11.08 to -2.27; P = .003), and differences between TA and SA (TA: 50.6; SA: 55.0; difference, -4.41; 95% CI, -8.62 to -0.19; P = .04) yet did not reach statistical significance after adjustment for multiple comparisons. There was no significant difference between SA and SOH. Group differences in Functional Assessment of Cancer Therapy-General scores revealed statistically significant group differences at week 4, with higher scores with TA vs SOH (TA: 101.6; SOH: 97.7; difference, 3.91; 95% CI, 1.43-6.38; P = .002) and at week 12, with higher scores with TA vs SA (TA: 102.1; SA: 98.4; difference, 3.64; 95% CI, 1.10-6.18; P = .005) and TA vs SOH (TA: 102.1; SOH: 97.4; difference, 4.61; 95% CI, 1.99-7.23; P = .001). The findings of this trial suggest that TA was more effective in treating chronic radiation-induced xerostomia 1 or more years after the end of radiotherapy than SA or SOH. ClinicalTrials.gov Identifier: NCT02589938.

Barriers and Facilitators to Health Professionals' Engagement in Quality Improvement Initiatives: A Mixed-Methods Systematic Review.

Background Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesised the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. Methods A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). The extracted data were synthesised using the JBI convergent integrated approach to MMSR. Results Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training and access to QI specialists. At the health professional level, barriers and facilitators were related to their organisational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organisational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives) and institutional priorities influenced health professionals' participation in QI. Conclusion This review highlights the complex interplay of organisational, individual and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organisational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.

Predicting wheat flour quality for making Japanese sponge cake using flour pasting properties as measured by the Rapid Visco Analyzer

AbstractBackground and ObjectivesThe objective of this study was to evaluate a series of Rapid Visco Analyzer (RVA) methods for their ability to produce results that were predictive of Japanese sponge cake (JSC) quality. Two solvents (water and 50% [w/w] sucrose in water) and two temperature profiles [Standard 1 (STD 1) and an internal cake temperature profile] were selected to run across a diverse set of flour samples from two crop years that possessed variable bake performance. The results were analyzed for predictive outcomes for JSC prepared using a mechanical fold method.FindingsThe solvent retention capacity (SRC) results did not show any significant trends with JSC quality. The RVA results from both profiles using water as the solvent did not show a significant correlation with JSC quality while the 50% (w/w) sucrose solvent was significantly correlated (p ≤ .01). The STD 1 and internal cake temperature profile batter pasting viscosity (BPV) using the sucrose solvent showed significant (p ≤ .01) correlations with mechanical folded JSC volume (r = .97), firmness (r = −.88), and overall score (r = .85).ConclusionsThe RVA BPV results showed that a 50% sucrose solvent could more accurately be used to predict and screen for JSC quality outcomes. Both RVA profiles could be used with a sucrose solvent to predict JSC quality. JSC volume and overall score showed significant positive correlations with BPV while firmness had a significant negative correlation.Significance and NoveltyThis research identified two RVA profiles that when paired with a 50% (w/w) sucrose solvent could be used to screen for JSC quality using less flour and taking less time than a bake test. This test could potentially assist breeders and millers in quicky screening flours for efficient decision making. This is the first time an RVA temperature profile that mimics the internal rise in temperature for a JSC during baking has been used to predict JSC quality. In addition, the STD 1 profile using the 50% (w/w) sucrose solvent has not been previously used to predict JSC quality.

Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study.

To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). A patient representative has been involved in planning this study.

Novel Feature-Based Difficulty Prediction Method for Mathematics Items Using XGBoost-Based SHAP Model

The level of difficulty of mathematical test items is a critical aspect for evaluating test quality and educational outcomes. Accurately predicting item difficulty during test creation is thus significantly important for producing effective test papers. This study used more than ten years of content and score data from China’s Henan Provincial College Entrance Examination in Mathematics as an evaluation criterion for test difficulty, and all data were obtained from the Henan Provincial Department of Education. Based on the framework established by the National Center for Education Statistics (NCES) for test item assessment methodology, this paper proposes a new framework containing eight features considering the uniqueness of mathematics. Next, this paper proposes an XGBoost-based SHAP model for analyzing the difficulty of mathematics tests. By coupling the XGBoost method with the SHAP method, the model not only evaluates the difficulty of mathematics tests but also analyzes the contribution of specific features to item difficulty, thereby increasing transparency and mitigating the “black box” nature of machine learning models. The model has a high prediction accuracy of 0.99 for the training set and 0.806 for the test set. With the model, we found that parameter-level features and reasoning-level features are significant factors influencing the difficulty of subjective items in the exam. In addition, we divided senior secondary mathematics knowledge into nine units based on Chinese curriculum standards and found significant differences in the distribution of the eight features across these different knowledge units, which can help teachers place different emphasis on different units during the teaching process. In summary, our proposed approach significantly improves the accuracy of item difficulty prediction, which is crucial for intelligent educational applications such as knowledge tracking, automatic test item generation, and intelligent paper generation. These results provide tools that are better aligned with and responsive to students’ learning needs, thus effectively informing educational practice.

Advanced Paternal Age in Focus: Unraveling Its Influence on Assisted Reproductive Technology Outcomes

As global demographics shift toward increasing paternal age, the realm of assisted reproductive technologies (ARTs), particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), faces new challenges and opportunities. This study provides a comprehensive exploration of the implications of advanced paternal age on ART outcomes. Background research highlights the social, cultural, and economic factors driving men toward later fatherhood, with a focus on the impact of delayed paternity on reproductive outcomes. Methods involve a thorough review of existing literature, centering on changes in testicular function, semen quality, and genetic and epigenetic shifts associated with advancing age. Study results point to intricate associations between the father’s age and ART outcomes, with older age being linked to diminished semen quality, potential genetic risks, and varied impacts on embryo quality, implantation rates, and birth outcomes. The conclusions drawn from the current study suggest that while advanced paternal age presents certain risks and challenges, understanding and mitigating these through strategies such as sperm cryopreservation, lifestyle modifications, and preimplantation genetic testing can optimize ART outcomes. Future research directions are identified to further comprehend the epigenetic mechanisms and long-term effects of the older father on offspring health. This study underscores the need for a comprehensive approach in navigating the intricacies of delayed fatherhood within the context of ART, aiming for the best possible outcomes for couples and their children.

Are principals really tireless? Conceptualizing the role of sleep in school leadership

The purpose of this conceptual paper is to highlight the impacts of psychological and biological health on the principalship, particularly as it relates to sleep. Job-related stress, heavy workloads, and unpredictable work schedules can impact principals’ mental health, diet, and consumptive behaviors, which can disrupt the much-needed restorative sleep for healthy cognition, physiological functioning, and efficacious leadership. We turn the field's attention towards the importance of quality sleep and how it impacts personal health and occupational performance. We provide a robust interdisciplinary review of literature on precursors and outcomes of poor sleep quality as it pertains to school leaders both personally and professionally. Empirical recommendations for improving sleep quality along with recommendations for preparation programs and the field of educational leadership are discussed.

Implementasi Gamifikasi pada Learning Management System Linsafe LPK Adiputra Purwokerto Berbasis Website

This study aims to apply gamification to the LPK Adiputra Purwokerto website-based learning management system (LMS) to increase participant motivation and involvement in the learning process. Gamification is a method of using game elements to influence the behavior of LPK Adiputra Purwokerto participants to achieve learning objectives. The research method used was a case study with participants consisting of LPK Adiputra students in Purwokerto using a quasi-experimental design and divided into two groups, The control group, and The experimental group. The control group took part in learning with an LMS without gamification elements, while the experimental group took part in learning with the application of gamification to an LMS. The number of research participants was 47 participants who took the LPK Adiputra Purwokerto driving course. During the research, the experimental group had access to an LMS that implemented gamification elements such as points, levels, rewards, challenges, and a ranking system. Experiment group participants are given the freedom to compete with themselves or other participants through the scoreboard and reach a certain level of learning. The results of the data analysis will later show that the experimental group that took part in gamification learning experienced a significant increase in motivation and engagement compared to the control group. It is hoped that this research can make an important contribution to the development of technology-based education and the use of LMS as an effective tool for increasing participant motivation and engagement. This study concludes that the implementation of gamification at the website-based LMS Linsafe LPK Adiputra Purwokerto will be effective in enhancing the learning experience of participants by incorporating game elements. LPK Adiputra Purwokerto participants should tend to be more motivated and actively involved in the learning process so that later they can improve the quality and overall learning outcomes.

Healthcare performance analytics based on the novel PDA methodology for assessment of efficiency and perceived quality outcomes: A machine learning approach

Efficient resource allocation in healthcare organizations remains a complex challenge, exacerbated by the intricate data structure and myriad variables involved. While traditional methods like Data Envelopment Analysis have been employed, these often lack the requisite discriminatory power for accurate evaluation. This study introduces the PDA methodology, a fusion of Principal Component Analysis, Data Envelopment Analysis, and Analysis of Variance algorithms, developed in a machine learning environment. To further optimize discriminative power, the Particle Swarm Optimization Algorithm was included. By applying the PDA methodology to hospitals in the Apulia region of Italy, we found that facilities with better perceived quality tend to be more efficient. Furthermore, we identified significant variations in efficiency based on network affiliation and hospital level. Machine learning algorithms, including linear regressions and neural networks, confirmed that our methodology outperforms traditional Data Envelopment Analysis models in precisely distinguishing between varying levels of hospital efficiency. In conclusion, this work provides a fresh perspective for future research and policy decisions in the healthcare domain, demonstrating how the use of advanced and machine learning algorithms can result in more accurate evaluations and targeted interventions.

Abstract PO4-27-08: A Phase II Multi-Institutional Study of Concurrent Radiotherapy, Palbociclib, and HormoneTherapy for Treatment of Bone Metastasis in Breast Cancer Patients

Abstract Background: This Phase II study aimed to determine the efficacy and safety of administering palliative radiotherapy (RT) to bone metastases (mets) in patients (pts) receiving concurrent palbociclib and hormone therapy (HT) for hormone receptor positive, Her2/neu negative breast cancer. The primary endpoint was response rate 3 months after RT. Methods: Pts with painful bone mets or asymptomatic bone mets with risk for impending clinical event were treated with RT to 30 Gy in 10 fractions or 20 Gy in 5 fractions with concurrent palbociclib and HT. Change in maximum pain score on the Brief Pain Inventory was used to assess pain response 3 months post RT relative to baseline. Among pts with asymptomatic bone lesions, response was defined as prevention of a clinical event (e.g., bone fracture) without evidence of local tumor growth on surveillance imaging. Patient reported outcomes (PROs) of fatigue, depression, anxiety, and quality of life were collected. Blood-based biomarkers were examined to determine their relationship with response and PROs. Using a non-inferiority study design, a sample size of at least 33 pts was needed to achieve 80% power to detect a non-inferiority proportion of 60% using a one-sided binomial test and assuming a Type I error of 0.05. Results: Among 38 patients enrolled, 79% had painful bone mets. 35 pts completed baseline and 3-month post RT assessments. 61% and 37% of pts received aromatase inhibitors and fulvestrant, respectively, with palbociclib. Median age was 60 years (31-83) and 25% of pts were non-Hispanic Black. The majority (72%) of pts received 5 fraction RT and 69% received RT to one bone region. 29 patients (83%) were responders [95% CI: 66%-93%, p=.003]. Median progression free survival (PFS) was 30.4 months (1.3 - 44.0). Three-year PFS and overall survival were 45.6% and 67.2%, respectively. Grade 3 neutropenia developed in 4 (11%), 4 (11%), and 7 (20%) pts at end of RT, 1 month, and 3 months post RT, respectively. No pts developed Grade 4 neutropenia. One patient developed Grade 3 gastrointestinal toxicity during RT, another developed Grade 3 dyspnea 1 month post XRT, and another developed a bone fracture 6 months after RT. >While patient reported measures of fatigue, depression, and overall quality of life did not significantly change during or after RT relative to baseline, pain scores (i.e., BPI pain severity and interference, BM22 pain characteristics and pain site subscales, EORTC C15 pain) significantly decreased 3 months post XRT relative to baseline. Heightened inflammatory marker levels (e.g., TNFRII, IL1ra, CRP, TNF alpha) were significantly associated with worse symptoms of fatigue (MFI) and depression (HADS), increased pain interference (BPI), and lower overall quality of life (SF-36), controlling for age and time using mixed effect models. Patients with improved pain symptoms and lower pain scores had significantly lower inflammatory marker levels relative to baseline (e.g., interleukin-6). Conclusions: Our study demonstrated high rates of response to concurrent RT with palbociclib and HT with acceptable levels of toxicity. These results suggest that RT to bone mets effectively alleviates pain in patients taking palbociclib and pain response to treatment is associated with decreased inflammatory markers. RT may be given to pts receiving palbociclib and HT for breast cancer. Clinical Trial Identification: NCT03691493 Citation Format: Mylin Torres, Jolinta Lin, Sarah Friend, Canhua Xiao, Yichun Cao, Shannon Kahn, Karen Godette, Sheela Hanasoge, David Yu, Tony Eng, Matthew Cheney, Nancy Wiggers, Andrew Pippas, Keerthi Gogineni, Jane Meisel, David Schuster, Aditya Bardia, Andrew Miller, Jennifer Felger, Jeffrey Switchenko, Amelia Zelnak, Kevin Kalinsky, Manali Bhave. A Phase II Multi-Institutional Study of Concurrent Radiotherapy, Palbociclib, and HormoneTherapy for Treatment of Bone Metastasis in Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-27-08.

Vision and Metamorphopsia Outcomes of Macular Buckling for Foveoschisis Associated Macular Detachment in Highly Myopic Eyes

Purpose: To assess the functional outcomes in visual acuity, metamorphopsia, and vision-related quality of life (VR-QOL) and to evaluate prognostic factors after macular buckling (MB) surgery in eyes with high myopia and foveoschisis (FS) associated macular detachment (MD). Methods: Thirty-nine eyes of 39 patients with FS associated MD underwent MB surgery were enrolled. Measured outcomes comprised best-corrected visual acuity (BCVA), metamorphopsia, VR-QOL, axial length (AL), macular reattachment, and resolution of foveoschisis. Additionally, factors affecting final BCVA and metamorphopsia were analyzed. Results: At 12 months postoperatively, 36 eyes (92.31%) achieved macular reattachment, 37 eyes (94.87%) achieved complete resolution of foveoshisis, and metamorphopsia diminished in 31 eyes (79.49%). LogMAR BCVAs at baseline and months 1, 3, 6 and 12 postoperatively were 0.62±0.35 (20/83), 0.65±0.3 (20/89), 0.59±0.31 (20/77), 0.54±0.31 (20/69) and 0.46±0.27 (20/57) (P < 0.001), respectively. Metamorphopsia scores by M-CHARTS were 1.36°±0.51°, 1.04°±0.51°, 0.74°±0.47°, 0.59°±0.47° and 0.13°±0.29° (P < 0.001). All VFQ-25 subscales demonstrated significant improvement postoperatively, with the exception of “general health” (P = 0.08) and “driving” (P = 0.111). Preoperative BCVA was an independent risk factor for postoperative BCVA at month 12 (r = 0.638, P < 0.001), and the preoperative M-score was an independent risk factor for postoperative M-score at month 12 (r = 0.187, P = 0.045). Conclusions: MB surgery significantly improved BCVA, metamorphopsia, and VR-QOL in patients with FS associated MD. Preoperative BCVA and metamorphopsia score were prognostic factors for postoperative BCVA and metamorphopsia score at month 12.

Home care practice behavior and its influencing factors of primary care providers: a multicenter cross-sectional study in Sichuan Province, China

BackgroundPrimary care providers play an important role in home health care, and their practice behavior is significant for care quality and patient outcomes. This study aimed to assess the home care practice behavior of Chinese primary care providers and to explore the factors associated with the practice behavior.MethodsA multicenter cross-sectional design with a convenience sample was used to survey 863 registered primary care providers from 62 primary health care settings in Sichuan Province, China. Descriptive statistics, t-test or ANOVA for one-way analysis, and Pearson’s correlation analyses were used to compare the differences and examine the relationships between participants’ demographics and experience of home care services and practice behavior. Multiple linear regression models were performed to identify salient variables associated with the practice behavior from among demographic and home care experience.ResultsThe score of home care practice behavior questionnaire was 97.25 ± 21.05. The average scores for the dimensions of home visit preparation, assessment, medical care behavior and safety practice were 3.70 ± 0.95, 3.76 ± 1.02, 3.66 ± 1.03, and 3.20 ± 0.46, respectively. Home care practice behavior was associated with working years, working experience in general hospitals, work area, home care experience such as client types of home care, service frequency and willingness, explaining 21.5% of the total variance.ConclusionChinese primary care providers had a medium to high level of home care practice behavior but poor implementation of safety practice. The results may provide clues to increased focus and implementation of safety practice, as well as providing targeted measures based on influencing factors.

Abstract PO3-10-01: How The Financial Toxicity of Metastatic Breast Cancer Affects Single Mothers with Young Children: Where Disparities Lie and Outcomes For Quality of Life

Abstract PURPOSE Financial Toxicity in underserved/underrepresented single mothers living with Metastatic Breast Cancer (MBC) diminishes patients' quality of life. The purpose of this abstract is to determine which demographic experiences financial toxicity the most and understand how assisting this patient population financially improves their physical, mental and emotional health, ultimately contributing to a better quality of life for them and their young children. METHOD From July 2022 to April 2023, we invited underserved/underrepresented single mothers living with MBC to apply for a six month financial grant to help pay for rent/mortgage. To be eligible, applicants needed to be 200 percent of the federal poverty level, and have children under the age of 18 for whom they were solely responsible. The patients applying were receiving treatment in different healthcare systems from premier cancer hospitals to small rural hospitals and lived in different states within the US. We were able to assess demographic factors, employment status, and familial support of each patient by the information requested on the application to determine qualification for financial assistance. RESULTS 48 women qualified for our grant based on the criteria stated above. Of those 48 qualified applicants, 26 were African American (54%), 8 were Latina (16%), 2 were Asian Pacific (4%) and 12 were caucasian (25%). All applicants were either no longer working due to treatment related illness or working significantly reduced hours. All were in need of rent/mortgage assistance or would face eviction and 7 were experiencing or had experienced homelessness. Those who had experienced homelessness were black. We provided each of these women with $1,000.00 per month for six months for the expense of rent/mortgage. We provided the funds for those who were homeless to find housing. We also provided grocery cards and funds for children's clothing when requested. All 48 patients receiving grants were able to remain in their home or acquire housing if they had been living in a homeless shelter. All patients reported that having this significant support allowed them to have less stress and therefore, an improved quality of life mentally and emotionally. Once the six months of financial help was removed, 25 African American patients (52%), 3 Latina patients (6%) and 1 Caucasian patient (2%) went back to experiencing financial toxicity and quality of life diminished once again. CONCLUSION This work highlights the tremendous financial burden faced by single mothers living with MBC. Direct financial assistance can help provide stability and support families in this time of significant need. Additional expansion to all states is planned. Citation Format: Roberta Lombardi, Maryam lustberg. How The Financial Toxicity of Metastatic Breast Cancer Affects Single Mothers with Young Children: Where Disparities Lie and Outcomes For Quality of Life [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-01.

Validation of a Natural Language Processing Algorithm using National Reporting Data to Improve Identification of Anesthesia-related ADVerse evENTs: The “ADVENTURE” Study

BackgroundReporting and analysis of adverse events (AE) is associated with improved healthcare learning, quality outcomes, and patient safety. Manual text analysis is time-consuming, costly, and prone to human errors. We aimed to demonstrate the feasibility of machine learning and natural language processing (NLP) approaches for early predictions of adverse events and provide input to direct quality improvement and patient safety initiatives. MethodsWe used machine learning to analyze 9,559 continuously reported AE by clinicians and healthcare systems to the French National Health accreditor (HAS) between January 1, 2009, and December 31, 2020, for a total of 135,000 unique de-identified AE reports. We validated the labeling and determined the associations between different root causes and patient consequences. The model was validated by independent expert anesthesiologists. ResultsThe machine learning and Artificial Intelligence (AI) model trained on 9,559 AE datasets accurately categorized 8800 (88%) of reported AE. The three most frequent AE types were “difficult orotracheal intubation” (16.9% of AE reports), “medication error” (10.5%), and “post-induction hypotension” (6.9%). The accuracy of the AI model reached 70.9% sensitivity, 96.6% specificity for “difficult intubation”, 43.2% sensitivity, and 98.9% specificity for “medication error.” ConclusionsThis unsupervised method provides an accurate, automated, AI-supported search algorithm that ranks and helps to understand complex patterns of risky patient situations and has greater speed, precision, and clarity when compared to manual human data extraction. Machine learning (ML) and natural language processing models can effectively be used to process natural language AE reports and augment expert clinician input. This model can support clinical applications and methodological standards of implementations and be used to better inform and enhance decision-making for improved risk management and patient safety. Trial RegistrationThe study was approved by the ethics committee of the French Society of Anesthesiology (IRB 00010254-2020-20) and the CNIL (CNIL: 118 58 95) and the study was registered with ClinicalTrials.gov (NCT: NCT05185479).

Belastung durch gestörten Schlaf und dessen Verbesserung durch topische Behandlung bei Psoriasis und atopischer Dermatitis

Patients with chronic inflammatory skin diseases often suffer from sleep disturbances. However, objective data on sleep architecture, especially to evaluate potential overall influences under therapy, are lacking. Pilot study on sleep quality changes including psoriasis and atopic dermatitis patients before and 2weeks after intensive topical treatment. In addition to disease activity rating, patient-rated outcomes for itch severity and sleep quality and polygraphy was performed before and after topical therapy. 14 psoriasis, eleven atopic dermatitis patients (10 female, 15 male) with a mean age of 49 years were included. Disease activity scores (EASI and PASI) were significantly reduced with topical therapy after 2weeks (p<0.001). Pruritus intensity (NRS) showed a significant influence on deep sleep, which resolved after therapy. Insomnia severity significantly decreased (r>0.50, p<0.05) and daytime sleepiness showed a significant reduction in 40% of patients. N3 (deep sleep) and REM sleep significantly improved, showing a strong effect (r>0.50). The apnea-hypopnea index decreased in one of four patients independent of the individual BMI. Through polygraphy, we demonstrated impaired sleep patterns in psoriasis and atopic dermatitis patients with itch as a relevant factor and beyond that, rapid sleep improvement under 2weeks of topical treatment.

Exploring COVID-19 census burdens by US hospital characteristics: Implications of quality reporting at rural and critical access hospitals.

By assessing longitudinal associations between COVID-19 census burdens and hospital characteristics, such as bed size and critical access status, we can explore whether pandemic-era hospital quality benchmarking requires risk-adjustment or stratification for hospital-level characteristics. We used hospital-level data from the US Department of Health and Human Services including weekly total hospital and COVID-19 censuses from August 2020 to August 2023 and the 2021 American Hospital Association survey. We calculated weekly percentages of total adult hospital beds containing COVID-19 patients. We then calculated the number of weeks each hospital spent at Extreme (≥20% of beds occupied by COVID-19 patients), High (10%-19%), Moderate (5%-9%), and Low (<5%) COVID-19 stress. We assessed longitudinal hospital-level COVID-19 stress, stratified by 15 hospital characteristics including joint commission accreditation, bed size, teaching status, critical access hospital status, and core-based statistical area (CBSA) rurality. Among n = 2582 US hospitals, the median(IQR) weekly percentage of hospital capacity occupied by COVID-19 patients was 6.7%(3.6%-13.0%). 80,268/213,383 (38%) hospital-weeks experienced Low COVID-19 census stress, 28% Moderate stress, 22% High stress, and 12% Extreme stress. COVID-19 census burdens were similar across most hospital characteristics, but were significantly greater for critical access hospitals. US hospitals experienced similar COVID-19 census burdens across multiple institutional characteristics. Evidence-based inclusion of pandemic-era outcomes in hospital quality reporting may not require significant hospital-level risk-adjustment or stratification, with the exception of rural or critical access hospitals, which experienced differentially greater COVID-19 census burdens and may merit hospital-level risk-adjustment considerations.

Development of Soil Quality Databases and Land Potential Assessment Using GIS: A Case Study of Lao Cai Province, Vietnam

The utilization of Geographic Information Systems (GIS), particularly the Mapinfo software, is indispensable in the establishment of a land quality and land potential database encompassing each land parcel within Lao Cai province. Through a multifaceted approach involving data collection techniques, field surveys, data analysis, and the creation of both spatial and attribute databases, the GIS application in Lao Cai province has successfully compiled a comprehensive dataset. This dataset encompasses a range of layers, including boundaries, administrative demarcations, land use statuses, survey points, soil types, slope characteristics, soil depth, irrigation patterns, climatic conditions, soil fertility data, and transportation and hydrological information. The amalgamation of this spatial data with attribute data yields a comprehensive repository featuring information on 405 units of agricultural land quality and potential, in addition to 65 aggregated non-agricultural land parcels. This combined dataset functions as the foundational land quality and potential database for Lao Cai province. Assessment outcomes for land quality and land potential throughout the entire province reveal that 51.42% of the land exhibits low quality, 35.06% demonstrates moderate quality, and 13.52% boasts high quality. In terms of land potential, 29.15% is categorized as having low potential, 44.88% as having moderate potential, and 25.97% as having high potential. Furthermore, the precise delineation of land quality and potential for each land parcel within the database effectively caters to the information retrieval needs of land administrators and stakeholders. This research also seeks to contribute to the standardization of land databases at both the provincial and national levels, thereby bolstering land management efforts within the context of globalization, development, and climate change adaptation.

To Approve or not to Approve? A Comparative Analysis of State-Company-Indigenous Community Interactions in Mining in Canada and Sweden.

This Special Section explores the interplay between Indigenous peoples, industry, and the state in five proposed and active mining projects in Canada and Sweden. The overall aim is to identify factors shaping the quality of Indigenous community-industry-state interactions in mining and mine development. An ambition underlying the research is to develop knowledge to help manage mining related land-use conflicts in Sweden by drawing on Canadian comparisons and experience. This paper synthesizes the comparative research that has been conducted across jurisdictions in three Canadian provinces and Sweden. It focuses on the interplay between the properties of the governance system, the quality of interaction and governance outcomes. We combine institutional and interactive governance theory and use the concept of governability to assess how and why specific outcomes, such as mutually beneficial interaction, collaboration, or opposition, occurred. The analysis suggests there are measures that can be taken by the Swedish Government to improve the governability of mining related issues, by developing alternative, and more effective, avenues to recognize, and protect, Sámi rights and culture, to broaden the scope and increase the legitimacy and transparency of the EIAs, to raise the quality of interaction and consultation, and to develop tools to actively stimulate and support collaboration and partnerships on equal terms. Generally, we argue that Indigenous community responses to mining must be understood within a larger framework of Indigenous self-determination, in particular the communities' own assessments of their opportunities to achieve their long-term objectives using alternative governing modes and types of interactions.