Mediamusic (E-Journal)
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Global Overview of Response Rates in Patient and Health Care Professional Surveys in Surgery: A Systematic Review
No full textObjective: Identify key demographic factors and modes of follow-up in surgical survey response. Summary Background Data: Surveys are widely used in surgery to assess patient and procedural outcomes, but response rates vary widely which compromises study quality. Currently there is no consensus as to what the average response rate is and which factors are associated with higher response rates. Methods: The National Library of Medicine (MEDLINE/PubMed) was systematically searched from Januray 1, 2007 until February 1, 2020 using the following strategy: (((questionnaire) OR survey) AND "response rate") AND (surgery OR surgical). Original survey studies from surgical(-related) fields reporting on response rate were included. Through one-way analysis of variance we present mean response rate per survey mode over time, number of additional contacts, country of origin, and type of interviewee. Results: The average response is 70% over 811 studies in patients and 53% over 1746 doctor surveys. In-person surveys yield an average 76% response rate, followed by postal (65%) and online (46% web-based vs 51% email) surveys. Patients respond significantly more often than doctors to surveys by mail (P < 0.001), email (P = 0.003), web-based surveys (P < 0.001) and mixed mode surveys (P = 0.006). Additional contacts significantly improve response rate in email (P = 0.26) and web-based (P = 0.041) surveys in doctors. Awide variation in response rates was identified between countries. Conclusions: Every survey is unique, but the main commonality between studies is response rate. Response rates appear to be highly dependent on type of survey, follow-up, geography, and interviewee type.</p
Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals:A Mixed Methods Study
No full textBACKGROUND: Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals' perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work.METHODS: A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer.RESULTS: On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals' joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality.CONCLUSION: Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.</p
Response to: 'Diagnostic accuracy of novel ultrasonographic halo score for giant cell arteritis: methodological issues' by Ghajari and Sabour
No full textResponse to: 'Diagnostic value of ultrasound halo count and Halo Score in giant cell arteritis:a retrospective study from routine care' by Molina Collada et al
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A person-centred approach to L2 learners’ informal mobile language learning
No full textMobile technologies provide opportunities for L2 learners to engage in complex interactions involving a multitude of cognitive, meta-cognitive, and affective factors. Understanding the process of learners’ mobile language learning thus needs holistic approaches that integratively consider learner attributes and their interaction with mobile technologies. In this study, we applied a holistic person-centred approach to examining L2 learners’ self-initiated engagement with mobile learning activities. Data were collected with a questionnaire and follow-up interviews. A cluster analysis performed on the questionnaire data yielded six types of learners with distinctly different learning experiences. We further found that each learner type brought along a distinct package of motivational, emotional, and linguistic interaction, and that the distinct learning experiences of each learner type bore different relationship to learners’ perceived L2 improvement. This study offers theoretical and methodological insights into the complexity and variety inherent in informal mobile language learning. Findings also inform teachers about the design of adaptive and tailored instruction and scaffolding.</p
Cigarette smoke increases risk for colorectal neoplasia in inflammatory bowel disease
No full textBACKGROUND AND AIMS: Patients with inflammatory bowel disease are at increased risk of colorectal neoplasia (CRN) due to mucosal inflammation. As current surveillance guidelines form a burden on patients and healthcare costs, stratification of high-risk patients is crucial. Cigarette smoke reduces inflammation in ulcerative colitis (UC) but not Crohn's disease (CD) and forms a known risk factor for CRN in the general population. Due to this divergent association, the effect of smoking on CRN in IBD is unclear and subject of this study.METHODS: In this retrospective cohort study, 1,386 IBD patients with previous biopsies analyzed and reported in the PALGA register, were screened for development of CRN. Clinical factors and cigarette smoke were evaluated. Patients were stratified for guideline-based risk of CRN. Cox-regression modeling was used to estimate the effect of cigarette smoke and its additive effect within the current risk stratification for prediction of CRN.RESULTS: 153 (11.5%) patients developed CRN. Previously described risk factors, i.e. first-degree family member with CRN in CD (p-value=0.001), presence of post-inflammatory polyps in UC (p-value=0.005), were replicated. Former smoking increased risk of CRN in UC (HR1.73;1.05-2.85), whereas passive smoke exposure yielded no effect. For CD, active smoking (2.20; 1.02-4.76) and passive smoke exposure (1.87;1.09-3.20) significantly increased CRN risk. Addition of smoke exposure to the current risk-stratification model significantly improved model fit for CD.CONCLUSIONS: This study is the first to describe the important role of cigarette smoke in CRN development in IBD patients. Adding this risk factor improves the current risk stratification for CRN surveillance strategies.</p
On the Role of a Conserved Methionine in the Na+-Coupling Mechanism of a Neurotransmitter Transporter Homolog
No full textExcitatory amino acid transporters (EAAT) play a key role in glutamatergic synaptic communication. Driven by transmembrane cation gradients, these transporters catalyze the reuptake of glutamate from the synaptic cleft once this neurotransmitter has been utilized for signaling. Two decades ago, pioneering studies in the Kanner lab identified a conserved methionine within the transmembrane domain as key for substrate turnover rate and specificity; later structural work, particularly for the prokaryotic homologs GltPh and GltTk, revealed that this methionine is involved in the coordination of one of the three Na+ ions that are co-transported with the substrate. Albeit extremely atypical, the existence of this interaction is consistent with biophysical analyses of GltPh showing that mutations of this methionine diminish the binding cooperativity between substrates and Na+. It has been unclear, however, whether this intriguing methionine influences the thermodynamics of the transport reaction, i.e., its substrate:ion stoichiometry, or whether it simply fosters a specific kinetics in the binding reaction, which, while influential for the turnover rate, do not fundamentally explain the ion-coupling mechanism of this class of transporters. Here, studies of GltTk using experimental and computational methods independently arrive at the conclusion that the latter hypothesis is the most plausible, and lay the groundwork for future efforts to uncover the underlying mechanism.</p
Barriers and Facilitators of Disclosing Domestic Violence to the UK Health Service
No full textDomestic violence victims frequently visit health care facilities yet rarely disclose, so it is important to understand what factors are barriers and facilitators of disclosure. UK-based qualitative investigations into barriers and facilitators of disclosure in health care settings have suffered from a limited focus on ethnic minority women. Therefore, the aim of this study was to explore victims’ perceptions and experiences of disclosing to health care services and to identify barriers and facilitators of disclosure within an ethnically diverse UK sample. Semi-structured interviews were administered among 29 British (8 ethnic minority) female victims. Content analysis demonstrated that barriers to disclosure were; emotional (e.g., fear, embarrassment/shame and self-blame), physical (e.g., partner’s physical presence, controlling behavior, and manipulation of professionals) and organizational (e.g., appropriateness of setting and time for disclosure). Additional problems for ethnic minority women were language difficulties and religious practices. Facilitators to disclosure were interpersonal relations, safety, and validation from health care professionals. Barriers and facilitators of disclosure in health care services are diverse and some are specific to minority ethnic groups. Health care professionals should receive awareness and skills training to establish a positive, validating, and safe environment for victim disclosure.</p
The contemporary pulmonary artery catheter. Part 2:measurements, limitations, and clinical applications
No full textNowadays, the classical pulmonary artery catheter (PAC) has an almost 50-year-old history of its clinical use for hemodynamic monitoring. In recent years, the PAC evolved from a device that enabled intermittent cardiac output measurements in combination with static pressures to a monitoring tool that provides continuous data on cardiac output, oxygen supply and-demand balance, as well as right ventricular performance. In this review, which consists of two parts, we will introduce the difference between intermittent pulmonary artery thermodilution using bolus injections, and the contemporary PAC enabling continuous measurements by using a thermal filament which heats up the blood. In this second part, we will discuss in detail the measurements of the contemporary PAC, including continuous cardiac output measurement, right ventricular ejection fraction, end-diastolic volume index, and mixed venous oxygen saturation. Limitations of all of these measurements are highlighted as well. We conclude that thorough understanding of measurements obtained from the PAC is the first step in successful application of the PAC in daily clinical practice.</p