Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital‐acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital‐acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score‐adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in‐hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30‐, 60‐, and 90‐day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital‐acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.
Traditional quality measures for chronic wounds have focused on objective outcomes that are challenging to risk adjust, lack patient input, and have limited ability to inform quality improvement interventions. Patient‐reported experience measures (PREMs) provide information from the patient perspective regarding health care quality and have potential to improve patient‐centredness, increase care efficiency, and generate actionable data for quality improvement. The purpose of this study was to understand patient experiences and health care processes that impact quality of care among patients with chronic wounds. Sixty patients at least 18 years of age with various wound aetiologies were recruited from Canada, Denmark, The Netherlands, and the United States as part of a larger phase 1 qualitative study to develop a patient‐reported outcome measure for chronic wounds (WOUND‐Q). All patients had a chronic wound for at least 3 months, were fluent in their native speaking language, and able to participate in a one‐on‐one semi‐structured interview. Interviews were digitally recorded and transcribed verbatim. Interpretive description was used to identify recurrent themes relating to patient experience and quality of care. We identified five domains (care coordination, establishing/obtaining care, information delivery, patient‐provider interaction, and treatment delivery) and 21 sub‐domains (access to patient information, interdisciplinary communication, encounter efficiency, provider availability, specialist referral, staff professionalism, travel/convenience, modality, reciprocity, understandability/consistency, accountability, continuity, credentials, rapport, appropriateness, complication management, continuity, environment/setting, equipment and supply needs, expectation, and patient‐centred) as potential opportunities to measure and improve quality of care in the chronic wound population. PREMs for chronic wounds represent an important opportunity to engage patients and longitudinally assess quality across clinical settings and providers. Future research should focus on developing PREMs to complement traditional objective and patient‐reported outcome measures for chronic wounds.
We estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healthcare utilisation of medically trained providers and reduction of out-of-pocket (OOP) expenditure among ready-made garment (RMG) workers.
We used a case–control study design with cross-sectional preintervention and postintervention surveys.
The study was conducted among workers of seven purposively selected RMG factories in Shafipur, Gazipur in Bangladesh.
In total, 1924 RMG workers (480 from the insured and 482 from the uninsured, in each period) were surveyed from insured and uninsured RMG factories, respectively, in the preintervention (October 2013) and postintervention (April 2015) period.
We tested the effect of a pilot ESHI scheme which was implemented for 1 year.
The outcome measures were utilisation of medically trained providers and reduction of OOP expenditure among RMG workers. We estimated difference-in-difference (DiD) and applied two-part regression model to measure the association between healthcare utilisation, OOP payments and ESHI scheme membership while controlling for the socioeconomic characteristics of workers.
The ESHI scheme increased healthcare utilisation of medically trained providers by 26.1% (DiD=26.1; p
The ESHI scheme significantly increased utilisation of medically trained providers among RMG workers. However, it has no significant effect on OOP expenditure. It can be recommended that an educational intervention be provided to RMG workers to improve their healthcare-seeking behaviours and increase their utilisation of ESHI-designated healthcare providers while keeping OOP payments low.
In this study, we assess the performance of public hospitals in Saudi Arabia. We detect the sources of inefficiency and estimate the optimal levels of the resources that provide the current level of health services. We enrich our analysis by employing locations and capacities of the hospitals.
We employ data envelopment analysis (DEA) to measure the technical efficiency of 91 public hospitals. We apply the input-oriented Charnes, Cooper and Rhodes, and Banker, Charne, Cooper models under Constant and Variable Returns-to-Scale. The assessment includes four inputs, and six output variables taken from the Ministry of Health databases for 2017. We conducted the assessment via PIM-DEA V.3.2 software.
Ministry of health-affiliated hospitals in the Kingdom of Saudi Arabia.
Findings identified 75.8% (69 of 91) of public hospitals as technically inefficient. The average efficiency score was 0.76, indicating that hospitals could have reduced their inputs by 24% without reduction in health service provision. Small hospitals (efficiency score 0.79) were more efficient than medium-sized and large hospitals. Hospitals in the central region were more efficient (efficiency score 0.83), than those located in other geographical locations. More than half of the hospitals (62.6%) were operating suboptimally in terms of the scale efficiency, implying that to improve efficiency, they need to alter their production capacity. Performance analysis identified overuse of physician’s numbers and shortage of health services production, as major causes of inefficiency.
Most hospitals were technically inefficient and operating at suboptimal scale size and indicate that many hospitals may improve their performance through efficient utilisation of health resources to provide the current level of health services. Changes in the production capacity are required, to facilitate optimal use of medical capacity. The inefficient hospitals could benefit from these findings to benchmarking their system and performance in light of the efficient hospital within their capacity and geographical location.
To explore how children and young adults from divorced families experience double bereavement when they lose a divorced parent with cancer and how the double bereavement influences their mental health consequences and need of support.
Children and young people who are confronted with the cancer and death of a parent is a highly stressful life event, which is associated with an increased risk of mental health problems, especially when children experience divorced parental cancer and death.
Participant observations and interviews with a phenomenological‐hermeneutic approach and COREQ standards for reporting qualitative research.
We conducted 340 hr of participant observations within nine different support groups totalling 27 children and young adults from divorced families and included 28 interviews with participants and relatives. Analyses are based on Ricoeur's theory of interpretation: naïve reading, structural analysis, interpretation and discussion.
The experiences with double bereavement identified three main themes: 1. navigating through multiple transitions and disruptions within two family worlds; 2. consequences for mental health including stress overload and disruptions to well‐being; and 3. need for accessible support derived from close relationships and professionals within and in‐between family worlds.
Children and young adult's double bereavement includes multiple transitions and disruptions often related to stress overload and mental health problems. Support from close relationships and professionals is experienced as helpful in the prevention and mitigation of mental health problems.
There is a need for targeted accessible support availability to children, young adults and their families when a divorced parent is dying of cancer in clinical practice. Our findings suggest that specific health policies for health professionals should be developed to target improved support for these families.
In June 2015, Alberta, Canada instituted a universal publicly funded rotavirus vaccination programme (Rotarix, RV1), with vaccine doses scheduled for 2 and 4 months of age. Vaccination was restricted so that infants were only allowed to receive first dose between 6 and 20 weeks of age, and second dose before eight calendar months of age. We assessed the coverage and schedule non-compliance of rotavirus vaccination for babies born between June 2015 and August 2016, that is, since the inception of the publicly funded rotavirus vaccination programme, and determined factors associated with rotavirus vaccine uptake.
Retrospective cohort study using linked administrative health data.
Cohort of 66 689 children.
(1) First and second dose rotavirus vaccination coverage, (2) percent of children non-compliant with recommended vaccine schedule and (3) adjusted ORs for factors associated with vaccination status.
For the 66 689 children included in the study, coverage levels for one-dose and two-dose rotavirus vaccination were 87% and 83%, respectively. In comparison, two-dose diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine coverage was 92%, despite having the same dosing schedule. Schedule non-compliance during the publicly funded programme was very low. We observed socioeconomic disparities in the uptake of the vaccine, with income, location of residence and number of children in the household all contributing to the odds of a child being vaccinated with rotavirus.
Compliance to the recommended rotavirus schedule was very high, suggesting that even with the restrictive rotavirus vaccine schedule, the vaccine can be delivered on-time. However, rotavirus vaccine coverage remained lower than DTaP, a similarly scheduled childhood vaccination. We also observed socioeconomic disparities in vaccine uptake. These findings raise concerns about rotavirus protection in the groups at highest risk for gastrointestinal illness, including low-income and rural populations.
To compare the effect of a lifestyle intervention programme using mobile application versus booklet for adults with metabolic syndrome living in the community.
A multi‐site randomized controlled trial with three parallel arms, namely, metabolic syndrome app group, booklet group and control group.
The research study has been supported by the Health and Medical Research fund in Hong Kong in 2019. The protocol was approved by the study university and the selected community centres. Three hundred and sixty subjects will be recruited from community centers and randomized into either one arm. Inclusion criteria are those adult with metabolic syndrome, able to use a smart phone. All participant receive a 30‐min health educational session. App Group participants will receive a mobile application while Booklet Group participants will receive a specific booklet of metabolic syndrome care and the control group receive a placebo booklet only. The primary outcomes comprises of body weight. The secondary outcomes include total physical exercise, cardiometablolic risk factors, cardiovascular endurance, self‐efficacy for exercise and stress level. Data will be collected at baseline, week 4, week 12 and week 24. SPSS and Generalized Estimating equations model will be employed for data analysis.
Metabolic syndrome is a common health problem associated with heightened risk of cardiovascular disease and the risks are potentially amenable to lifestyle intervention. The results will compare the relative effectiveness of a life‐ style intervention using an app versus a booklet on physical and psychological outcomes for adults with metabolic syndrome.
what problem will the study address?
The results will inform the health care professional and nurses about the effective way for health promotion, to enhance patient's life‐style modification and exercise sustainability that will be beneficial to clients’ health.
(a) To review the literature on the use of technology to offer emotional and social support to nurses; (b) to identify and evaluate gaps in the research; (c) to assess whether a systematic review would be valuable and (d) to make recommendations for future research.
A robust methodological scoping framework was used as the basis for this review design. A manualized systematic approach to quality appraisal was implemented.
Between 11–12 June 2018, five databases were searched. A search of the grey literature was conducted alongside hand searching reference lists of included studies.
Two researchers conducted the literature search, data extraction and quality appraisal. Three searches were conducted, combining nursing and technological terms. A narrative review approach to knowledge synthesis was used to compare and evaluate included studies.
Eleven articles were retrieved. Results are presented under three subheadings: (a) text messaging and messenger apps; (b) social media and online forums; and (c) online interventions accessible via PC, smartphone and tablet. All included studies described how such provision could be beneficial; decreasing stress, isolation and anxiety and fostering a sense of community.
The review identified a dearth of research into how technology can support the well‐being of nurses. A high proportion of studies were based on student nurse populations using small sample sizes, therefore further research is needed.
Technology may offer a sustainable and accessible means of providing support for nurses who find it difficult to communicate in person due to time pressures at work. It is important that the psychological well‐being of nurses is seriously addressed as more nurses are now leaving than joining the profession. Online interventions may offer a sustainable and accessible means of providing support for busy nursing staff who have difficulty finding time to communicate with one another face‐to‐face. Nurse retention is an international issue linked to quality of patient care. There are financial implications for healthcare providers who compensate for the workforce deficit by employing costly agency staff. This scoping review aims to map and evaluate the available literature on technology‐mediated support for the emotional and social well‐being of nurses. Recommendations for future research, policy and practice will be offered from the findings of the review.
The appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods.
We will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual’s first positive influenza test during the season, and potential controls will be defined based on an individual’s first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression.
Ethics approval was obtained from the University of Alberta’s Health Research Ethics Board—Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.
The objective of this analysis was to examine trends in malaria parasite prevalence and related socioeconomic inequalities in malaria indicators from 2006 to 2013 during a period of intensification of malaria control interventions in Siaya County, western Kenya.
Data were analysed from eight independent annual cross-sectional surveys from a combined sample of 19 315 individuals selected from 7253 households. Study setting was a health and demographic surveillance area of western Kenya. Data collected included demographic factors, household assets, fever and medication use, malaria parasitaemia by microscopy, insecticide-treated bed net (ITN) use and care-seeking behaviour. Households were classified into five socioeconomic status and dichotomised into poorest households (poorest 60%) and less poor households (richest 40%). Adjusted prevalence ratios (aPR) were calculated using a multivariate generalised linear model accounting for clustering and cox proportional hazard for pooled data assuming constant follow-up time.
Overall, malaria infection prevalence was 36.5% and was significantly higher among poorest individuals compared with the less poor (39.9% vs 33.5%, aPR=1.17; 95% CI 1.11 to 1.23) but no change in prevalence over time (trend p value
Despite attainment of equity in ITN use over time, socioeconomic inequalities still existed in the distribution of malaria. This might be due to a lower likelihood of treatment with an effective antimalarial and lower use of ITNs by poorest individuals. Additional strategies are necessary to reduce socioeconomic inequities in prevention and control of malaria in endemic areas in order to achieve universal health coverage and sustainable development goals.
To develop an understanding of how Indigenous mothers experience selecting and using health services for their infants can assist nurses in improving their access to care. This understanding may ultimately lead to improved health outcomes for Indigenous infants and their families.
Access to acute care services is important to minimise morbidity and mortality from urgent health issues; however, Indigenous people describe difficulties accessing care. Indigenous infants are known to use the emergency department frequently, yet little is known about the facilitators and barriers their mothers experience when accessing these services.
This study undertook a qualitative, interpretive description design.
This article adheres to the reporting guidelines of COREQ. Data collection methods included interviews and a discussion group with Indigenous mothers (n = 19). Data analysis was collaborative and incorporated both Indigenous and Western ways of knowing, through the application of Two‐Eyed Seeing.
A thematic summary resulted in six themes: (a) problematic wait times; (b) the hidden costs of acute care; (c) paediatric care; (d) trusting relationships; (e) racism and discrimination; and (f) holistic care.
The experiences of Indigenous mothers using acute care services for their infants suggest a role for culturally safe and trauma and violence‐informed care by health providers in the acute care context.
Nurses can improve access to acute care services for Indigenous mothers and infants through the provision of culturally safe and trauma and violence‐informed approaches care, by building rapport with families, providing care that is respectful and nonjudgemental, eliminating fees associated with using acute care services and linking families with cultural resources both in hospital and within the community.
Venepuncture involves the introduction of a needle into a vein to collect a representative blood sample for laboratory testing. In the pre‐analytical phase, haemolysis (the rupturing of erythrocytes and release of their contents into the extracellular compartment) has safety, quality and cost implications. Training in correct venepuncture practice has the potential to reduce in vitro haemolysis rates, but the evidence for this notion has yet to be synthesised.
Systematic review (PRISMA Checklist).
Published studies on the effectiveness of venepuncture training on haemolysis rates were searched in relevant databases. The McMaster critical appraisal tool was used to assess methodological quality. The GRADE tool was used to evaluate the body of evidence in relation to the research questions. Implementation fidelity was also scrutinised in each study.
Eight out of 437 retrieved studies met the inclusion criteria. None were randomised controlled trials (RCT). Between‐study heterogeneity in design, intervention characteristics and the biochemical threshold for haemolysis precluded a meta‐analysis. Post‐training reductions in haemolysis rates of between 0.4%–19.8% were reported in four of the studies, which developed their intervention according to a clear evidence base and included mentoring in the intervention. Rises in haemolysis rates of between 1.3%–1.9% were reported in two studies, while the intervention effect was inconsistent within two other studies.
There are no RCTS on the effectiveness of venepuncture training for reducing haemolysis rates, and findings from the existing uncontrolled studies are unclear. For a more robust evidence base, we recommend more RCTs with standardisation of haemolysis thresholds and training‐related factors.
While venepuncture training is an important factor influencing quality of blood sample in clinical practice, more robust evidence is needed to make specific recommendations about training content for reduction of haemolysis rates. Standardisation of haemolysis thresholds would also enable future meta‐analyses.
To assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service.
Population based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD).
Under-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD.
Antidepressant prescription rates per month per 100 000 depressed 4–17 year olds.
Following the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (β for change in trend –12.34 (95% CI –18.67 to –6.00, p
Despite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.
Infants born extremely preterm (EP,
The Victorian Infant Collaborative Study (VICS) is a prospective geographical cohort of all EP/ELBW survivors to 18 years of age born in the State of Victoria, Australia, from 1 January 1991 to 31 December 1992 (n=297) and contemporaneous term-born/NBW controls (n=262). Participants were recruited at birth and followed up at 2, 5, 8 and 18 years. This 25-year follow-up includes assessments of physical health (cardiovascular, respiratory and musculoskeletal), mental health and socioemotional functioning. Outcomes will be compared between the birth groups using linear and logistic regression, fitted using generalised estimating equations (GEEs). Trajectories of health outcomes from early childhood will be compared between the birth groups using linear mixed-effects models. Risk factors for adult outcomes will be assessed using linear and logistic regression (fitted using GEEs).
This study was approved by the Human Research Ethics Committees of the Royal Women’s Hospital, Mercy Hospital for Women, Monash Medical Centre and the Royal Children’s Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the internet and social media.
Some types of skin and soft tissue tumours may be misdiagnosed as scars because of the scar‐like manifestation or the history of injury. It is generally believed that injuries will activate wound healing, ultimately ending in fibrosis. Because of the tumour‐promoting properties of both the microenvironment of the wound and the wound‐healing process that may go awry, there is a likelihood that injuries may trigger tumour growth. From 2012 to 2016, we treated four patients who underwent unsuccessful treatments because of the misdiagnosis of scars or keloids. Upon the pathological diagnoses of skin and soft tissue tumours in the four cases, extended resection of the tumours was performed. Recurrence was not observed up to the last follow up. Since then, soft tissue tumours have much greater visibility and are considered during diagnosis if a wound is presented with the atypical appearance of scar after injuries. Under these circumstances, biopsy should be conducted.
Heart failure (HF) is considered a condition in which a portion of hospital admissions are preventable if timely and appropriate outpatient care management occurs. Facility readmission rates for HF are reportable and subject to penalty. Both military and civilian healthcare systems have fiscal responsibility and are accountable for successful disease management. Therefore, best practices and evidence‐based strategies to reduce readmissions are in critical demand. However, translating best evidence into practice can be challenging due to the complexities of the healthcare system.
This crosswalk paper provides strategies and considerations for nurses planning HF readmission reduction initiatives.
Insight regarding implementation strategies, challenges, successes, and lessons learned is shared through a framework‐guided description of two separate but similar HF readmission reduction projects conducted in military and civilian healthcare facilities.
Lessons learned suggest defined and attainable outcomes, multidisciplinary inclusivity, redundancy in roles, greater collaboration, and engagement with stakeholders are most beneficial when initiated before dedicating resources and continuously throughout practice change implementation, maintenance, and sustainment.
The authors advocate for interdisciplinary evidence‐based practice consortiums to share lessons learned that may promote success potential and optimize return on invested time and efforts in the same or similar initiatives—in this instance, reducing 30‐day readmissions for HF patients.