Routine Collection Research Articles

Key Performance Indicators as Predictors of Enterprise Gross Margin in English and Welsh Suckler Beef and Sheep Farms

A large proportion of the lowest annual farm profits in the United Kingdom in recent years comes from lowland and Less Favoured Area (LFA) beef and sheep farms. Benchmarking the performance of a business through routine data collection can provide the information needed to make changes to enterprise management and performance. Key performance indicators (KPIs) are globally recognised measures that can provide farmers with this capability. However, it is largely unknown if there are specific KPIs relating to livestock production that have a significant effect on financial performance. The aim of this study was to determine whether KPIs could be used as predictors of financial performance (gross margin, GM), on suckler beef and sheep farms in England and Wales. This was completed using data from the Farm Business Survey (FBS), which is the largest stratified financial survey of its kind in the UK. Following data extraction, multiple linear regression models were developed for four enterprise types: LFA suckler beef, lowland suckler beef, LFA ewe and lowland ewe. Several KPIs were significantly associated with gross margin per head in all enterprise types. KPIs that were positively associated with GM were measures of livestock productivity, which were lambs per breeding stock and calves per cow. The increased expenditure on concentrate feed had a significantly negative association within all enterprise types, except for LFA suckler beef enterprises, where cow mortality had the greatest significantly negative association. This is the first study to demonstrate the influence livestock production KPIs have on the financial performance of suckler beef and sheep enterprises in both England and Wales, highlighting the importance of routine data collection and benchmarking.

Unstructured Parental Feedback at A Tertiary Maternity Hospital: A Cohort Study Using Routinely Collected Health Data.

Hospital care for neonates can be challenging for parents, and a negative parental experience can affect the well-being of the infant after discharge. A family-centred approach is the gold standard of care in neonatology. This study aimed to identify common themes in voluntary unstructured feedback received from parents and caregivers of infants admitted to the neonatal intensive care unit, special care nursery or postnatal ward or followed up by neonatal outpatient services at a tertiary Australian Women and Children's Hospital. These findings are intended to inform the development of effective family-centred neonatal care approaches. This single-centre observational study used routinely collected unstructured parental voluntary feedback received between 2010 and 2021. All feedback is entered prospectively in the online consumer feedback module of a reporting database (RiskMan). Deductive thematic analysis (whereby themes, codes and categories were chosen prior to the analysis) was used to analyse the extracted quotations. During the study period, 3533 unstructured feedback items were received. Most of the feedback received was compliments (2725/3533, 77.1%). The main feedback category was 'staff competency and efficiency', which accounted for 80.8% (2201/2755) of the compliments and 45.0% (364/808) of the complaints. Most complaints were from outpatient services and postnatal wards and centred around 'infrastructure and systems' (280/808, 34.7%) and 'information, explanation and communication' (152/808, 18.8%). Parental satisfaction was positively affected by 'staff competency and efficiency'. This study supports collecting and analysing unstructured feedback to reflect parental experiences and drive quality improvement.

Migrant Health Country Profile tool (MHCP-t) for transforming health data collection and surveillance in the Middle East and North African (MENA) region: tool development protocol with embedded process evaluation

IntroductionThe Middle East and North Africa (MENA) region is characterised by major health disparities and complex migration flows. Yet, because of a lack of epidemiological data, there is an urgent...

Variation of the Risk Associated With Potentially Modifiable Risk Factors for Dementia Between Ethnic Groups Within One Country. A Retrospective Cohort Study Using Routinely Collected Health Data in Aotearoa New Zealand.

While risk factor prevalence of individual risk factors for dementia varies between ethnic groups in New Zealand (NZ), it is not known whether the effect of these risks is the same in each group. This retrospective cohort study identified incident cases of dementia. Cox regression models calculated the hazard ratio for dementia for each of the risk factors, after adjustment for age and sex. Education, smoking, diabetes, depression, physical activity and social isolation were associated with a 1.13-1.55 times increased risk of dementia. We did not demonstrate an association between dementia risk and hypertension, alcohol, or air pollution. Differences between ethnic groups is suggested but not confirmed due to study power. Differences in dementia prevention potential between ethnic groups in NZ are potentially contributed to by both differential prevalence and risk factor effects. Public health strategies must be tailored for the ethnic populations at most risk.

EP65 Is routine collection of pus swabs necessary during emergency incision and drainage of abscesses?

eP65 Is routine collection of pus swabs necessary during emergency incision and drainage of abscesses?

Informal Caregiving: Health System Cost Implications.

Informal caregiving is seen as a low-cost substitute for care provided by health care professionals. However, caregiving is known to negatively impact caregivers' health and, subsequently, their health care use and costs. This could potentially offset the caregivers' contributions to the health care system. We examined the impact of caregiving on costs associated with caregivers' use of publicly funded health care services in Ontario, Canada, in comparison with non-caregivers. We included Ontarians who participated in the Canadian Community Health Survey-Healthy Aging Supplement Survey of 2008/09 and linked responses to health care administrative databases. A difference-in-differences design was used to capture differences in caregivers' and non-caregivers' total health care costs 1 and 2 years before and after caregiving start date. Generalized Linear Models were used to model the total health care costs. The sample size was 4275 with 1265 caregivers and 3010 non-caregivers. We found that while health care utilization increased over time, it increased by a lesser amount for caregivers than non-caregivers. Adjusted total health care costs for caregivers were 11.32% (SE = 0.05, ρ = 0.02) lower than non-caregivers 2 years into caregiving. Our study reveals a critical gap in policy, practice, and research driven by a lack of routine data collection and caregiver identification. It also highlights the need for additional longitudinal research focusing on caregivers' objective health.

DAFNE is agile and responsive—a beacon of best practice

The original Dose Adjustment For Normal Eating (DAFNE) randomised controlled trial (RCT) was conducted nearly 25 years ago.1 It has transformed structured education for type 1 diabetes (T1DM) across the UK and is still evolving through its evidence base of further RCTs,2-3 and routine collection of real-world evidence (RWE),4 thereby proving that what works in a research setting, also benefits people with T1DM in the large number (more than half) of the hospital Trusts that have adopted DAFNE countrywide. This review summarises the latest national audit data, and describes future work responding to the rapid changes in technology used in T1DM, how we are evolving to support people living with type 2 diabetes (T2DM), and adapting our learning materials in the digital age. Through the strength and depth of committed multidisciplinary healthcare professionals (HCPs) we have been able to expand our portfolio of learning materials available to DAFNE centres, who pay a nominal annual fee of ~£5,000. By partnering with the Open University we now offer free accredited online learning to a wide range of HCPs, thereby helping to upskill the diabetes workforce at no extra cost to the NHS. Finally, in a new and exciting collaboration with the Diabetes Technology Network (DTN) and industry colleagues, DAFNE offers free online training to all people living with T1DM to prepare them for closed-loop therapy.

Close-Up on Ambulance Service Estimation in Indonesia: Monte Carlo Simulation Study.

Emergency medical services have a pivotal role in giving timely and appropriate responses to emergency events caused by medical, natural, or human-caused disasters. To provide adequate resources for the emergency services, such as ambulances, it is necessary to understand the demand for such services. In Indonesia, estimates of demand for emergency services cannot be obtained easily due to a lack of published literature or official reports concerning the matter. This study aimed to ascertain an estimate of the annual volume of hospital emergency visits and the corresponding demand for ambulance services in the city of Jakarta. In this study, we addressed the problem of emergency services demand estimation when aggregated detailed data are not available or are not part of the routine data collection. We used survey data together with the local Office of National Statistics reports and sample data from hospital emergency departments to establish parameter estimation. This involved estimating 4 parameters: the population of each area per period (day and night), the annual per capita hospital emergency visits, the probability of an emergency taking place in each period, and the rate of ambulance need per area. Monte Carlo simulation and naïve methods were used to generate an estimation for the mean ambulance needs per area in Jakarta. The results estimated that the total annual ambulance need in Jakarta is between 83,000 and 241,000. Assuming the rate of ambulance usage in Jakarta at 9.3%, we estimated the total annual hospital emergency visits in Jakarta at around 0.9-2.6 million. The study also found that the estimation from using the simulation method was smaller than the average (naïve) methods (P<.001). The results provide an estimation of the annual emergency services needed for the city of Jakarta. In the absence of aggregated routinely collected data on emergency medical service usage in Jakarta, our results provide insights into whether the current emergency services, such as ambulances, have been adequately provided.

Using Learning Health System Principles to Embed Patient Experience Data in Primary Care: A Qualitative Investigation.

Though an important component of high-quality healthcare, the routine collection of patient experience data is limited in primary care, as is the evidence for how this data is being used for quality improvement. This study used a learning health system (LHS) framework to describe how a university-affiliated community general practice is integrating patient experience data into service and quality improvement efforts, and to identify barriers and facilitators. A co-designed qualitative case study was conducted with academic researchers and staff from a university-affiliated general practice in Australia. Semi-structured interviews were conducted in April 2024 with practice staff, and transcripts were deductively coded according to a five-domain learning health systems framework, and with additional codes capturing barriers and facilitators. Eighteen (53%) practice staff were interviewed, including general practitioners (n=11), a practice nurse (n=1), and administrative staff (n=6). Participants identified multiple methods through which the practice captured the patient experience that spanned all domains of the LHS framework. However, there was less evidence of a coherent quality improvement strategy being employed, with associated barriers identified around staff workloads, training, and existing government funding policies. Key facilitators to the use of patient experience data included: membership of a larger health organisation and university; key dedicated administrative and clinical roles; and effective leadership, governance structures and policies to support continuous learning and drive service improvement. This study presents a case example of how patient experience data is being integrated into general practice and identifies key barriers and facilitators to initiating and translating this data for continuous healthcare improvement. By mapping the use of patient experience data to a LHS framework, this study shows how LHS principles can be applied to primary care to facilitate the capture and use of patient experience data on an ongoing basis.

A high proportion of patients demonstrate recall bias in the retrospective collection of patient-reported outcomes following hip arthroscopy.

The aim of this study is to assess agreement between retrospectively and prospectively collected patient-reported outcome measures (PROMs) following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Patients undergoing hip arthroscopy from 2021 to 2023 for FAIS completed preoperative PROMs, including the modified Harris Hip Score (mHHS) and the Non-Arthritic Hip Score (NAHS). Post-operatively, patients were surveyed and asked to recall their preoperative hip function. Paired two-sample t tests were used to compare baseline and recalled baseline PROMs and the difference between scores was compared to previously published minimally clinically important difference (MCID) values. Intraclass correlation coefficients (ICCs) were calculated to test the reliability between scores based on a single-rater, two-way mixed-effects model. Multivariable regression, accounting for age, sex and preoperative baseline scores, was used to evaluate the relationship of time elapsed since surgery with recall accuracy. A total of 116 patients (age: 37.6 ± 11.8 years; 61.2% female) were included. The mean time elapsed for recalled data was 13.1 months (range: 1-27 months). Overall, patients' recalled scores were significantly lower than those prospectively collected (mHHS: 52.9 ± 20.1 vs. 61.5 ± 18.5, p < 0.0001; NAHS: 54.7 ± 20.0 vs. 58.8 ± 19.1, p < 0.0001). Frequency distribution found 68.1% of recalled mHHS and 61.2% of NAHS scores to have a greater difference (between baseline and recalled scores) than the MCID. The ICC was moderate for both mHHS (ICC = 0.559, 95% confidence interval [CI] = [0.420-0.672], p < 0.001) and NAHS (ICC = 0.612, 95% CI = [0.484-0.714], p < 0.001). Multivariate regression analysis did not find time elapsed since surgery to be associated with the difference between baseline and recalled mHHS (n.s.) or NAHS (n.s.). There are significant differences between retrospective and prospectively collected PROMs in patients undergoing hip arthroscopy that are not predicted by time to recall. These findings should impact the interpretation of the existing literature, support the routine collection of prospective data and inform patient counsel regarding their perceived post-operative outcomes. Level IV.

Using Routinely Collected Health Data to Estimate the Prevalence of Alzheimer's Disease and Potentially Modifiable Risk Factors in Colombia.

With an increasing prevalence, Alzheimer's Disease (AD) is the most common cause of dementia. However, a percentage of potentially modifiable cases have been reported. This article describes the prevalence of four of these potentially modifiable risk factors: hearing loss, diabetes mellitus (DM), obesity, and hypertension. Descriptive cross-sectional study with data from 2018 to 2022, using the Colombian health system database SISPRO. The population of this study consisted of all people within the age range 50-100 with a main diagnosis of AD according to the ICD-10 codes. Subjects were divided by decades, and the prevalence ratio (PR) for the outcome of AD and each of its potentially modifiable risk factors was then calculated and adjusted by age using the Mantel-Haenszel formula. 167,556 cases of AD were identified, with 66.4% being females. Peak age was in octogenarians, and the five-years period prevalence for people older than 50 was 12.6 cases/1000 people. The PRs showed a positive association for all risk factors, except obesity. Following age correction, obesity's PR value shifted to positive in males and overall population but remained negative for females. The highest post-correction PR in the overall population was hypertension (1.44), followed by DM (1.34), hearing loss (1.31) and obesity (1.12). Notably, PRs had a greater magnitude in younger and male age groups. The results of this study are consistent with the fact that the prevalence of potentially modifiable risk factors is higher within the group of people with AD as their main diagnosis.

The Application of Digital-Genomic Tools to Improve Productivity and Profitability in Smallholder Dairy Systems in sub-Saharan Africa

Abstract The dairy sector contributes 30% and 44% of the livestock-related agricultural GDP in Tanzania and Kenya, respectively. Despite this significant contribution, it is predominantly comprised smallholder farmers with few cows providing vital support in terms of food security, household income and employment for millions of farmers. Research aimed at enhancing productivity and sustainability in these smallholder dairy systems is crucial for rural development, increasing farm incomes, creating employment and supporting women and youth. However, a major challenge is the absence of a routine performance data collection system. Previous efforts to address this limitation often relied on methods from well-established dairy systems in developed countries which frequently failed to adapt effectively. Advances in mobile technology have prompted attempts to investigate alternative cost-effective and practical data recording systems in the smallholder dairy farming with a major focus on information and communications technology (ICT). Successful implementation of digital tools for data collection and synthesis to generate management information as feedback to farmers using ICT-based extension tools has led to increased productivity and household income. Additionally, the use of genomic information allows for genetic evaluation with minimal pedigree information and supports the initiation of breed improvement programs for increased productivity. Information © The Authors 2024

Retrospective cohort study of ambulatory care pharmacist interventions’ impact on incidence of therapeutic response in anxiety and depression

AbstractIntroductionAmbulatory care pharmacists continue to expand their involvement in the management of various disease states across the United States, including anxiety and depression. There is limited literature assessing the clinical impact of these practice advances implemented by pharmacists who do not carry psychiatric training (i.e., psychiatric board certification or mental health training) within primary care.MethodsThis was a retrospective, multicenter, cohort study of adult patients who had at least one documented visit between February 2020 and August 2023 with an ambulatory care pharmacist who did not carry additional psychiatric training to comanage their diagnosis of depression and/or anxiety. The primary outcome was the achievement of a therapeutic response (a reduction of 50% or greater in Patient Health Questionnaire 9‐item depression scale [PHQ‐9] and/or the Generalized Anxiety Disorder 7‐item scale [GAD‐7] scores). Secondary outcomes included the change in PHQ‐9 and/or GAD‐7 scores, incidence of remission, predictors of therapeutic response, pharmacist intervention subtypes, and percentage use of pharmacogenomics.ResultsTherapeutic response for PHQ‐9 was achieved for 60 (48.4%) of 124 patients included after utilization of an ambulatory care pharmacist without additional psychiatric training embedded in primary care. While two‐thirds of patients had comorbid anxiety, 43 (57.4%) could not be evaluated for clinical improvement as they did not have available GAD‐7 scores for analysis. Available PHQ‐9 and GAD‐7 scores had median score reductions of 5 (−11,0) and 4.5 (−7.75, 3.5), respectively, at approximately 6 months (p &lt; 0.001 and p = 0.023). Patients had a median number of 4 (2, 5) visits with a pharmacist and a median number of 2 (1, 3) interventions.ConclusionsAmbulatory care pharmacists, regardless of additional psychiatric training, can help patients achieve a therapeutic response for depression and anxiety as well as significantly improve PHQ‐9 and GAD‐7 scores. Additional education on the importance of GAD‐7 monitoring is warranted given its lack of routine collection and evaluation among patients presenting with comorbid depression and anxiety.

Direct electron detection for EBSD of low symmetry & beam sensitive ceramics

Electron backscatter diffraction (EBSD) is a powerful tool for determining the orientations of near-surface grains in engineering materials. However, many ceramics present challenges for routine EBSD data collection and indexing due to small grain sizes, high crack densities, beam and charge sensitivities, low crystal symmetries, and pseudo-symmetric pattern variants. Micro-cracked monoclinic hafnia, tetragonal hafnon, and hafnia/hafnon composites exhibit all such features, and are used in the present work to show the efficacy of a novel workflow based on a direct detecting EBSD sensor and a state-of-the-art pattern indexing approach. At 5 and 10 keV primary beam energies (where beam-induced damage and surface charge accumulation are minimal), the direct electron detector produces superior diffraction patterns with 10x lower doses compared to a phosphor-coupled indirect detector. Further, pseudo-symmetric variant-related indexing errors from a Hough-based approach (which account for at least 4%-14% of map areas) are easily resolved by dictionary indexing. In short, the workflow unlocks fundamentally new opportunities to characterize materials historically unsuited for EBSD.

The role of routine and structured social needs data collection in improving care in US hospitals.

To understand how health-related social needs (HRSN) data are collected at US hospitals and implications for use. Using 2023 nationally representative survey data on US hospitals (N = 2775), we described hospitals' routine and structured collection and use of HRSN data and examined the relationship between methods of data collection and specific uses. Multivariate logistic regression was used to identify characteristics associated with data collection and use and understand how methods of data collection relate to use. In 2023, 88% of hospitals collected HRSN data (64% routinely, 72% structured). While hospitals commonly used data for internal purposes (eg, discharge planning, 79%), those that collected data routinely and in a structured format (58%) used data for purposes involving coordination or exchange with other organizations (eg, making referrals, 74%) at higher rates than hospitals that collected data but not routinely or in a non-structured format (eg, 93% vs 67% for referrals, P< .05). In multivariate regression, routine and structured data collection was positively associated with all uses of data examined. Hospital location, ownership, system-affiliation, value-based care participation, and critical access designation were associated with HRSN data collection, but only system-affiliation was consistently (positively) associated with use. While most hospitals screen for social needs, fewer collect data routinely and in a structured format that would facilitate downstream use. Routine and structured data collection was associated with greater use, particularly for secondary purposes. Routine and structured screening may result in more actionable data that facilitates use for various purposes that support patient care and improve community and population health, indicating the importance of continuing efforts to increase routine screening and standardize HRSN data collection.

Health related outcomes of patients with serious traumatic injury: Results of a longitudinal follow-up program delivered by trauma clinicians

IntroductionThe routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program. MethodsThis is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point. ResultsFive-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54–9.21, p=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09–3.48, p=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75–13.5, p=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points. ConclusionPersistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.

Revealed and stated preferences for sharing of patient-reported data in Austria

Abstract Objectives Routine collection of health data is essential for creating sustainable, efficient, and equitable health systems. While administrative health data are collected automatically, successful routine collection of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) depends on voluntary participation. The aim of this study is to investigate how to increase participation in routine patient-reported data collection. Methods This mixed methods study used representative survey data from the Austrian population aged 18-70 (N = 1260) and 15 semi-structured narrative interviews with citizens and health data experts collected in 2024. Survey respondents were shown examples of PREMs and PROMs and indicated their willingness to share them, depending on the recipient and purpose. Interviewees answered the same questions while providing insight into their decision-making process, which was analyzed using thematic analysis. Wilcoxon rank sum tests were used to assess differences in willingness to share across recipients and data collection purposes. Results Survey respondents were more willing to share PREMs than PROMs (“rather yes” vs. “rather no”, p &amp;lt; 0.001). One explanation given in the interviews is that PROMs are more personal and convey sensitive information. In terms of sharing PROMs, people were most likely to share with their GP (81%) and least likely to share with private companies (7%). Facilitators for sharing identified in the interviews were improving personal care and the health system, while barriers were use for profit generation and fear of negative consequences for the person sharing. Conclusions The results suggest handling the collection of PROMs demands greater caution compared to PREMs. Furthermore, clearly communicating personal and societal benefits arising from the collection and analysis of self-reported health data may increase participation in routine self-reported health data collection. Key messages • The collection of self-reported health data depends on voluntary participation. Clearly communicating personal and societal benefits of sharing self-reported data can motivate participation. • Self-reported data collection is essential for sustainable and efficient health systems. Compared to PREMs, people are more reluctant to share PROMs because they contain sensitive information.

7.P. Skills building seminar: Using health impact assessment for assessing tobacco control policies

Abstract Tobacco use is the largest contributor to premature death and preventable disease in Europe. Despite decreasing tobacco use in recent years, the European Commission estimates that the number of smokers in Europe is 26% in the population, and 29% among 15-24 year olds. This persistent public health risk is amenable to policy, but targeted and effective strategies are needed. Health impact assessment (HIA) methods can aid decision-makers in exploring the consequences of policy actions on select outcomes, providing a platform for informed, evidence-based policy design. Routine data collection on risk factors including smoking and tobacco use behaviour is common and available in Europe. Analysing and valorising these data can provide a better picture of vulnerable and target groups for which tobacco use is a persistent problem, or where the attributable disease burden is particularly high. These data can form the basis for robust projections and the application of HIA methods. In addition, a number of policy strategies exist for tobacco control including changes in packaging, taxation, labelling, ingredients, creation of smoke-free environments, and restrictions on advertising. These policies have a common goal in improving tobacco control, but may lead to differential effects across age groups, populations, and different measures of tobacco use. It is thus necessary to use robust tools to understand these effects and better coordinate and plan policy. HIA methods, each with their own strengths and limitations, have been applied successfully to estimate the impact of different tobacco control measures. Novel methodologies that make use of available data, computational power, and provide a low-cost way to explore policy interventions can be an essential tool to policy planning and in particular to tackle the intractable areas of tobacco control. This skills building workshop will present two key approaches, each with their own strengths and weaknesses, that have been applied in HIA studies on tobacco control - i.e., a static approach based on the calculation of potential impact fraction, and a dynamic approach based on microsimulation models. Furthermore, the workshop will demonstrate, using two real-life examples, how policy measures can be translated into effect size estimates - which is one of the most crucial steps in any HIA. By providing a step-by-step presentation of how HIA has been applied in practice, attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control. Key messages • Tobacco use remains the largest contributor to preventable disease burden in Europe; a key area for analysing policies using health impact assessment. • Attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control.

Predictive value of a positive pocket swab for the occurrence of device infection in implantable cardioverter defibrillator patients undergoing generator replacement or lead revision

Abstract Introduction Bacterial colonization of generator pockets in implantable cardioverter defibrillator (ICD) patients plays a key role in the development of device infection after revision surgery. Pocket swabs taken at revision may be useful for predicting device infection, but their prognostic value is not precisely known. Aim of the study was to evaluate the predictive value of positive pocket swabs for cardiac device infection in ICD patients undergoing revision surgery. Methods A total of 646 consecutive ICD patients from a prospective single-centre ICD-registry who underwent elective device replacement, system upgrade or lead revision between 2014 and 6/2023 were analyzed. Independent predictors for device infection were evaluated by a Cox regression analysis adjusting for age, gender, EF, insulin dependent diabetes, anticoagulation, multiple leads, revision surgery and the PADIT score. Results Positive pocket swabs were obtained in 12% of patients. The baseline characteristics of ICD patients with positive versus negative pocket swabs were similar (Table 1). With an average follow-up of 3 years, the infection rate in patients with positive pocket swabs was around 5 times higher than in patients with negative swabs (19% versus 4%, p &amp;lt; 0.001). In a Cox regression analysis, a positive pocket swab was the strongest independent predictor for device infection during follow-up (hazard ratio 4.26, 95% confidence interval 2.15 – 8.45, Table 2). Conclusion A positive swab from ICD-pockets in patients undergoing generator replacement or lead revision is an independent predictor of device infection during follow-up. These results support the routine collection of pocket swabs from patients undergoing revision surgery.Table 1Table 2

Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative.

The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings.