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Prevention Science : the Official... Jan 2015Poor implementation quality (IQ) is known to reduce program effects making it important to consider IQ for evaluation and dissemination of prevention programs. However,...
Poor implementation quality (IQ) is known to reduce program effects making it important to consider IQ for evaluation and dissemination of prevention programs. However, less is known about the ways specific implementation variables relate to outcomes. In this study, two versions of keepin' it REAL, a seventh-grade drug prevention intervention, were implemented in 78 classrooms in 25 schools in rural districts in Pennsylvania and Ohio. IQ was measured through observational coding of 276 videos. IQ variables included adherence to the curriculum, teacher engagement (attentiveness, enthusiasm, seriousness, clarity, positivity), student engagement (attention, participation), and a global rating of teacher delivery quality. Factor analysis showed that teacher engagement, student engagement, and delivery quality formed one factor, which was labeled delivery. A second factor was adherence to the curriculum. Self-report student surveys measured substance use, norms (beliefs about prevalence and acceptability of use), and efficacy (beliefs about one's ability to refuse substance offers) at two waves (pretest, immediate posttest). Mixed model regression analysis which accounted for missing data and controlled for pretest levels examined implementation quality's effects on individual level outcomes, statistically controlling for cluster level effects. Results show that when implemented well, students show positive outcomes compared to students receiving a poorly implemented program. Delivery significantly influenced substance use and norms, but not efficacy. Adherence marginally significantly predicted use and significantly predicted norms, but not efficacy. Findings underscore the importance of comprehensively measuring and accounting for IQ, particularly delivery, when evaluating prevention interventions.
Topics: Adolescent; Child; Curriculum; Female; Humans; Male; Ohio; Pennsylvania; Program Development; Program Evaluation; Quality Control; School Health Services; Substance-Related Disorders
PubMed: 24442403
DOI: 10.1007/s11121-014-0459-1 -
The Journal of Trauma and Acute Care... Feb 2022Social determinants of health (SDOH) impact patient outcomes in trauma. Census data are often used to account for SDOH; however, there is no consensus on which variables...
BACKGROUND
Social determinants of health (SDOH) impact patient outcomes in trauma. Census data are often used to account for SDOH; however, there is no consensus on which variables are most important. Social vulnerability indices offer the advantage of combining multiple constructs into a single variable. Our objective was to determine if incorporation of SDOH in patient-level risk-adjusted outcome modeling improved predictive performance.
METHODS
We evaluated two social vulnerability indices at the zip code level: Distressed Community Index (DCI) and National Risk Index (NRI). Individual variable combinations from Agency for Healthcare Research and Quality's SDOH data set were used for comparison. Patients were obtained from the Pennsylvania Trauma Outcomes Study 2000 to 2020. These measures were added to a validated base mortality prediction model with comparison of area under the curve and Bayesian information criterion. We performed center benchmarking using risk-standardized mortality ratios to evaluate change in rank and outlier status based on SDOH. Geospatial analysis identified geographic variation and autocorrelation.
RESULTS
There were 449,541 patients included. The DCI and NRI were associated with an increase in mortality (adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03 per 10% percentile rank increase; p < 0.01, respectively). The DCI, NRI, and seven Agency for Healthcare Research and Quality variables also improved base model fit but discrimination was similar. Two thirds of centers changed mortality ranking when accounting for SDOH compared with the base model alone. Outlier status changed in 7% of centers, most representing an improvement from worse-than-expected to nonoutlier or nonoutlier to better-than-expected. There was significant geographic variation and autocorrelation of the DCI and NRI (DCI; Moran's I 0.62, p = 0.01; NRI; Moran's I 0.34, p = 0.01).
CONCLUSION
Social determinants of health are associated with an individual patient's risk of mortality after injury. Accounting for SDOH may be important in risk adjustment for trauma center benchmarking.
LEVEL OF EVIDENCE
Prognostic/Epidemiologic, level IV.
Topics: Adult; Aged; Bayes Theorem; Female; Humans; Male; Middle Aged; Pennsylvania; Retrospective Studies; Social Determinants of Health; Trauma Centers; Wounds and Injuries
PubMed: 34739000
DOI: 10.1097/TA.0000000000003454 -
PloS One 2021We sought to assess the rate of unplanned hospital visits among patients undergoing ambulatory surgery.
OBJECTIVES
We sought to assess the rate of unplanned hospital visits among patients undergoing ambulatory surgery.
SUMMARY BACKGROUND DATA
The majority of surgeries performed in the United States now take place in outpatient settings. Post-discharge hospital visit rates have been shown to vary widely, suggesting variation in surgical or discharge care quality. Complicating efforts to address quality, most facilities and surgeons are unaware of their patients' hospital visits after surgery since patients may present to a different hospital.
METHODS
We used state-level, administrative data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project from California to assess unplanned hospital visits after ambulatory surgery. To compare rates across centers, we determined the age, sex, and procedure-adjusted rates of hospital visits for each facility using 2-level, hierarchical, generalized linear models using methods similar to existing Centers for Medicare and Medicaid Services measures.
RESULTS
Among a total of 1,260,619 ambulatory same-day surgeries from 440 surgical facilities, the risk adjusted 30-day rate of unplanned hospital visits was 4.8%, with emergency department visits of 3.1% and hospital admissions of 1.7%. Several patient characteristics were associated with increased risk of unplanned hospitals visits, including increased age, increased number of comorbidities (using the Elixhauser score), and type of procedure (p<0.001).
CONCLUSIONS
The overall rate unplanned hospital visits within 30 days after same-day surgery is low but variable, suggesting a difference in the quality of care provided. Further, these rates are higher among specific patient populations and procedure types, suggesting areas for targeted improvement.
Topics: Ambulatory Care; Ambulatory Surgical Procedures; Emergency Service, Hospital; Female; Health Care Costs; Hospitals; Humans; Male; Medicare; Middle Aged; Outpatients; Patient Discharge; Patient Readmission; Quality of Health Care; United States
PubMed: 34283840
DOI: 10.1371/journal.pone.0254039 -
La Clinica Terapeutica Nov 2021The nursing coordinator plays a crucial role within health organizations. She/he represents the connection between organi-zational needs, clinical-care needs and company... (Review)
Review
OBJECTIVE
The nursing coordinator plays a crucial role within health organizations. She/he represents the connection between organi-zational needs, clinical-care needs and company objectives. In order to be a nurse manager one must have acquired managerial characteristics, including strategic, relational and operational skills.
STUDY DESIGN
In this regard, a wide-ranging review was carried out in order to analyze the managerial qualities by the nursing coor-dinators.
MATERIALS AND METHODS
The main scientific databases were con-sulted, such as PubMed, Scopus and Cochrane Library, analyzing all the systematic reviews present in the literature, published in English and Italian in the last ten years. 10 reviews were included in the article. Quality assessment of systematic reviews included in the research were evaluated using the AMSTAR checklist.
RESULTS
The coordinating nurse is the one who guides and directs the activities of other people in order to achieve company's objectives. Empowerment and leadership are the main qualities that a coordinator must possess. They represent essential characteristics for the creation of a work environment that guarantees high quality care.
CONCLUSIONS
The coordinating nurse has a crucial role in this: she/he represents the focal point for the motivation of the group. Establishing a possible program of continuing education activities in healthcare directed to healthcare professionals can be an important way for reinforcing leadership aptitude.
Topics: Delivery of Health Care; Female; Humans; Leadership; Nurse Administrators; Workplace
PubMed: 34821353
DOI: 10.7417/CT.2021.2379 -
Veterinary World Apr 2022Duck eggs have high cholesterol levels; inulin addition combined with probiotic is known in several studies to lower cholesterol, while maintaining egg production...
BACKGROUND AND AIM
Duck eggs have high cholesterol levels; inulin addition combined with probiotic is known in several studies to lower cholesterol, while maintaining egg production capacity and blood hematology. This study aimed to investigate the effect of the addition of synbiotic preparations on egg production, egg quality, and hematology of Pengging ducks.
MATERIALS AND METHODS
A total of 200 female Pengging ducks aged 75 weeks (late production phase) and weighing 1467±90.87 g were maintained in litter cages, each measuring 1×1 ducks. The treatment included the addition of synbiotics between the inulin of gembili tuber ( L. and Ina CC B76) as follows: T0=control feed ("farmer feed"), T1=control feed+synbiotics 1 mL/100 g, T2=control feed+synbiotics 1.5 mL/g, and T3=control feed+synbiotics 2 mL/100 g in the feed. A completely randomized design was used in this study. The production performance, physical and chemical qualities of eggs, and hematological parameters of Pengging ducks were evaluated.
RESULTS
The addition of synbiotics had no significant impact on the production performance, physical and chemical qualities of eggs, and hematological parameters (p>0.05), except for the egg yolk cholesterol content. The cholesterol content decreased significantly (p<0.05) with T2 and T3 treatments, but they had no significant effect (p>0.05). A significant decrease (p<0.01) in cholesterol levels was observed when the synbiotic dose was given at 1.5 ml/100 g feed (T2). However, there was no further decrease in cholesterol level when the synbiotic dose was increased to 2 ml/100g fed (T3).
CONCLUSION
The addition of synbiotics preparations at 1.5 mL/100 g reduced the cholesterol content but did not improve egg production, egg physical quality, and hematology of Pengging ducks.
PubMed: 35698504
DOI: 10.14202/vetworld.2022.878-884 -
NIH Consensus and State-of-the-science...To provide health care providers, patients, and the general public with a responsible assessment of currently available data on improving end-of-life care. (Review)
Review
OBJECTIVE
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on improving end-of-life care.
PARTICIPANTS
A non-DHHS, non-advocate ten-member panel representing the fields of geriatrics, psychiatry, economics, health policy, nursing, philosophy, epidemiology, and oncology. In addition, 19 experts from fields related to the subject matter of the conference presented data to the panel and to the conference audience.
EVIDENCE
Presentations by experts and a systematic review of the medical literature prepared by the Southern California Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience.
CONFERENCE PROCESS
Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://www.consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://www.consensus.nih.gov.
CONCLUSIONS
(1) Circumstances surrounding end of life are poorly understood, leaving many Americans to struggle through this life event. (2) The dramatic increase in the number of older adults facing the need for end-of-life care warrants development of a research infrastructure and resources to enhance that care for patients and their families. (3) Ambiguity surrounding the definition of end-of-life hinders the development of science, delivery of care, and communications between patients and providers. (4) Current end-of-life care includes some untested interventions that need to be validated. (5) Subgroups of race, ethnicity, culture, gender, age, and disease states experience end-of-life care differently, and these differences remain poorly understood. (6) Valid measures exist for some aspects of end of life; however, measures have not been used consistently or validated in diverse settings or with diverse groups. (7) End-of-life care is often fragmented among providers and provider settings, leading to a lack of continuity of care and impeding the ability to provide high-quality, interdisciplinary care. (8) Enhanced communication among patients, families, and providers is crucial to high-quality end-of-life care. (9) The design of the current Medicare hospice benefit limits the availability of the full range of interventions needed by many persons at the end of life.
Topics: Decision Making; Evidence-Based Medicine; Health Services Research; Humans; Interdisciplinary Communication; Needs Assessment; Palliative Care; Professional-Family Relations; Quality of Life; Social Support; Terminal Care; United States
PubMed: 17308546
DOI: No ID Found -
IEEE/ACM Transactions on Audio, Speech,... Dec 2017The goal of this study was to investigate the performance of different feature types for voice quality classification using multiple classifiers. The study compared the...
The goal of this study was to investigate the performance of different feature types for voice quality classification using multiple classifiers. The study compared the COVAREP feature set; which included glottal source features, frequency warped cepstrum and harmonic model features; against the mel-frequency cepstral coefficients (MFCCs) computed from the acoustic voice signal, acoustic-based glottal inverse filtered (GIF) waveform, and electroglottographic (EGG) waveform. Our hypothesis was that MFCCs can capture the perceived voice quality from either of these three voice signals. Experiments were carried out on recordings from 28 participants with normal vocal status who were prompted to sustain vowels with modal and non-modal voice qualities. Recordings were rated by an expert listener using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and the ratings were transformed into a dichotomous label (presence or absence) for the prompted voice qualities of modal voice, breathiness, strain, and roughness. The classification was done using support vector machines, random forests, deep neural networks and Gaussian mixture model classifiers, which were built as speaker independent using a leave-one-speaker-out strategy. The best classification accuracy of 79.97% was achieved for the full COVAREP set. The harmonic model features were the best performing subset, with 78.47% accuracy, and the static+dynamic MFCCs scored at 74.52%. A closer analysis showed that MFCC and dynamic MFCC features were able to classify modal, breathy, and strained voice quality dimensions from the acoustic and GIF waveforms. Reduced classification performance was exhibited by the EGG waveform.
PubMed: 33748320
DOI: 10.1109/taslp.2017.2759002