Ward Level Research Articles

Measuring urbanicity as a risk factor for childhood wheeze in a transitional area of coastal ecuador: a cross-sectional analysis

BackgroundThe urbanisation process has been associated with increases in asthma prevalence, an observation supported largely by studies comparing urban with rural populations. The nature of this association remains poorly understood,...

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Inter and intra seasonal trends in livelihoods options have been reported at country and rarely at ward level in Zimbabwe. Evidence based on local level trends in livelihoods options is rare. This study thus   reviewed data on livelihoods activities based on the Agriculture Food Security Monitoring System (AFSMS) surveillance system. It was conducted by the Department of Crop and Livestock Production formerly Department of Agricultural Technical and Extension Services (AGRITEX) in four wards of Murewa District over 5 seasons from 2010 to 2014. It was done to document local trends in livelihoods options over time for improved food security. The review consulted AGRITEX records, secondary data from web and other public documents. The results showed that income generating activities and livelihoods options at local ward level fluctuate within the farming season and across seasons. However, contributing factors were not ascertained in this study. Casual labour and market gardening were major sources of livelihoods in the wards under study in contrast to generalised extension reports which indicate crop production as a major livelihood option in the study district. The paper provides local level evidence on trends of livelihoods options and  argues for diversified livelihoods coping strategies and adoption of extension messages that go beyond crop and livestock production to include other non–farm (off -farm) based livelihoods options such as brick moulding, arts and crafts. Key words: Trends in livelihoods, socio-economic, extension, income generation, food security, local level. &nbsp

Antimicrobial Resistance Patterns: Review of the Antibiogram of a Surgical Unit in a Public Tertiary Care Hospital of Pakistan.

IntroductionAntimicrobial resistance (AMR) has become a challenge in modern-day medical practice. The pace at which microbes are becoming resistant to antibiotics is greater than the discovery of novel antimicrobial agents. There is a need to study these antimicrobial patterns and, for this purpose, antibiograms should be developed at the levels of wards and hospitals and studied to guide us better on how to choose suitable empirical therapy for our patients.Methods and materialsA total of 286 reports were studied, which contained the culture and sensitivity data of all the patients admitted under the care of Surgical Unit-1 in Lahore General Hospital between April 1, 2019, and October 31, 2019. All the samples for culture and sensitivity were sent to the in-house laboratory of the hospital where the reporting was done by the pathology department. They were inoculated and then intubated, and gram staining was performed. Antibiotic resistance and susceptibility were measured by the disk diffusion method according to the Clinical and Laboratory standards institute (CSLI) guidelines.ResultsThe most common isolated organism was Escherichia coli​​​​​​​ (E. coli) in 65 (24%) patients, the next most common was Acinetobacter species in 62 (23%), followed by Pseudomonas species 52(19%), Klebsiella species 32 (13%), Staphylococcus aureus 30 (11%), Coagulase-negative Staphylococci 20 (7%), Enterobacter species (2%), and Citrobacter species (1%). The antimicrobial susceptibility of E. coli was highest for aminoglycosides and carbapenems like amikacin (78%), meropenem (71%), and imipenem (63%). Acinetobacter was most sensitive to colistin (100%), amikacin (31%), meropenem (21%), and cefoperazone + sulbactam (21%). Pseudomonas was also most sensitive to colistin (93%) and after that amikacin (52%), meropenem (52%), and imipenem (44%). Klebsiella was most sensitive to colistin (86%), imipenem (60%), and aminoglycosides (50%). Among gram-positive organisms, Staphylococcus aureus was sensitive to linezolid (100%) and vancomycin (100%).ConclusionThe vast majority of isolated organisms in this study were gram-negative bacteria, and most were showing high antimicrobial resistance. The antibiograms should be developed and regularly updated at every ward and hospital. There is a need to bring more awareness about the proper use of antimicrobials among healthcare workers, and antimicrobial stewardship programs can help in this matter.

Spatial Dynamics of Racialized Income Inequality in the Washington, DC, Metropolitan Area

This article presents findings of an analysis of the association between changes in neighborhoods’ racial composition and income inequality in the Washington, DC, metropolitan area. We cluster U.S. Census data at the ward and district levels and find that the connection between race and income inequality appears potent in Washington, DC. Racially more homogeneous wards have lower income inequalities than those that are racially heterogeneous. We also show that two alternative measures of neighborhood-level racial diversity—proportion white and an entropy score—account for substantial shares in the variation in household incomes in these wards. In contrast, these patterns in the surrounding counties are less pronounced. Our analysis suggests that the U.S. capital’s growing prosperity and improved fiscal health have intensified income inequality across the DC metropolitan area especially within Washington, DC. We probe into these differences and argue that place stratification theory is helpful to understand changing neighborhood compositions in the entire Washington, DC, metropolitan area. Our results illustrate a need for more effective policy coordination across jurisdictions as well as greater consideration of housing policy to help decrease residential segregation and support vulnerable residents in and around the U.S. capital city.

Shared decision-making in advance care planning for persons with dementia in nursing homes: a cross-sectional study

BackgroundShared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently.MethodsThe study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency.ResultsAt ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ = 16.09) and 81.11/100 (σ = 19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ = 10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ = 0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ = 0.51) and competence (x̄=3.76/5, σ = 0.27) with which these skills were practiced (P < 0.001).ConclusionsResidents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the three-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.

Hand Hygiene in Acute Care Hospitals—Evaluation of 12 Years National Hand Hygiene Campaign in Germany

Background: Hand hygiene is one of the most effective measures to prevent healthcare-associated infections and transmission of multidrug-resistant organisms in healthcare settings. The WHO proposes a multimodal intervention strategy to improve hand hygiene in healthcare settings. In 2008, a voluntary national campaign for hand hygiene was implemented in the German healthcare system. The objective of this study was to evaluate participation, practices, and performance of hand hygiene in German acute-care hospitals. Methods: In 2008 a national hand hygiene campaign began in Germany. Based on voluntary participation, the campaign’s goal was to implement the WHO 5 Moments model, to establish a national surveillance system for compliance to hand hygiene, to improve availability of alcohol-based hand-rub (ABHR) dispensers at points of care, and to implement interdisciplinary executive boards at each hospital to ensure sustainable implementation. Annual data on ABHR consumption and patient days (PD) were collected within the national surveillance system (HAND-KISS) on the individual ward level and were validated. Direct observation of compliance was performed according the recommendations of the WHO. Results: Overall, 1,047 of 1,942 acute-care hospitals in Germany participated in the national hand hygiene campaign in 2018, covering 81,571,917 patient days. Moreover, 9,360 regular wards (RWs), 338 intermediate care units (IMCs) and 1,342 intensive care units (ICUs) provided data on ABHR consumption. Between 2007 and 2018 in the ICU, ABHR consumption increased continuously from 70 mL/PD (IQR, 52–98) to 129 mL/PD (IQR, 102–162). In intermediate care units, ABHR consumption increased from 40 mL/PD (IQR, 15–54) to 67 mL/PD (IQR, 46–95), and on regular wards, ABHR consumption increased from 14 mL/PD (IQR, 10–21) to 29 mL/PD (IQR, 22–39). These increases were especially pronounced in wards that continuously provided annual data for ABHR consumption over the past 12 years. In 2014, electronic documentation for direct observation of compliance to hand hygiene was established. From 2014 until 2018, 1,598,209 opportunities were observed on 1,907 wards of 422 hospitals. The median directly observed compliance in 2018 was 76% (IQR, 66%–84%). Median compliance to the 5 Moments was 71% (IQR, 57%–82%) before touching a patient, 68% (IQR, 51%–85%) before clean or aseptic procedures, 83% (IQR, 72%–92%) after body fluid exposure or risk, 84% (IQR, 75%–90%) after touching a patient, and 74% (IQR, 61%–84%) after touching patient surroundings. Conclusions: The WHO multimodal intervention strategy has been successfully established in German acute-care hospitals. A surveillance system for ABHR consumption and direct observation of compliance to hand hygiene are widely used by hospitals in Germany. Hand hygiene practices have significantly improved in the German healthcare system.Funding: NoneDisclosures: None

The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study.

Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing. To explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards. Retrospective cohort. All unscheduled admissions to an English hospital of people aged ≥75 with cognitive screening over 14months. The exposure was defined as deviation in staffing hours from the ward daily mean, averaged across the patient stay. Outcomes were mortality in hospital/within 30days of discharge and 30-day re-admission. Analyses were stratified by CI. 12,544 admissions were included. Patients with CI (33.2%) were exposed to similar levels of staffing as those without. An additional 0.5 RN hours per day was associated with 10% reduction in the odds of death overall (odds ratio 0.90 [95% CI 0.84-0.97]): 15% in patients with CI (OR 0.85 [0.74-0.98]) and 7% in patients without (OR 0.93 [0.85-1.02]). An additional 0.5 NA hours per day was associated with a 15% increase in mortality in patients with no impairment. Readmissions decreased by 6% for an additional 0.5 RN hours in patients with CI. Although exposure to low staffing was similar, the impact on mortality and readmission for patients with CI was greater. Increased mortality with higher NA staffing in patients without CI needs exploration.

Practices of Policy Making and Planning: A Case of Annapurna Rural Municipality in Kaski District

This paper makes a brief description and analysis of policy formulation and planning process adopted by the local government of Nepal. The main objective of the paper is to study the exercise of policy making and planning of Annapurna Rural Municipality in Kaski District of Gandaki Province, Nepal. The study is based on telephone interviews and person-to-person interviews with elected representatives of the rural municipality and secondary sources of data. Annapurna Rural Municipality has so far formulated more than 23 policies (acts, rules and regulations) for addressing the interest of its citizens. Of these policies, four are acts, two regulations, nine procedural laws and eight codes of conduct. Moreover, official policy makers have a prominent role in public policy making while the unofficial policymakers have little influence on the public policy making. There is no provision of direct participation of people in the policy formulation process. Also, the local government has not developed a practice of taking assistance from hired experts while formulating public policies that demand technical expertise and knowledge. It is observed that the planning process followed by the rural municipality consists of seven steps: tole level assembly, ward level meeting, assembly of Ward, decisions forwarded to office of rural municipality, recommendation by the executive committee, approval by assembly of rural municipality and implementation by executive bodies like the office of rural municipality, ward office, etc. The results indicated that the rural municipality has, to some extent, guaranteed the participation of its citizens in the planning and implementation activities. However, despite the bottom-up approach of planning being practiced, all people, irrespective of their political orientation, do not have equal opportunity to make their voice being heard to the planning process. However, it lacks inclusiveness.

Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial

BackgroundPatients, particularly older people, often experience safety issues when transitioning from hospital to home. Although the evidence is currently equivocal as to how we can improve this transition of care, interventions that support patient involvement may be more effective. The ‘Your Care Needs You’ (YCNY) intervention supports patients to ‘know more’ and ‘do more’ whilst in hospital in order that they better understand their health condition and medications, maintain their daily activities, and can seek help at home if required. The intervention aims to reduce emergency hospital readmissions and improve safety and experience during the transition to home.MethodsAs part of the Partners At Care Transitions (PACT) programme of research, a multi-centred cluster randomised controlled trial (cRCT) will be conducted to explore the feasibility of the YCNY intervention and trial methodology. Data will be used to refine the intervention and develop a protocol for a definitive cRCT.Ten acute hospital wards (the clusters) from varying medical specialties including older peoples’ medicine, trauma and orthopaedics, cardiology, intermediate care, and stroke will be randomised to deliver YCNY or usual care on a 3:2 basis. Up to 200 patients aged 75 years and over and discharged to their own homes will be recruited to the study. Patients will complete follow-up questionnaires at 5-, 30-, and 90-days post-discharge and readmission data up to 90-days post-discharge will be extracted from their medical records.Study outcomes will include measures of feasibility (e.g. screening, recruitment, and retention data) and processes required to collect routine data at a patient and ward level. In addition, interviews and observations involving up to 24 patients/carers and 28 staff will be conducted to qualitatively assess the acceptability, usefulness, and feasibility of the intervention and implementation package to patients and staff. A separate sub-study will be conducted to explore how accurately primary outcome data (30-day emergency hospital readmissions) can be gathered for the definitive cRCT.DiscussionThis study will establish the feasibility of the YCNY intervention which aims to improve safety and experience during transitions of care. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of the YCNY intervention in a definitive cluster randomised controlled trial.Trial registrationUK Clinical Research Network Portfolio: 42191; ISTCRN: ISRCTN51154948. Registered 16/07/2019.

The Danish implementation study on response to pregnancy complications, MAMAACT

Abstract Differential incidence and severity of pregnancy complications are likely important contributing factors to the increased risk of poor pregnancy outcomes among ethnic minority women in Europe. To address this issue, the MAMAACT trial has been developed based on a thorough mixed methods needs assessment and co-creation process, feasibility tested, now implemented in a nationwide complex intervention. The overall aim of the Danish MAMAACT trial is to reduce ethnic and social disparity in stillbirth and newborns' health by improved management of pregnancy complications. The overall target group is all pregnant women, and the specific target group is women of non-Western origin. The hypothesis of MAMAACT is that improved communication between pregnant women and midwives regarding body symptoms that need prompt reaction will improve perinatal health among these vulnerable groups. The intervention consists of postgraduate training of midwives in intercultural communication and a smart phone application and a leaflet, both in six different languages. The app and leaflet target the women and explain the most serious warning signs of pregnancy complications and how to respond to them. MAMAACT is implemented and evaluated in a randomized controlled cluster trial and 10 maternity wards consist the intervention groups, while nine maternity wards are the control groups. The evaluation is a mixed method evaluation focusing on understanding the mechanisms of change, how context at both maternity ward level as well as in the everyday life of women affects the implementation, and finally if effects on health literacy of the women and perinatal health of the children can be documented.

Assessing tourism sustainability in hill towns: Case study of Shimla, India

Hill towns form a popular niche in tourism destinations. They are renowned for their natural beauty and distinctive cultural traditions. Unplanned development can lead to a loss in opportunity to access the potential of these resources or cause their damage. Development decisions need to adopt a sustainable approach that balances tourism growth with the preservation of the natural and cultural assets. The present research details a comprehensive assessment tool to study the sustainability of tourism in hill towns with a focus on Shimla, a popular hill destination in India. The tool specifies seven dimensions of sustainable tourism; 1) Tourism Assets; 2) Tourism Activity; 3) Tourism Related Linkages; 4) Tourism Related Leakages; 5) Environmental and Social Sustainability; 6) Infrastructure; and 7) Attractiveness. Primary data were collected through questionnaire surveys of local households and arriving tourists. Visual survey is conducted to map built-environment and land-use. Secondary data were gathered from government reports and scholarly articles. A framework of indicators and sub-indicators was developed to analyze the data at two levels — city and ward. While the appraisal of the city provides an overall view of the performance of the tourism industry, at the ward level a comparative analysis was carried out to reveal sector related potentials and issues. The study reveals the imbalanced tourism concentration in the core of the city as compared to other wards and the gap between tourist potential and infrastructure development. These are addressed through planning recommendations for more balanced development with a focus on eco-tourism. The research helps develop a framework which paves way to sustainable tourism development in Indian hill towns.

Towards Sustainable Food Services in Hospitals: Expanding the Concept of ‘Plate Waste’ to ‘Tray Waste’

Early debates on the sustainability of food-plating systems in hospitals have concentrated mostly on plate waste food served, but not eaten. This study aims to address the need for more comprehensive studies on sustainable food services systems by expanding the concept of plate waste, to that of tray waste (organic and inorganic materials), through a case study of a hospital in Saudi Arabia. Tray waste arising at the ward level was audited for three weeks, covering 939 meals. It was found that, on average, each patient threw away 0.41, 0.30, 0.12, and 0.02 kg of food, plastic, paper, and metal, respectively, each day. All this equated to 4831 tons of food, 3535 tons of plastic, 1414 tons of paper, and 235 tons of metal each year at hospitals across Saudi Arabia. As all of this waste ends up in landfills, without any form of recycling, this study proposes the need for a more comprehensive, political approach that unites all food system stakeholders around a shared vision of responsible consumption and sustainable development.

P58 Managing access to ‘Out Of Hours‘ medications in a tertiary paediatric hospital

AimsMany UK and Irish hospitals provide a Monday to Friday pharmacy service; automated dispensing cabinets and hospital-wide information systems remain uncommon. Locating and accessing out of hours (OOH) medications can be a significant workload for nursing staff. In an Irish 230-bed tertiary paediatric hospital processes involve: nursing staff contacting other wards by telephone to source items; completion of an ‘Out of Hours Requisition’; and either transferring stock between wards or contacting nursing administration staff (NAS) to access stock from the Pharmacy Department. A quality improvement project was undertaken to: measure current levels of OOH medications; identify areas for improvement; implement and assess impact of new processes.Methods‘Out of Hours Requisition’ data were entered into a custom-built database and analysed for the period January - December 2018. The findings were discussed with nursing staff and NAS. Improving processes for locating medications was identified as a key area for improvement. The ‘Out of Hours Requisition’ form was amended to provide clearer instructions for completion. Using data from clinical area stock lists, a searchable Medicines Locator Database was developed and made accessible to all staff in the pharmacy department, clinical areas and the NAS office in December 2018 enabling staff to remotely identify the location of all medications stocked in the hospital. Data for ‘Out of Hours Requisitions’ for the period January - May 2019 were collated, analysed and compared with data from the same time period in 2018 (January - May). Microsoft Excel® was used for data collection, analyses and development of the Medicines Locator Database.ResultsA total of 1747 OOH medications were accessed by NAS from pharmacy in 2018, 746 during the period January - May 2018. Anti-microbial agents (36%) were most common, with requests originating from 16 clinical areas. Request from the paediatric intensive care units (36%) and the surgical/orthopaedic ward (36%) were most frequent. 515 medications were accessed in the first 5 months after the introduction of the Medicines Locator Database (January - May 2019). This represents a 35% reduction in the number of medications dispensed in the same time period in 2018. No changes to the types of medications were identified, but some differences in clinical areas were found.ConclusionThis significant reduction (35%) in numbers of medications accessed out of hours, and the corresponding reduction in workload for NAS, demonstrates the benefits of reviewing medication management processes. Further substantial time savings for nursing staff locating stock at ward level are likely. Readily-available technology can be successfully employed to improve processes in the absence of more sophisticated technological solutions. A staff survey is planned to evaluate awareness and usability of the database and identify further areas for improvement.

Letter: Strategies for Prevention and Control of 2019 Novel Coronavirus Infection Among Medical Staff.

Letter: Strategies for Prevention and Control of 2019 Novel Coronavirus Infection Among Medical Staff.

Challenges and learning in carrying out an enhanced sample to provide small area data for the dental survey of five-year-old children in England.

To investigate the method, learning and challenges of using an enhanced sample to provide small area data for the dental survey of five-year-old children in England. Pilot in six London local authorities, of increased sample size during a national survey to enable a more precise sample size calculation to deliver information accurate at electoral ward level. Challenges were explored through interviews with the teams who either planned or conducted the survey. A revised sample size recommendation for the national guidance on carrying out dental surveys of five-year-old children in England, where caries levels are similar to those seen in the pilot areas; the challenges identified were gaining access to schools and consent from parents, making the calculation for the additional sample and securing sufficient workforce. This paper has described a method for delivering small area caries data by increasing the size of the sample. Learning, and understanding the outcomes and challenges from this work can inform planning and delivery of future surveys using an enhanced sample at ward level.

Green space indicators in a social-ecological system: A case study of Varanasi, India

From an ecological perspective, quantification indicators of urban green space distribution and accessibility have been the focus of only a few studies. To determine the thresholds of various urban drivers influencing the extent of green spaces was the major objective of this study. We selected Varanasi, a typical city having transition-features of a rapidly growing million-plus city, as a model using a multivariate approach. The ward level differences with literates, workers, population density, household density, per-capita green space, open spaces, built area and green spaces were found to be non-linearly distributed. Indicators for green spaces were identified using the Generalized Additive Model (GAM). Varanasi showed a variation of per capita green-spaces from 0 to 59.95 m2 at the ward level. Green-spaces showed a large negative correlation with population density (τ = −0.5), household density (τ = −0.5) and built area (τ = −0.7). Sustainability thresholds for built land use and open spaces were identified as 49–76 % and 5.6 %, respectively. Provision of greenspaces even in very small amounts and education based on a local environmental perspective is essential in creating a sustainable urban landscape. The threshold values of identified indicators can help in devising a “safe operating space” for sustainable and healthy urban landscape planning, worldwide.

Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data

BackgroundThe level of registered nurse (RN) staffing is a fundamental factor influencing patient safety. Craniotomy patients need intensive care after surgery, the majority of which is provided by RNs.MethodsThis study was conducted to investigate the relationship of the RN staffing level of general wards and intensive care units (ICUs) with in-hospital mortality after craniotomy using Korean National Health Insurance claim data. The RN staffing level was categorized based on the bed-to-RN ratio.ResultsThe in-hospital mortality rate of craniotomy patients was elevated at hospitals with a high bed-to-RN ratio in general wards, ICUs, and hospitals overall. It was determined that in-hospital mortality of craniotomy patients could be decreased by more than 50% by reducing the bed-to-RN ratio from 4.5 or more to less than 3.5 in general wards, from 1.25 or more to less than 0.88 in ICUs, and from 2.5 or more to less than 1.67 in hospitals overall.ConclusionsSince the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, a sufficient staffing level of RNs should be ensured to reduce the mortality of craniotomy patients.

Effectiveness of Group Problem Management Plus (Group-PM+) for adults affected by humanitarian crises in Nepal: study protocol for a cluster randomized controlled trial

BackgroundGlobally, the lack of availability of psychological services for people exposed to adversities has led to the development of a range of scalable psychological interventions with features that enable better scale-up. Problem Management Plus (PM+) is a brief intervention of five sessions that can be delivered by non-specialists. It is designed for people in communities in low- and middle-income countries (LMIC) affected by any kind of adversity. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the effectiveness of individually delivered PM+. A group version of PM+ has been developed to make the intervention more scalable and acceptable. This paper describes the protocol for a cluster randomized controlled trial (c-RCT) on locally adapted Group PM+ in Nepal.Methods/designThis c-RCT will compare Group PM+ to enhanced usual care (EUC) in participants with high levels of psychological distress recruited from the community. The study is designed as a two-arm, single-blind c-RCT that will be conducted in a community-based setting in Morang, a flood affected district in Eastern Nepal. Randomization will occur at ward level, the smallest administrative level in Nepal, with 72 enrolled wards allocated to Group PM+ or to EUC (ratio 1:1). Group PM+ consists of five approximately 2.5-h sessions, in which participants are taught techniques to manage their stressors and problems, and is delivered by trained and supervised community psychosocial workers (CPSWs). EUC consists of a family meeting with (a) basic information on adversity and mental health, (b) benefits of getting support, (c) information on seeking services from local health facilities with mhGAP-trained staff. The primary outcome measure is levels of individual psychological distress at endline (equivalent to 20 ± 1 weeks after baseline), measured by the General Health Questionnaire (GHQ-12). Secondary outcome measures include levels of functioning, depressive symptoms, post-traumatic stress disorder symptoms, levels of social support, somatic symptoms, and ways of coping. We hypothesize that skills acquired will mediate any impact of the intervention.DiscussionThis c-RCT will contribute to the growing evidence-base for transdiagnostic psychological interventions delivered by non-specialists for people in communities affected by adversity. If Group PM+ is proven effective, the intervention manual will be released for use, giving the opportunity for further adaptation and implementation of the intervention in diverse settings with communities that require better access to psychological interventions.Trial registrationClinicalTrials.gov, NCT03747055.

Do organisational and ward-level factors explain the variance in multi-site musculoskeletal pain in eldercare workers? A multi-level cross-sectional study.

Multi-site musculoskeletal pain (MSP) is highly prevalent among eldercare workers, leading to increased incidence of sickness absence and early retirement. Most research on MSP in eldercare workers has focused on individual-level factors reported by the employees, with limited focus at the organisation and ward level. To address this gap, the aim of this study was to investigate whether organisation and ward-level factors explain the variance in MSP among Danish eldercare workers. A multi-level cross-sectional study was conducted among 20 Danish nursing homes, containing 126 wards, and 418 workers who participated in measurements of organisational factors, working environment factors, and MSP (classified as reporting pain in 2 or more body regions). Data were collected at the level of the organisation, ward, and individual. The proportion of variance in MSP explained by each level was estimated using variance components analysis. The association between factors at each level of the organisation and MSP was investigated using generalised linear mixed-effects regression. Sixty seven percent of participants reported having MSP. The organisational and ward-level factors explained 0% of the variance in MSP, while the individual-level factors explained 100% of the variance in MSP. Moreover, no factors at the organisational and ward levels showed statistically significant associations with MSP. Individual-level perceived physical exertion and quantitative demands had a statistically significant association with a higher prevalence of MSP. The organisation and ward levels did not contribute to explaining any of the variance in MSP. All variance in MSP was explained at the individual level.

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BackgroundThe use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners.MethodsThe aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation.ResultsA continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a ‘positive narration’ of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals’ levels.ConclusionsThe PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours.