scholarly journals A stochastic model for MRSA transmission within a hospital ward incorporating environmental contamination

2016 ◽  
Vol 145 (4) ◽  
pp. 825-838 ◽  
Author(s):  
X. J. LEE ◽  
G. R. FULFORD ◽  
A. N. PETTITT ◽  
F. RUGGERI
Keyword(s):  
Stochastic Model ◽  
Outcome Measures ◽  
Environmental Contamination ◽  
Disease Burden ◽  
Outcome Measure ◽  
Adverse Outcomes ◽  
Potential Outcome ◽  
Targeted Interventions ◽  
Transmission Process ◽  
Hospital Wards

SUMMARYMethicillin-resistant Staphylococcus aureus (MRSA) transmission in hospital wards is associated with adverse outcomes for patients and increased costs for hospitals. The transmission process is inherently stochastic and the randomness emphasized by the small population sizes involved. As such, a stochastic model was proposed to describe the MRSA transmission process, taking into account the related contribution and modelling of the associated microbiological environmental contamination. The model was used to evaluate the performance of five common interventions and their combinations on six potential outcome measures of interest under two hypothetical disease burden settings. The model showed that the optimal intervention combination varied depending on the outcome measure and burden setting. In particular, it was found that certain outcomes only required a small subset of targeted interventions to control the outcome measure, while other outcomes still reported reduction in the outcome distribution with up to all five interventions included. This study describes a new stochastic model for MRSA transmission within a ward and highlights the use of the generalized Mann–Whitney statistic to compare the distribution of the outcome measures under different intervention combinations to assist in planning future interventions in hospital wards under different potential outcome measures and disease burden.

scholarly journals Retrospective delirium ascertainment from case notes: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042440
Author(s):  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Outcome Measures ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome Measure ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Targeted Interventions ◽  
Improved Outcomes

ObjectivesThis study sets out to ascertain if recognition of delirium impacts on patient outcomes.DesignRetrospective cohort study.SettingUnscheduled admissions to acute care trust/secondary care UK hospitals.ParticipantsSix hundred and fifty-six older adults aged ≥65 years admitted on 14 September 2018.MeasurementsDelirium was ascertained retrospectively from case notes using medical notes. Documented delirium was classified as recognised delirium and retrospectively ascertained delirium was classified as unrecognised delirium.Primary and secondary outcome measuresPrimary outcome measure: inpatient mortality. Secondary outcome measures: length of stay, discharge destination.ResultsDelirium was present in 21.1% (132/626) of patients at any point during admission. The presence of delirium was associated with increased mortality (HR 2.65, CI 1.40 to 5.01). Recognition of delirium did not significantly impact on outcomes.ConclusionsDelirium is associated with adverse outcomes in hospitalised older adults. However, there is insufficient evidence that recognition of delirium affects outcomes. However, delirium recognition presents an opportunity to discuss a person’s overall prognosis and discuss this with the patient and their family. Further research is needed to assess the pathophysiology of delirium to enable development of targeted interventions towards improved outcomes in patients with delirium.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

scholarly journals Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study

Spinal Cord ◽  
2021 ◽  
Author(s):  
Helge Kasch ◽  
Uffe Schou Løve ◽  
Anette Bach Jønsson ◽  
Kaare Eg Severinsen ◽  
Marc Possover ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Control Group ◽  
Walking Ability ◽  
Data Set ◽  
Cord Injury

Abstract Study design 1-year prospective RCT. Objective Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. Methods Inclusion criteria: traumatic spinal cord injury (SCI), age 18–55 years, neurological level-of-injury Th4–L1, time-since-injury >1 year, and AIS-grades A–B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. Primary outcome measure: Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. Secondary outcome measures: Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). Results Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4–L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. Conclusion The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.

scholarly journals Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038829
Author(s):  
Ross McQueenie ◽  
Barbara I Nicholl ◽  
Bhautesh D Jani ◽  
Jordan Canning ◽  
Sara Macdonald ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Adverse Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Uk Biobank ◽  
Long Term Conditions ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Clinical Records

ObjectiveTo investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).DesignPopulation-based longitudinal cohort study.SettingUK Biobank.ParticipantsUK Biobank participants (n=502 533) aged between 37 and 73 years old.Primary outcome measuresPrimary outcome measures were risk of all-cause mortality and MACE.MethodsWe examined the relationship between LTC count and individual comorbid LTCs (n=42) on adverse clinical outcomes in participants with self-reported RA (n=5658). Risk of all-cause mortality and MACE were compared using Cox’s proportional hazard models adjusted for lifestyle factors (smoking, alcohol intake, physical activity), demographic factors (sex, age, socioeconomic status) and rheumatoid factor.Results75.7% of participants with RA had multimorbidity and these individuals were at increased risk of all-cause mortality and MACE. RA and >4 LTCs showed a threefold increased risk of all-cause mortality (HR 3.30, 95% CI 2.61 to 4.16), and MACE (HR 3.45, 95% CI 2.66 to 4.49) compared with those without LTCs. Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in participants with RA compared with those without RA or LTCs: twofold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55 to 3.12) and threefold increased risk of MACE (HR 3.17, 95% CI 2.27 to 4.64). These findings remained in a subset (n=3683) with RA diagnosis validated from clinical records or medication reports.ConclusionThose with RA and other LTCs, particularly comorbid osteoporosis, are at increased risk of adverse outcomes, although the role of corticosteroids could not be evaluated in this study. These results are clinically relevant for the monitoring and management of RA across the healthcare system, and future clinical guidelines for RA should acknowledge the importance of multimorbidity.

scholarly journals The use of shoulder scoring systems and outcome measures in the UK

2014 ◽  
Vol 96 (8) ◽  
pp. 590-592 ◽  
Author(s):  
M Varghese ◽  
J Lamb ◽  
R Rambani ◽  
B Venkateswaran
Keyword(s):  
Los Angeles ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Constant Score ◽  
Scoring Systems ◽  
Surgical Performance ◽  
Public Survey ◽  
Future Outcomes ◽  
The Uk ◽  
The University

Introduction In future, outcomes following shoulder surgery may be subject to public survey. Many outcome measures exist but we do not know whether there is a consensus between shoulder surgeons in the UK. The aim of this study was to survey the preferred outcome measures used by National Health Service (NHS) shoulder surgeons operating in the UK. Methods A total of 350 shoulder surgeons working in NHS hospitals were asked to complete a short written questionnaire regarding their use of scoring systems and outcome measures. Questionnaires were sent and responses were received by post. Results Overall, 217 responses were received (62%). Of the respondents, 171 (79%) use an outcome measure in their shoulder practice while 46 (21%) do not. There were 118 surgeons (69%) who use more than one outcome measure. The Oxford shoulder score was most commonly used by 150 surgeons (69%), followed by the Constant score with 106 (49%), the Oxford shoulder instability score with 82 (38%), and the Disabilities of the Arm, Shoulder and Hand score with 54 (25%). The less commonly used outcome measures were the SF-36® and SF-12® health questionnaires with 19 (9%), the University of California at Los Angeles activity score with 8 (4%), the American Shoulder and Elbow Surgeons shoulder assessment form with 8 (4%) and the EQ-5D™ with 10 (3%). Conclusions Validated outcome measures should be adopted by all practising surgeons in all specialties. This will allow better assessment of treatments in addition to assessment of surgical performance in a transparent way.

Prospective, comparative, cohort study comparing the rhinogram, Sino-Nasal Outcome Test-20 and Heath-Related Quality of Life questionnaire

2010 ◽  
Vol 124 (6) ◽  
pp. 623-630 ◽  
Author(s):  
P M Patel ◽  
S Maskell ◽  
R Heywood ◽  
N Eze ◽  
J Hern
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Life Questionnaire ◽  
Chi Square ◽  
Quality Of Life Questionnaire ◽  
Related Quality ◽  
Comparative Cohort Study

AbstractBackground:Many outcome measures exist for rhinosinusitis. However, few are used in the clinical setting due to their long completion times.Objective:To assess the validity, reliability and responsiveness of the rhinogram, compared with two validated rhinosinusitis outcome measures: the Sino-Nasal Outcome Test-20 and the Heath-Related Quality of Life questionnaire.Methods:Fifty-one patients were entered into a prospective, comparative, cohort study using all three outcome measures one week pre-operatively and three months post-operatively. Outcome scores were then correlated using non-parametric Spearman's rank correlation and chi-square testing for the diagnostic criteria of all three outcome measures.Results:Statistically significant correlations were found between all three outcome measures for all symptom scores, individually as well as combined (p < 0.01 for all calculations). Comparison of the diagnostic accuracy of the rhinogram, compared with the Sino-Nasal Outcome Test-20 and the Heath-Related Quality of Life questionnaire, showed statistical significance (p < 0.05; chi-square test).Conclusion:The rhinogram is a reliable, valid and responsive rhinosinusitis outcome measure which can assist patient diagnosis and management in the clinical setting. Due to its quick completion time, this outcome measure could be used in rhinology out-patient clinics.

scholarly journals Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: a simulation and economic modelling study

2020 ◽  
Author(s):  
Peter Griffiths ◽  
Christina Saville ◽  
Jane E Ball ◽  
Jeremy Jones ◽  
Thomas Monks
Keyword(s):  
Cost Effectiveness ◽  
Significant Proportion ◽  
Nurse Staffing ◽  
Cost Savings ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
List Type ◽  
Economic Modelling ◽  
The Face ◽  
Hospital Wards

AbstractBackgroundIn the face of pressure to contain costs and make best use of scarce nurses, flexible staff deployment (floating staff between units and temporary hires) guided by a patient classification system may appear an efficient approach to meeting variable demand for care in hospitals.ObjectivesWe modelled the cost-effectiveness of different approaches to planning baseline numbers of nurses to roster on general medical/surgical units while using flexible staff to respond to fluctuating demand.Design and SettingWe developed an agent-based simulation model, where units move between being understaffed, adequately staffed or overstaffed as staff supply and demand, measured by the Safer Nursing Care Tool, varies. Staffing shortfalls are addressed firstly by floating staff from overstaffed units, secondly by hiring temporary staff. We compared a standard staffing plan (baseline rosters set to match average demand) with a ‘resilient’ plan set to match higher demand, and a ‘flexible’ plan, set at a lower level. We varied assumptions about temporary staff availability. We estimated the effect of unresolved low staffing on length of stay and death, calculating cost per life saved.ResultsStaffing plans with higher baseline rosters led to higher costs but improved outcomes. Cost savings from low baseline staff largely arose because shifts were left under staffed. Cost effectiveness for higher baseline staff was improved with high temporary staff availability. With limited temporary staff available, the resilient staffing plan (higher baseline staff) cost £9,506 per life saved compared to the standard plan. The standard plan cost £13,967 per life saved compared to the flexible (low baseline) plan. With unlimited temporary staff, the resilient staffing plan cost £5,524 per life saved compared to the standard plan and the standard plan cost £946 per life saved compared with the flexible plan. Cost-effectiveness of higher baseline staffing was more favourable when negative effects of high temporary staffing were modelled.ConclusionFlexible staffing can be guided by shift-by-shift measurement of patient demand, but proper attention must be given to ensure that the baseline number of staff rostered is sufficient.In the face of staff shortages, low baseline staff rosters with high use of flexible staff on hospital wards is not an efficient or effective use of nurses whereas high baseline rosters may be cost-effective. Flexible staffing plans that minimise the number of nurses routinely rostered are likely to harm patients because temporary staff may not be available at short notice.Study registration: ISRCTN 12307968Tweetable abstractEconomic model of hospital wards shows low baseline staff levels with high use of flexible staff are not cost-effective and don’t solve nursing shortages].What is already known?Because nursing is the largest staff group, accounting for a significant proportion of hospital’s variable costs, ward nurse staffing is frequently the target of cost containment measuresStaffing decisions need to address both the baseline staff establishment to roster, and how best to respond to fluctuating demand as patient census and care needs varyFlexible deployment of staff, including floating staff and using temporary hires, has the potential to minimise expenditure while meeting varying patient need, but high use of temporary staff may be associated with adverse outcomes.What this paper addsOur simulation shows that low baseline staff rosters that rely heavily on flexible staff increase the risk of patient death and provide cost savings largely because wards are often left short staffed under real world availability of temporary staff.A staffing plan set to meet average demand appears to be cost effective compared to a plan with a lower baseline but is still associated with frequent short staffing despite the use of flexible deployments.A staffing plan with a higher baseline, set to meet demand 90% of the time, is more resilient in the face of variation and may be highly cost effective

Minimal Important Difference in Patient Reported Outcome Measures in Persons with Severe Mental Illness, a Post-hoc Pre-Post Analysis

2020 ◽  
Author(s):  
Titus Beentjes ◽  
Steven Teerenstra ◽  
Hester Vermeulen ◽  
Maria W.G. Nijhuis-van der Sanden ◽  
Betsie G.I. van Gaal ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Minimal Important Difference ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Illness Management And Recovery ◽  
Patient Reported ◽  
Complementary Intervention

Abstract Background: Complementary interventions for persons with severe mental illness (SMI) provide broad strategies for recovery and illness self-management. It is not known which outcome measure can be considered to be relevant for persons with SMI. This knowledge can motivate a professional to offer and stimulate a person to participate in that intervention. This paper aimed to identify the outcome measures that determine the most relevant and meaningful change and capture the benefits of a complementary intervention. Methods: By using anchor-based and distribution-based methods, we estimated the minimal important difference (MID) to determine which outcome measure persons improved in beyond the MID to reflect a relevant change in pre-post effect of a complementary intervention, in casu the Illness Management and Recovery programme (IMR).Results: The anchor MID was based on the results of the measure Rand General Health Perception (Rand-GHP). On all MIDs, the Mental Health Recovery Measure (MHRM) had the highest score on the effect compared to its MIDs, and also on all MIDs the MHRM had the highest percentages of participants that scored above the MID. Conclusion: The Rand-GHP is considered to be an excellent measure for investigating the MID as a result of an intervention. The results of our study can be used in shared decision-making processes to determine which intervention is suitable for a person with SMI. A person who desires a recovery outcome, as measured by the MHRM, can be recommended to do the IMR programme.

scholarly journals Development of MRC Centre MRI calf muscle fat fraction protocol as a sensitive outcome measure in Hereditary Sensory Neuropathy Type 1

2019 ◽  
Vol 90 (8) ◽  
pp. 895-906 ◽  
Author(s):  
Umaiyal Kugathasan ◽  
Matthew R B Evans ◽  
Jasper M Morrow ◽  
Christopher D J Sinclair ◽  
John S Thornton ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Sensory Neuropathy ◽  
Intramuscular Fat ◽  
Calf Muscle ◽  
Fat Accumulation ◽  
Hereditary Sensory Neuropathy ◽  
Fat Fraction

ObjectivesHereditary sensory neuropathy type 1 (HSN1) is a rare, slowly progressive neuropathy causing profound sensory deficits and often severe motor loss. L-serine supplementation is a possible candidate therapy but the lack of responsive outcome measures is a barrier for undertaking clinical trials in HSN1. We performed a 12-month natural history study to characterise the phenotype of HSN1 and to identify responsive outcome measures.MethodsAssessments included Charcot-Marie-Tooth Neuropathy Score version 2 (CMTNSv2), CMTNSv2-Rasch modified, nerve conduction studies, quantitative sensory testing, intraepidermal nerve fibre density (thigh), computerised myometry (lower limbs), plasma 1-deoxysphingolipid levels, calf-level intramuscular fat accumulation by MRI and patient-based questionnaires (Neuropathic Pain Symptom Inventory and 36-Short Form Health Survey version 2 [SF-36v2]).Results35 patients with HSN1 were recruited. There was marked heterogeneity in the phenotype mainly due to differences between the sexes: males generally more severely affected. The outcome measures that significantly changed over 1 year and correlated with CMTNSv2, SF-36v2-physical component and disease duration were MRI determined calf intramuscular fat accumulation (mean change in overall calf fat fraction 2.36%, 95% CI 1.16 to 3.55, p=0.0004), pressure pain threshold on the hand (mean change 40 kPa, 95% CI 0.7 to 80, p=0.046) and myometric measurements of ankle plantar flexion (median change −0.5 Nm, IQR −9.5 to 0, p=0.0007), ankle inversion (mean change −0.89 Nm, 95% CI −1.66 to −0.12, p=0.03) and eversion (mean change −1.61 Nm, 95% CI −2.72 to −0.51, p=0.006). Intramuscular calf fat fraction was the most responsive outcome measure.ConclusionMRI determined calf muscle fat fraction shows validity and high responsiveness over 12 months and will be useful in HSN1 clinical trials.

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