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The Lancet. Healthy Longevity Jul 2023Comprehensive geriatric assessment is the core toolkit of geriatric medicine. Awareness of and engagement in comprehensive geriatric assessment are crucial competences... (Review)
Review
Comprehensive geriatric assessment is the core toolkit of geriatric medicine. Awareness of and engagement in comprehensive geriatric assessment are crucial competences for all professionals caring for older people living with frailty. The fundamental tenet of comprehensive geriatric assessment is person centredness, which means orienting problem evaluation and intervention plans around an individual's specific biopsychosocial situation to maximise their function and participation. Person-centred outcomes are frequently neglected from measurements of health-care delivery, service improvement, and research. Instead, systems tend to measure outcomes of the health-care service (ie, resource use) or a person's destination following a health-care process. The absence of person-centred outcome measures risks the delivery of health care that seeks to achieve, and is benchmarked against, outcomes that are not best for the patient. We must, therefore, ensure that the outcomes that matter to older people are being measured.
Topics: Humans; Aged; Delivery of Health Care; Geriatrics; Outcome Assessment, Health Care
PubMed: 37336229
DOI: 10.1016/S2666-7568(23)00084-3 -
Intensive Care Medicine Feb 2020To explore contemporary clincial case management of patients with Ebola virus disease. (Review)
Review
PURPOSE
To explore contemporary clincial case management of patients with Ebola virus disease.
METHODS
A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease.
RESULTS
Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation.
CONCLUSION
With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.
Topics: Antibodies, Monoclonal; Critical Illness; Disease Outbreaks; Ebolavirus; Hemorrhagic Fever, Ebola; Humans; Outcome Assessment, Health Care; Standard of Care
PubMed: 32055888
DOI: 10.1007/s00134-020-05949-z -
Clinical Obstetrics and Gynecology Jun 2022The field of obstetrics and gynecology is constantly replenished with the newest research findings. In an era of rapidly available study publications, there are a number... (Review)
Review
The field of obstetrics and gynecology is constantly replenished with the newest research findings. In an era of rapidly available study publications, there are a number of challenges to interpreting the obstetrics and gynecology literature. Common pitfalls include the over reliance on the dichotomized P-value, lack of transparency, bias in study reporting, limitations of resources, absence of standardized practices and outcomes in study design, and the rare concerns for data integrity. We review these predominant challenges and their potential solutions, in interpreting the obstetrics and gynecology literature.
Topics: Bias; Female; Gynecology; Humans; Obstetrics; Outcome Assessment, Health Care; Pregnancy
PubMed: 35318984
DOI: 10.1097/GRF.0000000000000707 -
Frontiers in Public Health 2022
Topics: Humans; Burnout, Professional; Burnout, Psychological; Outcome Assessment, Health Care
PubMed: 36424976
DOI: 10.3389/fpubh.2022.1023462 -
Brain : a Journal of Neurology Dec 2023The capacity and power of data from cohorts, registries and randomized trials to provide answers to contemporary clinical questions in neurology has increased... (Review)
Review
The capacity and power of data from cohorts, registries and randomized trials to provide answers to contemporary clinical questions in neurology has increased considerably over the past two decades. Novel sophisticated statistical methods are enabling us to harness these data to guide treatment decisions, but their complexity is making appraisal of clinical evidence increasingly demanding. In this review, we discuss several methodological aspects of contemporary research of treatment effectiveness in observational data in neurology, aimed at academic neurologists and analysts specializing in outcomes research. The review discusses specifics of the sources of observational data and their key features. It focuses on the limitations of observational data and study design, as well as statistical approaches aimed to overcome these limitations. Among the examples of leading clinical themes typically studied with analyses of observational data, the review discusses methodological approaches to comparative treatment effectiveness, development of diagnostic criteria and definitions of clinical outcomes. Finally, this review provides a brief summary of key points that will help clinical audience critically evaluate design and analytical aspects of studies of disease outcomes using observational data.
Topics: Humans; Treatment Outcome; Outcome Assessment, Health Care; Registries; Research Design; Neurology
PubMed: 37587541
DOI: 10.1093/brain/awad278 -
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 -
Journal of the American College of... Jan 2021
Topics: Cardiology; Humans; Outcome Assessment, Health Care; Patient Care; Societies, Medical
PubMed: 33384193
DOI: 10.1016/j.jacc.2020.12.001 -
Acta Diabetologica Mar 2021The global epidemic of diabetes mellitus continues to expand, including its large impact on national health care. Measuring diabetes outcomes and their causes of... (Review)
Review
AIMS
The global epidemic of diabetes mellitus continues to expand, including its large impact on national health care. Measuring diabetes outcomes and their causes of variation highlights areas for improvement in care and efficiency gains; large registries carry this potential. By means of a systematic review, we aimed to give an overview of national registries worldwide by quantifying their data and assessing their influence on diabetes care.
METHODS
The literature on MEDLINE up to March 31, 2020, was searched, using keywords diabetes mellitus, national, registry, registration, and/or database. National disease-specific registries from corresponding articles were included. Database characteristics and clinical variables were obtained. All registries were compared to the ICHOM standard set of outcomes.
RESULTS
We identified 12 national clinical diabetes registries, comprising a total of 7,181,356 diabetic patients worldwide. Nearly all registries recorded weight, HbA1c, lipid profile, and insulin treatment; the recording of other variables varied to a great extent. Overall, registries corresponded fairly well with the ICHOM set. Most registries proved to monitor and improve the quality of diabetes care using guidelines as a benchmark. The effects on national healthcare policy were more variable and often less clear.
CONCLUSIONS
National diabetes registries confer clear insights into diagnostics, complications, and treatment. The extent to which registries influenced national healthcare policy was less clear. A globally implemented standard outcome set has the potential to improve concordance between national registries, enhance the comparison and exchange of diabetes outcomes, and allocate resources and interventions where most needed.
Topics: Databases, Factual; Diabetes Mellitus; Endocrinology; Female; Humans; Male; Outcome Assessment, Health Care; Registries
PubMed: 32770407
DOI: 10.1007/s00592-020-01576-8 -
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