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Colorectal Disease : the Official... Oct 2021Surgical research has been under-powered, under-funded and under-delivered for decades. A solution may be to form large research collaborations and thereby enable...
Surgical research has been under-powered, under-funded and under-delivered for decades. A solution may be to form large research collaborations and thereby enable implementation of successful interventional trials as well as robust international observational studies with thousands of patients. There are many such research collaborations in colorectal surgery, and in this paper we have highlighted the experiences from the West Midlands Research Collaborative (WMRC), the Scandinavian Surgical Outcomes Research Group (SSORG) and the European Society of Coloproctology. With active research networks, it is possible to deliver large, high-quality studies and provide high-level evidence for solving important clinical questions in an efficient and timely manner.
Topics: Colorectal Neoplasms; Colorectal Surgery; Humans; Outcome Assessment, Health Care; Research Design
PubMed: 34272802
DOI: 10.1111/codi.15814 -
Child Abuse & Neglect Feb 2020This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited...
This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes a long-term psychotherapeutic intervention started by Arpan in 2010, in an institution named Advait Foundation. Advait runs a rehabilitation home, Project Baharati, in Vasai, Mumbai, India. Project Bharati serves adolescent females who have experienced commercial sexual exploitation and sexual abuse. The psychotherapeutic intervention uses group and individual therapy, employing trauma-focused cognitive behavioral and arts-based therapeutic techniques.
Topics: Adolescent; Art Therapy; Awareness; Child Abuse, Sexual; Cognitive Behavioral Therapy; Female; Human Trafficking; Humans; India; Outcome Assessment, Health Care; Program Development; Sex Work; Sexual Trauma; Treatment Outcome
PubMed: 31519409
DOI: 10.1016/j.chiabu.2019.104152 -
NeuroRehabilitation 2020Traumatic brain injury (TBI) remains a silent and global epidemic which creates an aftermath of convoluted dynamics. Despite significant incidence rates and increasing... (Review)
Review
BACKGROUND
Traumatic brain injury (TBI) remains a silent and global epidemic which creates an aftermath of convoluted dynamics. Despite significant incidence rates and increasing awareness over the long-term catastrophic implications, there remain marked contrasts between acute vs. post-acute rehabilitation processes in the United States.
OBJECTIVE
To explore existing research and highlight the complexity of TBIs to inform vital changes needed to reduce the significant differences and inconsistencies across post-acute treatment settings. To highlight how psychologists/neuropsychologists and other rehabilitation professionals maintain a prominent operational presence in post-acute settings resulting in key leadership opportunities to support a more efficient longitudinal continuation of care model.
METHODS
Literature search of various health science databases was completed for articles between 1987 to 2019 to explore the range and depth of post-acute treatment, model, and outcomes research.
RESULTS
Despite progressive medical advancements, translation of relevant rehabilitation research and practices into post-acute treatment settings remains inconsistent.
CONCLUSIONS
Significant barriers remain for objective and comprehensive evaluation(s) of post-acute program quality and purported patient outcomes in the United States. There remains a lack of consensually relevant and objective metrics. Further investigation is recommended for: consensus on longitudinal post-acute brain injury outcome measures; functional relevance of program accreditations/certifications; outcome differences based on team composition and program resources; and patient/stakeholder variables/input to support optimal post-acute service access and delivery.
Topics: Brain Injuries; Brain Injuries, Traumatic; Female; Humans; Longitudinal Studies; Male; Outcome Assessment, Health Care; Psychosocial Support Systems
PubMed: 32083600
DOI: 10.3233/NRE-192969 -
Psychology and Psychotherapy Mar 2024This paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as... (Review)
Review
PURPOSE
This paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as some of the challenges for addressing gaps. It will guide the direction of future work and the steps needed to develop and advance this approach.
METHOD
This paper reviews evidence of how evolutionary models such as social rank theory and attachment theory have greatly contributed to our understanding of psychosis and provide a clear rationale and evidence base for the mechanisms of change in CFT for psychosis. It reviews the evidence for outcomes of compassion training more generally, and early feasibility evaluations of CFT for psychosis.
RESULTS
The process evidence shows that people with psychosis have highly active social rank and threat systems, and the benefits of switching into attachment and care systems, which can support emotion regulation and integrative mind states. The outcomes evidence shows that compassion training impacts not only psychological outcomes, but also physiological outcomes such as neural circuits, immune system, and the autonomic nervous system. Within the psychosis field, outcomes research is still in the early days, but there are good indications of feasibility and a clear path forward for the next steps.
CONCLUSIONS
CFT for psychosis is an approach that integrates biopsychosocial processes, an integration that's evidenced across each aspect of the model, from theoretical foundations (evolution-informed) to interventions (e.g., body/breath training and relational techniques), to evaluation. Future RCTs are required to understand the effects on biopsychosocial outcomes for people with psychosis.
Topics: Humans; Empathy; Psychotic Disorders; Outcome Assessment, Health Care
PubMed: 37578215
DOI: 10.1111/papt.12490 -
Current Opinion in Anaesthesiology Dec 2022Recent advancements in big data analytical tools and large patient databases have expanded tremendously the opportunities to track patient and safety outcomes.We discuss... (Review)
Review
PURPOSE OF REVIEW
Recent advancements in big data analytical tools and large patient databases have expanded tremendously the opportunities to track patient and safety outcomes.We discuss the strengths and limitations of large databases and implementation in practice with a focus on the current opportunities to use technological advancements to improve patient safety.
RECENT FINDINGS
The most used sources of data for large patient safety observational studies are administrative databases, clinical registries, and electronic health records. These data sources have enabled research on patient safety topics ranging from rare adverse outcomes to large cohort studies of the modalities for pain control and safety of medications. Implementing the insights from big perioperative data research is augmented by automating data collection and tracking the safety outcomes on a provider, institutional, national, and global level. In the near future, big data from wearable devices, physiological waveforms, and genomics may lead to the development of personalized outcome measures.
SUMMARY
Patient safety research using large databases can provide actionable insights to improve outcomes in the perioperative setting. As datasets and methods to gain insights from those continue to grow, adopting novel technologies to implement personalized quality assurance initiatives can significantly improve patient care.
Topics: Humans; Databases, Factual; Electronic Health Records; Registries; Big Data; Outcome Assessment, Health Care
PubMed: 36302209
DOI: 10.1097/ACO.0000000000001201 -
European Heart Journal. Quality of Care... Jan 2020The Myocardial Ischaemia National Audit Project (MINAP) collects data from admissions in England, Wales, and Northern Ireland with Type 1 myocardial infarction (T1 MI).... (Review)
Review
AIMS
The Myocardial Ischaemia National Audit Project (MINAP) collects data from admissions in England, Wales, and Northern Ireland with Type 1 myocardial infarction (T1 MI). The project aims to improve clinical care through the audit process and to provide powerful high-resolution data for research.
METHODS AND RESULTS
MINAP collects data spanning 130 data fields covering the course of patient care, from the moment the patient calls for professional help through to hospital discharge and rehabilitation. Data are entered by clinicians and clerical staff within hospitals, and pseudonymized records are uploaded centrally to the National Institute for Cardiovascular Outcomes Research (NICOR), hosted by Barts Health NHS Trust, London, UK. Two hundred and six hospitals submit over 92 000 new cases to MINAP annually. Approximately 1.5 million patient records are currently held in the database. Patient demographics, medical history, clinical assessment, investigations, treatments, drug therapy prior to admission, during hospital stay, and at discharge are collected. Data completeness of three key data fields (age, admission blood pressure, and heart rate) is over 91%. Vital status following hospital discharge is obtained via linkage to data from the United Kingdom Office for National Statistics. An annual report is compiled using these data, with individual hospital summary data included. Datasets are available to researchers by application to NICOR.
CONCLUSION
MINAP is the largest single healthcare system heart attack registry, and includes data from hospitalizations with T1 MI in England, Wales, and Northern Ireland. It includes high-resolution data across the patient pathway and is a powerful tool for quality improvement and research.
Topics: Clinical Audit; Humans; Myocardial Ischemia; Outcome Assessment, Health Care; Quality Improvement; Registries; United Kingdom
PubMed: 31511861
DOI: 10.1093/ehjqcco/qcz052 -
Critical Care Medicine Dec 2021Evaluation of potential benefits of noninvasive ventilation for bronchiolitis has been precluded in part by the absence of large, adequately powered studies. The...
OBJECTIVES
Evaluation of potential benefits of noninvasive ventilation for bronchiolitis has been precluded in part by the absence of large, adequately powered studies. The objectives of this study were to characterize temporal trends in and associations between the use of noninvasive ventilation in bronchiolitis and two clinical outcomes, invasive ventilation, and cardiac arrest.
DESIGN
Multicenter retrospective cross-sectional study.
SETTING
Forty-nine U.S. children's hospitals participating in the Pediatric Health Information System database.
PATIENTS
Infants under 12 months old who were admitted from the emergency department with bronchiolitis between January 1, 2010, and December 31, 2018.
MEASUREMENTS AND MAIN RESULTS
Primary outcomes were rates of noninvasive ventilation, invasive ventilation, and cardiac arrest. Trends over time were assessed with univariate logistic regression. In the main analysis, hospital-level multivariable logistic regression evaluated rates of outcomes including invasive ventilation and cardiac arrest among hospitals with high and low utilization of noninvasive ventilation. The study included 147,288 hospitalizations of infants with bronchiolitis. Across the entire study population, noninvasive and invasive ventilation increased between 2010 and 2018 (2.9-8.7%, 2.1-4.0%, respectively; p < 0·001). After adjustment for markers of severity of illness, hospital-level noninvasive ventilation (high vs low utilization) was not associated with differences in invasive ventilation (5.0%, 1.8%, respectively, adjusted odds ratio, 1.8; 95% CI, 0·7-4·6) but was associated with increased cardiac arrest (0.36%, 0.02%, respectively, adjusted odds ratio, 25.4; 95% CI, 4.9-131.0).
CONCLUSIONS
In a large cohort of infants at children's hospitals, noninvasive and invasive ventilation increased significantly from 2010 to 2018. Hospital-level noninvasive ventilation utilization was not associated with a reduction in invasive ventilation but was associated with higher rates of cardiac arrest even after controlling for severity. Noninvasive ventilation in bronchiolitis may incur an unintended higher risk of cardiac arrest, and this requires further investigation.
Topics: Bronchiolitis; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Male; Noninvasive Ventilation; Outcome Assessment, Health Care; Retrospective Studies
PubMed: 34259666
DOI: 10.1097/CCM.0000000000005210 -
Aesthetic Plastic Surgery Aug 2020Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In... (Review)
Review
Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In the realm of facial plastic surgery, many outcomes are subjective evaluations based on the patient and physician's judgment as to the surgical result, but little has been done to quantify these qualitative results in an objective manner. This paper discusses the basis for outcomes research and suggests its application to the field of facial plastic surgery. Four new facial plastic outcomes instruments have been developed and are provided for the potential use in measuring the quality of life results of rhytidectomy, rhinoplasty, blepharoplasty, and skin rejuvenation procedures.
Topics: Humans; Outcome Assessment, Health Care; Patient Satisfaction; Quality of Life; Rhytidoplasty; Surgery, Plastic
PubMed: 32766912
DOI: 10.1007/s00266-020-01809-9 -
Implementation Science : IS Jul 2023Proctor and colleagues' 2011 paper proposed a taxonomy of eight implementation outcomes and challenged the field to address a research agenda focused on... (Review)
Review
BACKGROUND
Proctor and colleagues' 2011 paper proposed a taxonomy of eight implementation outcomes and challenged the field to address a research agenda focused on conceptualization, measurement, and theory building. Ten years later, this paper maps the field's progress in implementation outcomes research. This scoping review describes how each implementation outcome has been studied, research designs and methods used, and the contexts and settings represented in the current literature. We also describe the role of implementation outcomes in relation to implementation strategies and other outcomes.
METHODS
Arksey and O'Malley's framework for conducting scoping reviews guided our methods. Using forward citation tracing, we identified all literature citing the 2011 paper. We conducted our search in the Web of Science (WOS) database and added citation alerts sent to the first author from the publisher for a 6-month period coinciding with the WOS citation search. This produced 1346 titles and abstracts. Initial abstract screening yielded 480 manuscripts, and full-text review yielded 400 manuscripts that met inclusion criteria (empirical assessment of at least one implementation outcome).
RESULTS
Slightly more than half (52.1%) of included manuscripts examined acceptability. Fidelity (39.3%), feasibility (38.6%), adoption (26.5%), and appropriateness (21.8%) were also commonly examined. Penetration (16.0%), sustainability (15.8%), and cost (7.8%) were less frequently examined. Thirty-two manuscripts examined implementation outcomes not included in the original taxonomy. Most studies took place in healthcare (45.8%) or behavioral health (22.5%) organizations. Two-thirds used observational designs. We found little evidence of progress in testing the relationships between implementation strategies and implementation outcomes, leaving us ill-prepared to know how to achieve implementation success. Moreover, few studies tested the impact of implementation outcomes on other important outcome types, such as service systems and improved individual or population health.
CONCLUSIONS
Our review presents a comprehensive snapshot of the research questions being addressed by existing implementation outcomes literature and reveals the need for rigorous, analytic research and tests of strategies for attaining implementation outcomes in the next 10 years of outcomes research.
Topics: Humans; Delivery of Health Care; Outcome Assessment, Health Care
PubMed: 37491242
DOI: 10.1186/s13012-023-01286-z -
Value in Health : the Journal of the... Nov 2020
Topics: Betacoronavirus; COVID-19; Coronavirus; Coronavirus Infections; Cost-Benefit Analysis; Humans; Outcome Assessment, Health Care; Pandemics; Pneumonia, Viral; SARS-CoV-2; United Kingdom
PubMed: 33127008
DOI: 10.1016/j.jval.2020.09.009