Data Collection Template Research Articles

Racial and socioeconomic disparities in patient experience of clinician empathy: a protocol for systematic review and meta-analysis

IntroductionClinician empathy is a vital component of high-quality healthcare. Healthcare disparities may reflect a societal lack of empathy for disadvantaged persons in general, and recent research suggests that socioeconomic disparities...

Indoor air monitoring: Sharing and accessing data via the Information Platform for chemical monitoring (IPCHEM).

The European Commission has developed and put in place the Information Platform for Chemical Monitoring Data (IPCHEM), to promote a more coherent approach to the generation, collection, storage and use of chemical monitoring data in relation to humans and the environment. This paper describes the specific development of the IPCHEM thematic module "Products and Indoor Air Data" which aims to facilitate the retrieval of and access to existing and future chemical monitoring data sources stemming from e.g. national monitoring programs of EU Member States and EU funded projects. The current development focusses on harmonised data and metadata templates and code lists related to indoor air monitoring data. The extension and revision of the IPCHEM metadata and data collection templates for indoor air monitoring data was based on harmonisation and standardisation efforts on the development of indoor air monitoring protocols and guidelines for monitoring indoor pollution attributed to chemical and biological stressors, which were undertaken by European Commission Services, EU funded projects and research networks and EU Members States. A list of ten candidate data collections for potential integration were identified and prioritised. A different level of relevance was attributed to the enhanced metadata and data elements (mandatory, recommended, optional) to allow for their flexible applicability by end users. These elements should be provided for reaching the required quality in the data documentation as well as for ensuring a correct data traceability and interpretation. The proposed enhanced metadata and data models of the IPCHEM thematic module "Products and Indoor Air Data" can be used by data providers when planning and setting up their future indoor air monitoring campaigns, or to further mapping and harmonising data elements of their existing data collections for further integration into IPCHEM. This will boost the effective implementation of a coordinated approach for collecting, accessing and sharing existing and future indoor air monitoring data in support of policy making.

A data management workflow of biodiversity data from the field to data users.

PremiseHeterogeneity of biodiversity data from the collections, research, and management communities presents challenges for data findability, accessibility, interoperability, and reusability. Workflows designed with data collection, standards, dissemination, and reuse in mind will generate better information across geopolitical, administrative, and institutional boundaries. Here, we present our data workflow as a case study of how we collected, shared, and used data from multiple sources.MethodsIn 2012, we initiated the collection of biodiversity data relating to Michigan prairie fens, including data on plant communities and the federally endangered Poweshiek skipperling (Oarisma poweshiek).ResultsOver 23,000 occurrence records were compiled in a database following Darwin Core standards. The records were linked with media and biological, chemical, and geometric measurements. We published the data as Global Biodiversity Information Facility data sets and in Symbiota SEINet portals.DiscussionWe highlight data collection techniques that optimized transcription time, including the use of predetermined and controlled vocabulary, Darwin Core terms, and data dictionaries. The validity and longevity of our data were supported by voucher specimens, metadata with measurement records, and published manuscripts detailing methods and data sets. Key to our data dissemination was cooperation among partners and the utilization of dynamic tools. To increase data interoperability, we need flexible and customizable data collection templates, coding, and enhanced communication among communities using biodiversity data.

Chronic neuropathic pain after traumatic peripheral nerve injuries in the upper extremity: prevalence, demographic and surgical determinants, impact on health and on pain medication.

Background and aims Aside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated with chronic neuropathic pain after nerve injuries in the upper extremity were assessed. Methods A standardized data collection template was employed prospectively and retrospectively for all patients with traumatic nerve injuries accepted at the Hand Surgery Department, Uppsala, Sweden between 2010 and 2018. The template included demographic data, pain diagnosis, type of injured nerve, level of injury, date of the lesion and repair, type of procedure, reoperation, time since the procedure, S-LANSS questionnaire (Self report-Leeds Assessment of Neuropathic Symptoms and Signs), RAND-36 (Item short form health survey), QuickDASH (Disability of Shoulder, Arm and Hand) and additional questionnaires concerned medication, pain intensity were sent to 1,051 patients with nerve injuries. Partial proportional odds models were used to investigate the association between persistent pain and potential predictors. Results More than half of the patients undergoing a surgical procedure developed persistent pain. Prevalence of neuropathic pain was 73% of the patients with pain (S-LANSS ≥ 12 or more). Multivariate analysis indicated that injury of a major nerve OR 1.6 (p = 0.013), years from surgery OR 0.91 (p = 0.01), younger age OR 0.7 (p < 0.001), were the main factors for predicting pain after surgery. The type of the nerve injured was the strongest predictor for chronic pain with major nerves associated with more pain (p = 0.019). Conclusions A high prevalence of chronic pain and neuropathic pain with a negative impact on quality of life and disability were found in patients after traumatic nerve injury. Major nerve injury, younger age and less time from surgery were predictors for chronic pain.

Effectiveness of Interventions Aimed at Increasing Statin-Prescribing Rates in Primary Cardiovascular Disease Prevention

Statins are a cornerstone medication in cardiovascular disease prevention, but their use in clinical practice remains suboptimal, with less than half of people who are indicated for statins actually taking the medication. To perform a systematic review and synthesis of the literature on patient-oriented and physician-oriented interventions aimed at increasing statin-prescribing rates in adults without a history of cardiovascular disease. PubMed, Embase, and the Cochrane Library were searched for randomized clinical trials published between January 2000 and May 2019. Data abstraction was performed using the Cochrane Public Health Review Group's data collection template, and a narrative synthesis of study results was conducted. The risk of bias in each study was qualitatively assessed, and a funnel plot was created to further evaluate the risk of publication bias. Among 7948 citations and 128 full-text articles reviewed, 20 studies (of 109 807 patients) were included in the review. Eight trials reported a statistically significant increases in statin-prescribing rates. Among the effective trials, absolute effect sizes ranged from 4.2% (95% CI, 2.2%-6.4%) to 23% (95% CI, 7.3%-38.9%) and odds ratios from 1.29 (95% CI, 1.01-1.66) to 11.8 (95% CI, 8.8-15.9). Patient-education initiatives were the most commonly effective intervention, with 4 of 7 trials indicating increases in statin-prescribing rates. Two trials combined electronic decision-support tools with audit-and-feedback systems, both of which were effective overall. Physician-education programs without dynamic input regarding patient risk or updated treatment recommendations were generally found to be less effective. While heterogeneous in their interventions and outcomes, a number of interventions have demonstrated increases in statin-prescribing rates, with patient-education initiatives demonstrating more promising results than those focused on physician education alone. As opposed to more education about generic recommendations, tailored patient-focused and physician-focused interventions were more effective when they provided personalized cardiovascular risk information, dynamic decision-support tools, or audit-and-feedback reports in a multicomponent program. There are a number of modestly successful approaches to implement increases in rates of statin prescribing, a proven yet underused cardiovascular disease prevention class of therapy.

Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries

BackgroundProcess evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD).MethodsPreliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified.ResultsThe case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation.ConclusionThis research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts.

Overseas GP recruitment: comparing international GP training with the UK and ensuring that registration standards and patient safety are maintained.

BackgroundAmbitious overseas recruitment targets have been set by the UK government to help alleviate the current GP shortage. European Economic Area (EEA) doctors can join the UK’s GP register under European law. Non-EEA doctors must obtain a Certificate of Eligibility for General Practice Registration (CEGPR), demonstrating equivalence to UK-trained doctors. CEGPR applications can be time-consuming and burdensome. To meet overseas recruitment targets, it is important to facilitate the most efficient route into UK general practice while maintaining registration standards and patient safety.AimTo develop a methodology to map postgraduate GP training and healthcare contextual data from an overseas country to the UK.Design & settingDesk-based research and stakeholder interviews.MethodFour stages were undertaken: 1) developing a data collection template; 2) conducting a case study (using Australia as a test case); 3) refining the data collection template; and 4) creating a mapping framework. The case study used the 2016 curricula for the UK and Australia.ResultsFive ‘domains’ were identified: healthcare context, training pathway, curriculum, assessment, and continuing professional development (CPD) and revalidation. The final data collection template comprised 49 mapping items across the domains. The methodology incorporated the application of a red, amber, or green (RAG) rating to indicate similarity of data across the five domains. Australia was rated ‘green’ for training pathway, curriculum, and assessment, and ‘amber’ for healthcare context and CPD and revalidation. The overall rating was ‘green’.ConclusionImplementing this systematic methodology for mapping GP training between countries may support the UK’s ambitions to recruit more GPs, and alleviate current GP workforce pressures.

Health outcomes related to the provision of free, tangible goods: A systematic review.

BackgroundFree provision of tangible goods that may improve health is one approach to addressing discrepancies in health outcomes related to income, yet it is unclear whether providing goods for free improves health. We systematically reviewed the literature that reported the association between the free provision of tangible goods and health outcomes.MethodsA search was performed for relevant literature in all languages from 1995-May 2017. Eligible studies were observational and experimental which had at least one tangible item provided for free and had at least one quantitative measure of health. Studies were excluded if the intervention was primarily a service and the free good was relatively unimportant; if the good was a medication; or if the data in a study was duplicated in another study. Covidence screening software was used to manage articles for two levels of screening. Data was extracted using an adaption of the Cochrane data collection template. Health outcomes, those that affect the quality or duration of life, are the outcomes of interest. The study was registered with PROSPERO (CRD42017069463).FindingsThe initial search identified 3370 articles and 59 were included in the final set with a range of 20 to 252 246 participants. The risk of bias assessment revealed that overall, the studies were of medium to high quality. Among the studies included in this review, 80 health outcomes were statistically significant favouring the intervention, 19 health outcomes were statistically significant favouring the control, 141 health outcomes were not significant and significance was unknown for 28 health outcomes.InterpretationThe results of this systematic review provide evidence that free goods can improve health outcomes in certain circumstances, although there were important gaps and limitations in the existing literature.

Teaching Observational Data Collection to Early Childhood Preservice Educators

Making data-based decisions is a pervasive expectation for educators and is linked to improved outcomes for students. Observational data collection for progress monitoring, in particular, can help educators track and support students’ progress toward individualized educational goals in inclusive settings. Yet, many educators struggle with data collection. In this study, the authors use a multiple baseline across participants’ single-case design to investigate the effectiveness of a data collection intervention on early childhood preservice educators’ data collection quality. Preservice educators received data collection templates, instruction, and individualized feedback to improve their ability to collect observational data and use it to inform practice. Preservice educators’ participation in the instructional program improved the quality of their data collection; however, continued feedback was necessary for some skills to improve. Implications for preparing early educators to collect and use observational progress monitoring data are discussed.

CE: Original Research: New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do?

This study sought to assess the frequency with which family caregivers of cognitively impaired older adults sought prehospital guidance from health care professionals when that resource was available to them, and to describe the characteristics of such events. This study used a retrospective chart review of patients who were enrolled in the Orlando Veterans Affairs Medical Center HBPC program for at least one month between October 1, 2013, and September 30, 2014; had a diagnosis indicative of cognitive impairment (Alzheimer's disease, vascular dementia, or mild cognitive impairment); had a dedicated family caregiver; and were not enrolled in hospice care. Data were collected from data collection templates and nurses' narrative notes. Univariate descriptive analyses were conducted regarding the type of staff contacted by family caregivers, the presenting diagnoses, the guidance offered by staff, and the number of unplanned acute care encounters. Among the 215 patients studied, there were 254 unplanned acute care encounters (including ED visits followed by discharge to home and ED visits resulting in hospital admission). Family caregivers sought guidance from a health care professional 22% of the time before such an encounter. The presenting clinical issues were most often new problems (43%) that included falls, feeding tube problems, fever, new pain, rash or other skin problems, and unexplained edema. Overall, 25% of all unplanned acute care encounters were for reasons considered potentially avoidable. About half of the patients who were subsequently hospitalized had symptoms of delirium, indicating that their illness had significantly advanced before presentation. It's important for health care professionals to ensure that family caregivers of cognitively impaired older adults can access professional guidance readily when facing decisions about a loved one's care, especially when there is an acute onset of new symptoms. Teaching caregivers how to recognize such symptoms early in order to prevent exacerbations of chronic illness and subsequent hospitalization should be a high priority. Our findings underscore the need to do so, so that caregivers can best use the resources that HBPC programs have (or ought to have) in place, in particular 24/7 guidance and decision assistance.

The application of keystone flap combined with vacuum-assisted closure in the repair of sacrococcygeal skin defect after tumor resection.

We aimed to explore the efficacy of keystone flap combined with vacuum-assisted closure (VAC) in the repair of sacrococcygeal wounds. This study is a retrospective review of patients undergoing keystone flap reconstruction between January 2014 and January 2018. A standardized data collection template was used to collect related variables. The detailed process of the reconstructive surgery is carefully described in this study. The postoperative healing process was closely observed. Twelve patients underwent keystone flap repair between January 2014 and January 2018. The average wound size before closure measured 7.83 ± 1.93 × 5.28 ± 0.91 cm. All the patients achieved primary wound healing and the flaps survived during the follow-up period, which ranged from 1 to 24 months. No severe complications and obvious scar appeared, and the patients were satisfied with both appearance and function. The application of keystone flap combined with VAC is a promising way to repair wounds in the sacrococcygeal region with little postoperative complication and similar soft-tissue thickness to the surrounding tissue.

An inventory framework for inclusion of textile chemicals in life cycle assessment

PurposeToxicity impacts of chemicals have only been covered to a minor extent in LCA studies of textile products. The two main reasons for this exclusion are (1) the lack of life cycle inventory (LCI) data on use and emissions of textile-related chemicals, and (2) the lack of life cycle impact assessment (LCIA) data for calculating impacts based on the LCI data. This paper addresses the first of these two.MethodsIn order to facilitate the LCI analysis for LCA practitioners, an inventory framework was developed. The framework builds on a nomenclature for textile-related chemicals which was used to build up a generic chemical product inventory for use in LCA of textiles. In the chemical product inventory, each chemical product and its content was modelled to fit the subsequent LCIA step. This means that the content and subsequent emission data are time-integrated, including both original content and, when relevant, transformation products as well as impurities. Another key feature of the framework is the modelling of modularised process performance in terms of emissions to air and water.Results and discussionThe inventory framework follows the traditional structure of LCI databases to allow for use together with existing LCI and LCIA data. It contains LCI data sets for common textile processes (unit processes), including use and emissions of textile-related chemicals. The data sets can be used for screening LCA studies and/or, due to their modular structure, also modified. Modified data sets can be modelled from recipes of input chemicals, where the chemical product inventory provides LCA-compatible content and emission data. The data sets and the chemical product inventory can also be used as data collection templates in more detailed LCA studies.ConclusionsA parallel development of a nomenclature for and acquisition of LCI data resulted in the creation of a modularised inventory framework. The framework advances the LCA method to provide results that can guide towards reduced environmental impact from textile production, including also the toxicity impacts from textile chemicals.RecommendationsThe framework can be used for guiding stakeholders of the textile sector in macro-level decisions regarding the effectiveness of different impact reduction interventions, as well as for guiding on-site decisions in textile manufacturing.

Summary of available surveillance data on hepatitis C virus infection from eight Arctic countries, 2012 to 2014.

We summarised available hepatitis C virus (HCV) surveillance data for 2012–14 from Arctic/sub-Arctic countries/regions. We sent a HCV data collection template by email to public health authorities in all jurisdictions. Population statistics obtained from census sources for each country were used to estimate rates of reported acute and chronic/undifferentiated HCV cases. Seven countries with Arctic regions (Canada, Denmark, Finland, Greenland, Norway, Sweden and the United States, represented by the state of Alaska), including three Canadian territories and one province, as well as 11 Russian subnational Arctic regions, completed the data collection template. Data on acute HCV infection during 2014 was available from three Arctic countries and all Russian Arctic regions (rate range 0/100,000 population in Greenland, as well as Nenets and Chukotka Automous Okrugs (Russian subnational Arctic regions) to 3.7/100,000 in the Russian Republic of Komi). The rate of people with chronic/undifferentiated HCV infection in 2014 ranged from 0/100,000 in Greenland to 171.2/100,000 in Alaska. In most countries/regions, the majority of HCV-infected people were male and aged 19–64 years. Differences in surveillance methods preclude direct comparisons of HCV surveillance data between Arctic countries/regions. Our data can inform future efforts to develop standardised approaches to HCV surveillance in the Arctic countries/regions by identifying similarities/differences between the surveillance data collected.

Radionuclide synovectomy/synoviorthesis (RS) in patients with bleeding disorders: A review of patient and procedure demographics and functional outcomes in the ATHNdataset.

Radionuclide synovectomy/synoviorthesis (RS) to manage proliferative synovitis in persons with bleeding disorders has been utilized for decades; however, aggregate US results are limited. To determine the prevalence of RS utilization, patient and procedure related demographics and functional outcomes in United States haemophilia treatment centres (HTCs). The ATHNdataset includes US patients with bleeding disorders who have authorized the sharing of their demographic and clinical information for research. We performed a multi-institutional, observational cohort study utilizing this dataset through 2010. Cases treated with RS procedure were compared to controls within the dataset. Standard template for data collection included patient and procedure related demographics as well as functional outcomes including range of motion (ROM) of the affected joint. Normative age- and sex-matched control ROM was obtained from published data. In the ATHNdataset there were 19539 control-patients and 196 case-patients treated with RS. Patients with severe haemophilia were more likely to have had RS compared to those with mild/moderate haemophilia, although the proportion of RS performed was similar between severe HA and HB. Inhibitory antibodies, HIV and hepatitis C infection were significantly more common in cases. There were 362 RS procedures captured with 94 cases having >1 RS procedures. Right-sided joint procedures were more prevalent than left-sided procedures. Overall, case-patients had worse joint ROM compared to control-patients and published normative values. Geographically, there was regional variation in RS utilization, as the Southeast region had the largest percent of case-patients.

Sources and reliability of property market information for property valuation practice in Ghana

PurposeAdequate reliable property market data are critical to the production of professional and ethical valuations as well as better real estate transaction decision-making. However, the availability of reliable property market information represents a major barrier to improving valuation practices in Ghana and it is regarded as a key challenge. The purpose of this paper is to investigate the sources and reliability of property market information for valuation practice in Ghana. The aim is to provide input into initiatives to address the availability of reliable property market data challenges.Design/methodology/approachA mixed methods research approach is used. The study, thus, relies on a combination of a systematic identification and review of literature, a stakeholder workshop and a questionnaire survey of real estate valuers in Accra, Ghana’s capital city to obtain requisite data to address the aim.FindingsThe study identifies seven property market data sources used by valuers to obtain market data for valuation practice. These are: valuers own database; public institutions; professional colleagues; property owners; estate developers; estate agents; and the media. However, access to property market information for valuations is a challenge although valuers would like to use reliable market data for their valuations. This is due to incomplete and scattered nature of data often borne out of administrative lapses; non-disclosure of details of property transactions due to confidentiality arrangements and the quest to evade taxes; data integrity concerns; and lack of requisite training and experience especially for estate agents to collect and manage market data. Although professional colleagues is the most used market data source, valuers own databases, was regarded as the most reliable source compared to the media, which was considered as the least reliable source.Research limitations/implicationsFindings from the study imply a need for the development of a systematic approach to property market data collection and management. This will require practitioners to demonstrate care, consciousness and a set of data collection skills suggesting a need for valuers and estate agents to undergo regular relevant training to develop and enhance their knowledge, skills and capabilities. The establishment of a property market databank to help in the provision of reliable market data along with a suitable market data collection template to ensure effective and efficient data collection are considered essential steps.Originality/valueThe study makes a significant contribution to the extant knowledge by providing empirical evidence on the frequency of use and the reliability of the various sources of market data. It also provides useful insights for regulators such as the Ghana Institution of Surveyors (GhIS), the Royal Institution of Chartered Surveyors (RICS) and other stakeholders such as the Commonwealth Association of Surveying and Land Economy (CASLE) and the Government to improve the provision of reliable property market information towards developing valuation practice not only in Ghana, but across the Sub-Saharan Africa Region. Also, based on these findings, the study proposes a new property market data collection template and guidelines towards improving the collection of effective property market data. Upon refinement, these could aid valuation practitioners to collect reliable property market data to improve valuation practice.

Two years retrospective study of maxillofacial trauma at a tertiary center in North West Ethiopia

BackgroundMaxillofacial injury poses a challenge to oral and maxillofacial surgeons working in developing countries with limited resource and human power. The present study aimed to determine the etiology, pattern, and management of maxillofacial trauma in Gondar university of Gondar hospital.MethodsA retrospective descriptive study design was used. Medical registration retrieving of patients with maxillofacial trauma visited dental center of University of Gondar Hospital from September 2013 to August 2015 was done. During data collection, etiology of trauma, pattern of fracture, treatment modality and complications were recorded using predesigned data collection template and analyzed using SPSS computer software version 20. Statistical analysis was done to show the sex distribution of maxillofacial trauma and the effect of alcohol intake on the incidence of trauma.ResultsDuring 2-year period, September 2013–August 2015, 326 patients of maxillofacial trauma were treated in the dental center of university of Gondar hospital. The mean age was 29.12 (± 8.62) with age range of 11–75 years. Majority of the study participants (47.2%) were within the age group of 21–30 years. Eighty percent of the participants were male with a male to female ratio of 4.02:1. Interpersonal violence (75.8%) and Road traffic accident (21.5%) were the leading causes. Males are at high risk of maxillofacial trauma relative to females (P < 0.0001). There was high incidence of trauma in the weekend, rural residents, December to February, mandibular fractures and soft tissue injuries were the most common injuries. There was an associated injury in 79 (24.2%) patients in head and neck area, thoracic, abdominal and extremities. Half of the patients were managed conservatively (49.7%) with debridement and suture, while 45.7% of the patients were closed reduction and 4.6% were surgical open reduction. There were 25 post procedure complications especially in mandibular fractures.ConclusionInterpersonal violence was the major cause of maxillofacial trauma, while mandible and soft tissue were the most affected maxillofacial areas. The federal ministry of health, Ethiopia should have well-organized maxillofacial center in tertiary hospitals for emergency management to avoid morbidity and mortality.

EFFECT OF CASH RECONCILIATION ON THE FINANCIAL PERFORMANCE OF COMMERCIAL BANKS IN KENYA

Purpose: The main aim of the study was to examine the effect of cash reconciliation on the financial performance of commercial banks in Kenya.Methodology: The research was carried out through a descriptive survey research design. The study population was all the 43 commercial banks registered and licensed to operate in Kenya. A multi stage sampling approach was used. In the first stage, a census of all the 43 commercial banks was conducted, that is, the units of analysis were the commercial bank. In the second stage, purposive sampling was used where two respondents from every organization were taken. The study used both primary and secondary data for analysis. Primary data was collected using questionnaires while secondary data was obtained using secondary data collection template. A multiple linear regression model was used to link variables.Findings: The study findings indicated a positive correlation between cash reconciliation and financial performance of commercial banks. Cash reconciliation was positively and significantly related to both ROE and ROA. The study concluded that cash reconciliation is positively and significantly related to financial performance of commercial banks in Kenya.Unique contribution to theory, practice and policy: The study recommends that commercial banks and other financial institutions involved in handling of cash should put in place proper reconciliation practices. The commercial banks should focus on increasing the number of times books are reconciled, increase the regularity of auditing the cash books, put in place and implement a policy on cash reconciliation, training its staff on conducting cash reconciliation and segregating the duties of cash reconciliation other duties so as to evolve specialization. The study recommended further studies to establish the effect of cash handling practices on financial performance of other financial institutions other than commercial banks. This will be crucial in comparison of the results and identification of more research gaps for future studies.

EFFECT OF CASH TRANSPORT ON THE FINANCIAL PERFORMANCE OF COMMERCIAL BANKS IN KENYA

Purpose: The main aim of the study was to assess the effect of cash transport on the financial performance of commercial banks in Kenya.Methodology: The research was carried out through a descriptive survey research design. The study population was all the 43 commercial banks registered and licensed to operate in Kenya. A multi stage sampling approach was used. In the first stage, a census of all the 43 commercial banks was conducted, that is, the units of analysis were the commercial bank. In the second stage, purposive sampling was used where two respondents from every organization were taken. The study used both primary and secondary data for analysis. Primary data was collected using questionnaires while secondary data was obtained using secondary data collection template. A multiple linear regression model was used to link variables.Findings: The study findings indicated a positive correlation between cash transport and financial performance of commercial banks. Cash transport was positively and significantly related to ROA. The study concluded that cash reconciliation is positively and significantly related to financial performance of commercial banks in Kenya,Unique contribution to theory, practice and policy: The study recommends that commercial banks and other financial institutions involved in handling of cash should have a cash transport policy which clearly stipulates how cash in transit should be handled, regularly review the contracts of companies which transport cash for them so as to avoid known routines, have tracking devices in the vehicles that transport cash, engage administrative police in security arrangements when transporting cash and invest in cash in transit measures like chase cars. The study recommended further studies to establish the effect of cash handling practices on financial performance of other financial institutions other than commercial banks. This will be crucial in comparison of the results and identification of more research gaps for future studies.

The changing face of acute pain services

Background and AimsAcute Pain Services have been implemented initially to treat inadequate postoperative pain. This study was undertaken to prospectively review the current challenges of the APS team in an academic hospital assessing the effects of its activity on both surgical and medical pain intensity. It also define the characteristics of the patients and the risk factors influencing the multiple visits from the APS team. MethodThis prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to the APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before, after treatment and the number of follow-ups. The patients were visited by APS at regular intervals and divided by the number of visits by APS team into several groups: group 1 (one visit and up to 2 follow ups); group 2 (3 to 4 follow-ups); group 3 (5 to 9 follow-ups); group 4 (10 to 19 follow-ups); group 5 (>20 followups). The difference between groups were analyzed with ordinal logistic regression analyses. ResultsPatients (n=730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P=0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 8.7–9.9) to 6.3 (6.1–7.4) for the severe pain (P<0.0001), from 3.8 (3.2–4.3) to 2.4 (1.8–2.9) for the moderate pain. The odds ratio for frequent follow-ups of the patients between 18 and 85 years (n=609) was 2.33 (95% CI: 1.35–4.02) if the patient had a history of chronic neuropathic pain, 1.80(1.25–2.60) in case the patient had a history of chronic nociceptive pain, 2.06(1.30–3.26) if he had mental diseases, and 3.35(2.21–5.08) if he had opioid dependency at the time of consultation from APS. Strong predictors of frequent visits included female gender (P=0.04). ConclusionsBeside the benefits of APS in reducing pain intensity, this study demonstrates that the focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients with a high comorbidity of psychiatric diseases, opioid dependency and chronic pain. ImplicationsThe concept of an APS will ultimately be redefined according to the new clinical variables. In the light of the increasing number of patients with complex pain states and chronic pain, opioid dependency and psychiatric comorbidities it is mandatory that the interdisciplinary APS team should include other specialties besides the “classical interdisciplinary APS team”, as psychiatry, psychology, rehabilitation and physiotherapy with experience in treating chronic pain patients.

LO05: In patients presenting to the ED with STEMI, is the provision of morphine associated with worse patient outcomes?

Introduction: ST-elevation myocardial infarction (STEMI) presenting to the ED is a significant health burden. The provision of IV morphine with doses titrated to provide comfort is recommended in the AHA STEMI Guidelines, yet there is limited evidence of safety in this setting. The primary objective of this study was to measure potential harm associated with the provision of IV morphine in STEMI patients presenting to the ED. Methods: This was a two centre retrospective chart review from an urban, inner city, academic ED with an annual census of 85,000 visits, and an affiliated community hospital with 35,000 annual visits. Consecutive patients from April 2009 to January 2015 presenting to the 2 EDs with a diagnosis of STEMI were identified in the ED database. Eight trained research assistants, blinded to the study hypothesis, used standardized data collection templates. The primary investigator double collected 20% of all data to ensure completeness and accuracy. Results: We included 311 patients with STEMI (124 received morphine [M]; 187 no morphine [nM]). The ages of the two groups were similar (mean 64 yrs [M] &amp;amp; 67 yrs [nM]; median 63 yrs [M] &amp;amp; 66 yrs [nM]; IQR 45-81 [M] and 45.5-86.5 [nM]); as were the proportion of female patients (21.0% [M] &amp;amp; 23.5% [nM]. The pre-STEMI Charlson comorbidity scores (mean 2.6), median time to first ECG (11 min [M] &amp;amp; 16 min [nM]), and mean time-to-needle for PCI (96.8 min [M] &amp;amp; 92.0 min [nM]) were similar between groups. The mean CCU length of stay (LOS) (9.3 days vs 6.3 days) and hospital LOS (7.4 days vs 4.6 days) were longer for patients receiving morphine than those not receiving morphine. Rates of congestive heart failure, acute kidney injury and cardiac arrest in hospital were unchanged between the groups. Unadjusted mortality was similar (10.5% [M] vs 13.3% [nM]) between groups. Binary logistic regression controlling for age, Charlson score, first and peak troponin values demonstrated an association between receiving morphine in the ED and an increased risk of death at 30 days (OR 8.1; 95% CI 7.1.-9.1). Conclusion: The provision of morphine to patients with STEMI in the ED may be associated with increased CCU and hospital LOS. When controlling for age, pre-STEMI Charlson score, first and peak troponin values, receiving morphine was associated with an increased risk of death at 30 days. Further research to elucidate this association is warranted.