267 research outputs found
Health system guidance appraisal-concept evaluation and usability testing
No full textHealth system guidance (HSG) provides recommendations aimed to address health system challenges. However, there is a paucity of methods to direct, appraise, and report HSG. Earlier research identified 30 candidate criteria (concepts) that can be used to evaluate the quality of HSG and guide development and reporting requirements. The objective of this paper was to describe two studies aimed at evaluating the importance of these 30 criteria, design a draft HSG appraisal tool, and test its usability.; This study involved a two-step survey process. In step 1, respondents rated the 30 concepts for appropriateness to, relevance to, and priority for health system decisions and HSG. This led to a draft tool. In step 2, respondents reviewed HSG documents, appraised them using the tool, and answered a series of questions. Descriptive analyses were computed.; Fifty participants were invited in step 1, and we had a response rate of 82 %. The mean response rates for each concept within each survey question were universally favorable. There was also an overall agreement about the need for a high-quality tool to systematically direct the development, appraisal, and reporting of HSG. Qualitative feedback and a consensus process by the team led to refinements to some of the concepts and the creation of a beta (draft) version of the HSG tool. In step 2, 35 participants were invited and we had a response rate of 74 %. Exploratory analyses showed that the quality of the HSGs reviewed varied as a function of the HSG item and the specific document assessed. A favorable consensus was reached with participants agreeing that the HSG items were easy to understand and easy to apply. Moreover, the overall agreement was high for the usability of the tool to systematically direct the development (85 %), appraisal (92 %), and reporting (81 %) of HSG. From this process, version 1.0 of the HSG appraisal tool was generated complete with 32 items (and their descriptions) and 4 domains.; The final tool, named the Appraisal of Guidelines for Research and Evaluation for Health Systems (AGREE-HS) (version 1), defines expectations of HSG and facilitates informed decisions among policymakers on health system delivery, financial, and governance arrangements
Validity and usability testing of a health systems guidance appraisal tool, the AGREE-HS
No full textAbstract Background Health systems guidance (HSG) provides recommendations to address health systems challenges. No tools exist to inform HSG developers and users about the components of high quality HSG and to differentiate between HSG of varying quality. In response, we developed a tool to assist with the development, reporting and appraisal of HSG – the Appraisal of Guidelines for Research and Evaluation–Health Systems (AGREE-HS). This paper reports on the validity, usability and initial measurement properties of the AGREE-HS. Methods To establish face validity (Study 1), stakeholders completed a survey about the AGREE-HS and provided feedback on its content and structure. Revisions to the tool were made in response. To establish usability (Study 2), the revised tool was applied to 85 HSG documents and the appraisers provided feedback about their experiences via an online survey. An initial test of the revised tool’s measurement properties, including internal consistency, inter-rater reliability and criterion validity, was conducted. Additional revisions to the tool were made in response. Results In Study 1, the AGREE-HS Overview, User Manual, quality item content and structure, and overall assessment questions were rated favourably. Participants indicated that the AGREE-HS would be useful, feasible to use, and that they would apply it in their context. In Study 2, participants indicated that the quality items were easy to understand and apply, and the User Manual, usefulness and usability of the tool were rated favourably. Study 2 participants also indicated intentions to use the AGREE-HS. Conclusions The AGREE-HS comprises a User Manual, five quality items and two overall assessment questions. It is available at agreetrust.org
Application of risk control principles in relations with the health care community
No full textPlan BThis study examines historical and current practices and trends in the evolution of the relationships that exist between corporations and the insurance and health care industries in the context of occupational health care, prevention and wellness initiatives, and benefits. The historical implementation of prevention, health and wellness programs by industry is traced, and the development of managed care as an adaptation by the insurance industry of these workplace initiatives is discussed. The practice of occupational health is discussed, including developments in traditional medical approaches as well as emerging concepts of the role of complementary and alternative options in the provision of occupational health services. The role of chiropractic is particularly examined. Methodology includes literature review, professional experience of the author, review of examples of clinical settings in occupational health, personal communication and interviews with practitioners in occupational health and vocational consultation. Corporations are identified as having the core financial stake in the development of innovative approaches to amelioration of challenges faced in protecting the health and well being of their workforce. Corporate concerns are seen historically as the source of concepts that have been co-opted by other industries, such as managed care concepts by the insurance industry, or wellness and prevention by the health care industry. Significantly, the insurance and health care industries can be seen in some respects as reactive to the innovations and demands of the corporate marketplace, rather than proactive. Results are discussed in terms of actions corporate management systems might take to develop more effective policies and programs in their health and wellness endeavors
Rape revisited: Joanna Bourke reflects on historicising sexual violence, in conversation with Ruth Beecher
No full textJoanna Bourke’s career as a social and cultural historian span more than three decades. She is a Professor of History at Birkbeck, University of London, a Fellow of the British Academy and the current Professor of Rhetoric at Gresham College. She is the prizewinning author of sixteen books, including histories of violence, modern warfare, medicine and science, psychology and psychiatry, the emotions, pain and what it means to be human. Her ground-breaking 2007 book Rape debunked ‘theories’ espoused by academics, doctors, lawyers and scientists that it was women who were responsible for rape; she insisted that we place the responsibility for sexual violence firmly with the rapist. It catalysed a new and vibrant scholarship. In 2018, Bourke established the Wellcome Trust-funded Sexual Harms and Medical Encounters (SHaME) Research Hub at Birkbeck to explore the role of medicine and psychiatry in sexual violence. The reflections below are based on a conversation between Bourke and Ruth Beecher, a post-doctoral historian and applied researcher in the SHaME team. It took place on the publication of Bourke’s new book, Disgrace: Global Reflections on Sexual Violence, published by Reaktion Books in July 2022. Disgrace explores how sexual violence varies widely across time and place, delving into the factors that facilitate violence and giving voice to survivors and activists. Ultimately, Bourke argues for a transnational feminism that will promote a rape- and violence-free world
Consolidated health economic evaluation reporting standards (CHEERS) statement
No full text<p>Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication.</p>
<p>The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp).</p>
<p>We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.</p>
Lesson learned from early experience in pediatric epilepsy surgery service in Surabaya, Indonesia
No full textIndonesia is a large country with approximately 265 million people. About 70 millions people are at pediatric age.1 Until 2009, there is only one epilepsy surgery center in Indonesia, located at Semarang - Central Java, that performs surgery for mostly adult patients.2,3 In 2009, our center started to perform epilepsy surgery for children with epilepsy. This brief communication presents the development of the newly established pediatric epilepsy surgery center in Surabaya, Indonesia; the limitations and obstacles, the lesson learned from the early experience, and how we manage the difficulties. We reviewed medical records of all epilepsy surgery cases performed at Dr. Soetomo General Hospital Surabaya from 2009-2016. Pre-operative conference was employed with the team and the family. The team includes pediatric neurologist/epileptologist (PIG), neurosurgeons (WS, HS, MAP, and AT) and neuroradiologist. Pre-operative examination included semiology of the seizure, full neurologic examination, interictal scalp electroencephalography (EEG), brain magnetic resonance imaging (MRI), with specific attention to the area of suspected ictal onset. Surgical procedures were performed by the author (WS) with assistance by HS and AT. Pre-operative and post-operative treatment was by all authors. Regimen and dosing adjustment of anti-epileptic drugs (AED) was by neuropediatrician (PIG). Specimens from operative field were sent to patholog
Desensitization With Imlifidase for HLA-Incompatible Deceased Donor Kidney Transplantation: A Delphi International Expert Consensus
No full textHLA incompatible; Desensitization; Kidney transplantationHLA incompatible; Desensibilització; Trasplantament renalHLA incompatible; Desensibilización; Trasplante renalHighly sensitized (HS) patients in need of kidney transplantation (KTx) typically spend a longer time waiting for compatible kidneys, are unlikely to receive an organ offer, and are at increased risk of antibody-mediated rejection (AMR). Desensitization using imlifidase, which is more rapid and removes total body immunoglobulin G (IgG) to a greater extent than other methods, enables transplantation to occur between HLA-incompatible (HLAi) donor–recipient pairs and allows patients to have greater access to KTx. However, when the project was launched there was limited data and clinical experience with desensitization in general and with imlifidase specifically. Hence, this Delphi methodology was used to reach a consensus from a multi-disciplinary team (MDT) of experts from 15 countries on the management of HS patients undergoing imlifidase HLAi from a deceased donor (DD) KTx. This Delphi consensus provides clinical practice guidance on the use of imlifidase in the end-to-end management of HS patients undergoing an HLAi DD KTx and supports centers in the development of guidelines for the utilization and integration of imlifidase into clinical practice.The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The authors declare that this study received funding from Hansa Biopharma for the development of this project. The funder had the following involvement with the study: logistic support for the project meetings and contracting services of an independent medical education agency to support the medical writing
Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination
No full textBackground
An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level.
Objectives
To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care.
Methods
Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care.
Results
Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance.
Conclusions
On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care
Upper extremity nerve lesions (diagnosis, indications, surgical techniques)
No full textOBJECTIVE: Revision and questioning of orthodox principles regarding the conduction of nerve impulse. DESIGN: Retrospective study with clinical analysis of results. SITE: Hospital das Clinicas (HCFMSP), public university institution with research programs and tertiary attention to health. GROUP MEMBERS: Author and a team of residents and trainees. OPERATION: Direct suture of nervous stumps utilizing auxiliary technical procedures:- joint-flexion, nerve transposition, tendon transplants, bone shortening. MEASUREMENT: Clinical evaluation and objective tests for tactile and stereognostic function recovery (WeberTest). RESULTS: Variable, depending on preoperative conditions: - type of lesion, time elapsed since injury. CONCLUSIONS: Neurorrhaphy should be the procedure of choice even for long term lesions, although the expected results may be less favourable. Periodical evaluation from 24 hs. postoperative, checking for early undefined signals of nervous function recovery. Association of specific drugs for chemical biophysics of the nerve
Recommended from our members
Systematic review of post-COVID-19 syndrome rehabilitation guidelines.
No full textINTRODUCTION: Post-COVID-19 syndrome is associated with significant health and potential socioeconomic burden. Due to its novel nature, there is a lack of clarity over best practice for the rehabilitation of patients with ongoing or new symptoms following acute COVID-19 infection. We conducted a systematic review of clinical and service guidelines for post-COVID-19 syndrome rehabilitation. METHODS: This review was registered on PROSPERO and is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included guidelines formally published or endorsed by a recognised professional body, covering rehabilitation of people with symptoms following resolution of acute COVID-19 infection. We searched Medline, Embase, PsycINFO, CINAHL, Web of Science, NHS Evidence, MedRxiv, PsyArXiv and Google for terms related to COVID-19, rehabilitation and guideline. Two reviewers independently screened articles for inclusion, data extracted and quality assessed using the AGREE II and AGREE-REX tools for clinical guidelines and the AGREE-HS tool for service guidelines. We included guidelines of sufficient quality in a narrative synthesis. RESULTS: We identified 12 790 articles, of which 37 guidelines (19 clinical only, 7 service only and 11 combined clinical and service) were included. Guidelines covered a range of countries, rehabilitation types, populations and rehabilitation settings. Synthesis of clinical guidelines (n=4) was structured following the patient pathway, from identification, to assessment, treatment and discharge, with consideration of specific patient groups. Synthesis of service guidelines (n=8) was structured according to the Donabedian framework. DISCUSSION: Though the available post-COVID-19 syndrome rehabilitation guidelines were generally of poor quality, there was a high degree of consensus regarding the breadth of symptoms, the need for holistic assessment by a broad multidisciplinary team and person-centred care. There was less clarity on management options, measuring outcomes and discharge criteria. PROSPERO REGISTRATION NUMBER: CRD42021236049
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