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The sustainability of hospital accreditation models:a cross-sectional study
No full textBackground: Despite the importance of hospital accreditation, its sustainability is jeopardized. This is due to the disparity between the rapid changes in the health sector and the accreditation standards that remain unchanged. This study aims to examine what improvements are important in enhancing the sustainability of the hospital accreditation model in Saudi Arabia. Methods: All quality managers in accredited Saudi Arabian hospitals were invited to participate in a cross-sectional questionnaire-based study in July-August 2022. A structured questionnaire was developed, tested, piloted, and factorially validated using exploratory factor analysis. On a 5-point Likert scale, respondents were asked to rate the importance of recommended changes that are proposed to enhance the sustainability of accreditation policies, standards development, evaluation methods, and the evaluation team. The importance of the recommendations, according to the respondents, was described using the relative importance index, while multivariate linear regression was used to analyse the association with independent variables. Results: A total of 158 valid questionnaires (64% response rate) were included in the analysis. On average, participants had 6.9 (SD 2.1) years of experience in quality management. The overall mean importance attached to improving standards development, accreditation policies, evaluation team, and evaluation methods were 3.55, 3.43, 3.41, and 3.21, on a 5-point scale, respectively. Shifting the focus of accreditation standards from structure and compliance to outcomes and improvement (mean importance = 4.47), updating standards periodically to reflect current best practices and research (mean importance = 4.41), and integrating consumer perspectives in all aspects of accreditation (mean importance = 4.37) were the most important perceived recommendations. Multivariate regression analysis yielded that managers with more years of experience had significantly higher mean scores on the importance of improving accreditation policies (beta = 0.120, P = .037), standards development (beta = 0.246, P < .001), evaluation methods (beta = 0.268, P < .001), and the evaluation team (beta = 0.369, P < .001). Conclusions: Improving accreditation policies, standards development, evaluation methods, and the evaluation team are important in enhancing the sustainability of hospital accreditation programmes. This study offers insights to assist policymakers and other stakeholders in redesigning traditional accreditation models to make them more sustainable and that can supplement other performance improvement tools in improving the quality of healthcare services
Association between individual Warburg-related proteins and prognosis in colorectal cancer
No full textWe previously showed that Warburg subtyping (low/moderate/high), based on the expression of six glycolytic proteins and transcriptional regulators [glucose transporter 1 (GLUT1), pyruvate kinase M2 (PKM2), lactate dehydrogenase A (LDHA), monocarboxylate transporter 4 (MCT4), p53, and PTEN], holds independent prognostic value in colorectal cancer (CRC) patients. The present study aimed to investigate whether the expression level of one of the proteins (GLUT1, PKM2, LDHA, MCT4, p53, and PTEN) can act as a proxy for our previously identified six protein-based Warburg subtypes. Protein expression levels for individual Warburg-related proteins were available for 2,251 CRC patients from the Netherlands Cohort Study. Kaplan-Meier curves and Cox regression were used to explore associations between individual Warburg-related proteins and CRC-specific and overall survival. Previously identified associations between Warburg subtypes and CRC-specific and overall survival were adjusted for individual proteins, showing a significant association with survival in the current study. Multivariable-adjusted analyses showed that the expression of GLUT1, LDHA, MCT4, PKM2, or p53 was associated with neither CRC-specific nor overall survival. Decreasing PTEN expression was associated with significantly poorer overall survival (p-trend(categories) = 0.026). Additional adjustment for PTEN expression had minimal impact on the previously identified association between Warburg subtypes and survival, and the six protein-based Warburg-high subtype remained a statistically significant predictor of overall survival (hazard ratio 1.15; 95% CI 1.01-1.32). In conclusion, our results emphasise that individual Warburg-related proteins cannot serve as a proxy or surrogate marker for Warburg subtyping, thereby highlighting the importance of combining the expression levels of multiple Warburg-related proteins when examining the prognostic significance of a complex biological pathway such as the Warburg effect
The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey
No full textBackgroundThe total amount of heparin administered through flush fluids in stroke patients is not considered in recent trials, possibly influencing main results. We investigated the use of heparin among treating physicians worldwide.MethodsWe conducted a survey from November 2022 to January 2023 to identify the variability of heparin administration during stroke endovascular treatment (EVT). We calculated the total heparin dose per hour (IU/h) by adding the intravenous (IV)-bolus dose to the amount administered through flush fluids, calculated by a multiplication of the number of infusion bags, drip rate[mL/h] and heparin concentration[IU/L].ResultsA total of 315 participants from different countries worldwide completed the survey and 231/315(73%) respondents administer heparin during EVT. The majority administered heparin only through flush fluids (168/231; 72.7%), followed by both IV-bolus and flush fluids (36/231; 16%), and those who used only an IV-bolus (27/231; 11.7%). From the participants that administer heparin through flush fluids, the median heparin concentration was 2000 IU/L (range:100 IU/L-10000 IU/L). The total heparin dose (administered through flush fluids and IV-bolus) among 23 respondents showed a median of 4650 IU/h (IQR:3432-5900). Among the respondents who administer heparin through IV-bolus only, the median was 5250 IU (IQR:3750-7500).ConclusionThis survey revealed variable heparin doses administered by physicians worldwide during EVT and reflects the lack of international guidelines. Caution is warranted, specifically during complex/long EVT procedures. Furthermore, heparin flush doses should be considered in future trials regarding periprocedural anticoagulants, since imbalances could potentially confound results
Patterns of sick leave and unemployment prior to a diagnosis of young onset Alzheimer's disease
No full textINTRODUCTION: Early symptoms in young onset Alzheimer's disease (YOAD) may be misinterpreted, causing delayed diagnosis. This population-based study aimed to map adverse occupational events preceding YOAD diagnosis as potential prodromal signs. METHODS: In a register-based, incidence density matched nested case-control study, we examined unemployment and long-term sick leave among individuals diagnosed with YOAD in Danish memory clinics between 2016 and 2022 compared to controls over a 13-year period. Conditional logistic regression produced incidence rate ratios (IRRs). RESULTS: The study included 2434 cases and 12,170 controls. YOAD patients had higher rates of adverse occupational events, particularly long-term sick leave, starting from 8 years before diagnosis (IRR 1.40, 95% confidence interval [CI] 1.07-1.84) and increasing to an IRR of 29.59 (95% CI 18.97-46.13) in the year before diagnosis. DISCUSSION: Adverse occupational events may serve as warning signs of YOAD. Timely diagnosis could facilitate restructuring the remaining working life to accommodate cognitive deficits or in seeking a disability pension. HIGHLIGHTS This is a retrospective, nested case-control study of young onset Alzheimer's disease (YOAD). Unemployment rates rise significantly 5 years before the YOAD diagnosis. Long-term sick leave rates rise significantly 8 years before the YOAD diagnosis. This emphasizes the importance of occupational history in the timely diagnosis of YOAD. Findings suggest the need for earlier YOAD diagnosis for work-life management
Microbiome profiling inpatients with Bladder Pain Syndrome/Interstitial cystitis
No full textWe conducted a microbiome study on BPS/IC patients with Hunner's lesions to investigate the differences in local microbiome compositions within a single bladder. In addition, we compared BPS/IC urine samples with matched controls and overactive bladder (OAB) patients with or without detrusor overactivity. Furthermore, we performed a small pilot to evaluate the stability of the microbiome composition over time in a single BPS/IC patient. Tissue samples were obtained from bladder mucosa from five adult female BPS/IC patients with confirmed Hunner's lesions. From each patient one biopsy was taken from within the Hunner's lesion area and one from outside the Hunner's lesion area. Urine samples from all five BPS/IC patients were compared to urine samples from normal age and sex matched controls (n = 12), female OAB patients with detrusor overactivity (n = 12) and female OAB patients without detrusor overactivity (n = 9). The 16S rRNA V1-V2 region amplification and gel electrophoresis were used to determine the microbiota. Our results showed the small tissue size from a cold-cup mucosal biopsy yielded insufficient microbial DNA for 16S rRNA gene sequence analysis. Urine microbiome analyses demonstrated that there was no single bacterial genus that was specific for BPS/IC patients compared to the other groups. There was a wide variability in microbiome composition between the BPS/IC patients, but no significant difference was observed in the Shannon numerical analyses (microbiome diversity) in BPS/IC patients compared to controls. The small pilot that was done to evaluate microbiome stability over time in a single BPS/IC patient, showed remarkable stability of microbiome composition during a one-year follow-up
Developing an App for Real-Time Daily Life Observations in a Nursing Home Setting:Qualitative User-Centered Co- Design Approach
No full textBackground: Assessing the daily lives of older adults, including their activities, social interactions, and well-being is essential, particularly in nursing homes, as it gains insights into their quality of life. Methods such as the Microsoft Excel- based Maastricht Electronic Daily Life Observation (MEDLO) tool are time-consuming and require extensive manual input, making them difficult to use. Objective: This study aimed to develop an app-based version of the MEDLO using a user-centered design (UCD) and co-design approach to enhance efficiency and usability. We looked to actively involve researchers and care professionals who have used the MEDLO before, throughout the development process. Methods: Participants included a diverse group of researchers and care professionals experienced in using the MEDLO tool. The UCD approach involved multiple iterative phases including semistructured interviews, user research sessions, and application development. Data were analyzed using a qualitative (thematic) approach of UCD and user research sessions. The app, which was preferred to the traditional Excel-based MEDLO, underwent multiple iterations. This method primed the continuous iterative development of the app, aimed for a minimum viable product (MVP). Results: This study included 14 participants, primarily female, from diverse professional backgrounds. Their feedback highlighted the need for efficiency improvements in tool preparation and data management. Key improvements included automated data handling, an intuitive tablet interface, and functionalities such as randomization and offline data syncing. Conclusions: The iterative development process led to an app that aligns with end-user needs, indicating potential for improved usability. Early and continuous user involvement was key in enhancing the application's usability, demonstrating the importance of user feedback in the development process
Association between Adverse Childhood Experiences and long-term outcomes in people at Clinical High-Risk for Psychosis
No full textAdverse childhood experiences (ACEs) are common in people at clinical high-risk for psychosis (CHR), however, the relationship between ACEs and long-term clinical outcomes is still unclear. This study examined associations between ACEs and clinical outcomes in CHR individuals. 344 CHR individuals and 67 healthy controls (HC) were assessed using the Childhood Trauma Questionnaire (CTQ), the Bullying Questionnaire and the Childhood Experience of Care and Abuse (CECA). CHR were followed up for up to 5 years. Remission from the CHR state, transition to psychosis (both defined with the Comprehensive Assessment of an At Risk Mental State), and level of functioning (assessed with the Global Assessment of Functioning) were assessed. Stepwise and multilevel logistic regression models were used to investigate the relationship between ACEs and outcomes. ACEs were significantly more prevalent in CHR individuals than in HC. Within the CHR cohort, physical abuse was associated with a reduced likelihood of remission (OR = 3.64, p = 0.025). Separation from a parent was linked to an increased likelihood of both remission (OR = 0.32, p = 0.011) and higher level of functioning (OR = 1.77, p = 0.040). Death of a parent (OR = 1.87, p = 0.037) was associated with an increased risk of transitioning to psychosis. Physical abuse and death of a parent are related to adverse long-term outcomes in CHR. The counter-intuitive association between separation from a parent and outcomes may reflect the removal of a child from an adverse environment. Future studies should investigate whether interventions targeting the effect of specific ACEs might help to improve outcomes in this population
Bridging regulation and practice:CJEU and Dutch case law on botanical health claims
No full textIntroduction Even though botanicals are increasingly popular ingredients for food supplements, health claims related to their putative bene ts remain unclearly regulated.Methods Through an analysis of EU and national case law from the Netherlands, including self-regulatory decision-making, we have studied the implications of case law on botanical health claims.Results Our analysis reveals that there are multiple issues related to claims on botanical-containing products: whether it should be classi ed as food or medicine; what statements should be understood as health claims; what type of evidence should underlie health claims and, more specically, botanical health claims; and how to deal with online commercial communication. The case law analysis highlights rst that a gray area will continue to exist when classifying products as foods or medicinal products, particularly when it comes to products that contain botanical ingredients. Most importantly, our study also reveals that claims-even when they are on hold, like botanical claims-need a certain scienti c foundation before they can be used on products. Finally, the courts believe that even though on-hold claims will continue to give a certain level of uncertainty for food business operators, this is not a legal but rather a regulatory issue.Discussion The findings from our case law analysis highlight that even though case law is useful in further interpretation of legislation, it does not provide any policy advancement. In the case of botanicals, a political decision regarding their substantiation is highly desired
Evaluation of change in the orientation of intraocular lens in the bag using intraoperative spectral-domain optical coherence tomography before and after capsular tension ring implantation
No full textPurpose: The purpose is to study the change in the contact of the IOL with the posterior capsule using intraoperative SD-OCT before and after implantation of the CTR post implantation of the IOL in the capsular bag. Methods: A total of 51 eyes of 51 patients with senile immature cataract underwent topical phacoemulsification procedure with implantation of an extended depth of focus intraocular lens by a single experienced surgeon. The Rescan 700 SD-OCT system was used for intraoperative imaging. These patients were imaged using intraoperative SD-OCT after implantation of the IOL and before and after implantation of appropriate size of CTR. The vertical height between posterior surface of the lens capsule and the posterior surface of the IOL was measured and compared across 3 CTR sizes. Results: The vertical height between the posterior surface of the lens capsule and the posterior surface of the IOL reduced significantly post CTR implantation (P value < 0.001) in all three groups. The change in height after CTR implantation was seen highest with the CTR size 13 mm and lowest with CTR size 11 mm. Conclusion: Significant improvement of contact between the IOL and the posterior capsule was shown after implantation of the CTR. Larger the size CTR, more the contact of the IOL with the bag was shown
Bronchodilator responsiveness and future chronic airflow obstruction:a multinational longitudinal study
No full textBackground Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time. Methods The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003 and December 26, 2016. Follow-up measurements were collected between January 29, 2019 and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers. Findings We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20). Interpretation Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings. Funding National Heart and Lung Institute, UK Medical Research Council, and Wellcome Trust. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)