Protocol for a mixed method acceptability evaluation of a codesigned bundled COmmunication intervention for use in the adult ICU during the COVID-19 PandEmic: the COPE study

IntroductionPatients requiring invasive mechanical ventilation via an artificial airway experience sudden voicelessness placing them at risk for adverse outcomes and increasing provider workload. Infection control precautions during the COVID-19 pandemic, including the use of personal protective equipment (eg, gloves, masks, etc), patient isolation, and visitor restrictions may exacerbate communication difficulty. The objective of this study is to evaluate the acceptability of a codesigned communication intervention for use in the adult intensive care unit when infection control precautions such as those used during COVID-19 are required.Methods and analysisThis three-phased, prospective study will take place in a medical surgical ICU in a community teaching hospital in Toronto. Participants will include ICU healthcare providers, adult patients and their family members. Qualitative interviews (target n: 20–25) will explore participant perceptions of the barriers to and facilitators for supporting patient communication in the adult ICU in the context of COVID-19 and infection control precautions (phase 1). Using principles of codesign, a stakeholder advisory council of 8–10 participants will iteratively produce an intervention (phase 2). The codesigned intervention will then be implemented and undergo a mixed method acceptability evaluation in the study setting (phase 3). Acceptability, feasibility and appropriateness will be evaluated using validated measures (target n: 60–65). Follow-up semistructured interviews will be analysed using the theoretical framework of acceptability (TFA). The primary outcomes of this study will be acceptability ratings and descriptions of a codesigned COmmunication intervention for use during and beyond the COVID-19 PandEmic.Ethics and disseminationThe study protocol has been reviewed, and ethics approval was obtained from the Michael Garron Hospital. Results will be made available to healthcare providers in the study setting throughout the study and through publications and conference presentations.

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To err is system; a comparison of methodologies for the investigation of adverse outcomes in healthcare

Journal of Patient Safety and Risk Management ◽

10.1177/2516043521990261 ◽

2021 ◽

pp. 251604352199026

Author(s):

Peter Isherwood ◽

Patrick Waterson

Keyword(s):

Patient Safety ◽

System Performance ◽

Healthcare Delivery ◽

Healthcare Providers ◽

Real Life ◽

Adverse Outcomes ◽

System Level ◽

Future Performance ◽

System A ◽

Regulatory Bodies

Patient safety, staff moral and system performance are at the heart of healthcare delivery. Investigation of adverse outcomes is one strategy that enables organisations to learn and improve. Healthcare is now understood as a complex, possibly the most complex, socio-technological system. Despite this the use of a 20th century linear investigation model is still recommended for the investigation of adverse outcomes. In this review the authors use data gathered from the investigation of a real life healthcare near incident and apply three different methodologies to the analysis of this data. They compare both the methodologies themselves and the outputs generated. This illustrates how different methodologies generate different system level recommendations. The authors conclude that system based models generate the strongest barriers to improve future performance. Healthcare providers and their regulatory bodies need to embrace system based methodologies if they are to effectively learn from, and reduce future, adverse outcomes.

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Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Nutrients ◽

10.3390/nu13041339 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1339

Author(s):

Moustapha Dramé ◽

Cécilia Cofais ◽

Maxime Hentzien ◽

Emeline Proye ◽

Pécory Souleymane Coulibaly ◽

...

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Clinical Outcomes ◽

Oxygen Therapy ◽

Invasive Mechanical Ventilation ◽

Adverse Outcomes ◽

Aged Patients ◽

Aged People ◽

Severity Of The Disease

Background: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. Methods: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. Results: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). Conclusion: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

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Military spouses with deployed partners are at greater risk of poor perinatal mental health: a scoping review

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2018-001069 ◽

2019 ◽

Vol 165 (5) ◽

pp. 363-370 ◽

Cited By ~ 1

Author(s):

Lauren Rose Godier-McBard ◽

L Ibbitson ◽

C Hooks ◽

M Fossey

Keyword(s):

Mental Health ◽

Social Support ◽

Scoping Review ◽

Healthcare Providers ◽

Well Being ◽

Perinatal Period ◽

Poor Mental Health ◽

Adverse Outcomes ◽

Military Spouses ◽

Perinatal Mental Health

BackgroundPoor mental health in the perinatal period is associated with a number of adverse outcomes for the individual and the wider family. The unique circumstances in which military spouses/partners live may leave them particularly vulnerable to developing perinatal mental health (PMH) problems.MethodsA scoping review was carried out to review the literature pertaining to PMH in military spouses/partners using the methodology outlined by Arksey and O’Malley (2005). Databases searched included EBSCO, Gale Cengage Academic OneFile, ProQuest and SAGE.ResultsThirteen papers fulfilled the inclusion criteria, all from the USA, which looked a PMH or well-being in military spouses. There was a strong focus on spousal deployment as a risk factor for depressive symptoms and psychological stress during the perinatal period. Other risk factors included a lack of social/emotional support and increased family-related stressors. Interventions for pregnant military spouses included those that help them develop internal coping strategies and external social support.ConclusionsUS literature suggests that military spouses are particularly at risk of PMH problems during deployment of their serving partner and highlights the protective nature of social support during this time. Further consideration needs to be made to apply the findings to UK military spouses/partners due to differences in the structure and nature of the UK and US military and healthcare models. Further UK research is needed, which would provide military and healthcare providers with an understanding of the needs of this population allowing effective planning and strategies to be commissioned and implemented.

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Diagnostic Tests Can Stem the Threat of Antimicrobial Resistance: Infectious Disease Professionals Can Help

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1527 ◽

2020 ◽

Author(s):

Dana Trevas ◽

Angela M Caliendo ◽

Kimberly Hanson ◽

Jaclyn Levy ◽

Christine C Ginocchio

Keyword(s):

Infectious Disease ◽

Antimicrobial Resistance ◽

Diagnostic Tests ◽

Healthcare Providers ◽

Federal Funding ◽

Antibiotic Use ◽

Advisory Council ◽

Resistant Bacteria ◽

Research Development ◽

Antibiotic Resistant

Abstract Uptake of existing diagnostics to identify infections more accurately could minimize unnecessary antibiotic use and decrease the growing threat of antibiotic resistance. The Infectious Diseases Society of America (IDSA) and the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) agree that, to improve uptake of existing diagnostics, healthcare providers, health systems, and payors all need better clinical and economic outcomes data to support use of diagnostic tests over empiric use of antibiotics, providers need better tools and education about diagnostic tests, and diagnostics developers need federal funding in the absence of a viable diagnostics market. Recommendations from PACCARB and the IDSA are amplified. Incentives for—and challenges to—diagnostics research, development, and uptake are summarized. Advocacy opportunities are given for infectious disease professionals to join the fight against antimicrobial resistance.

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COVID-IRS: A novel predictive score for risk of invasive mechanical ventilation in patients with COVID-19

PLoS ONE ◽

10.1371/journal.pone.0248357 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0248357

Author(s):

José Antonio Garcia-Gordillo ◽

Antonio Camiro-Zúñiga ◽

Mercedes Aguilar-Soto ◽

Dalia Cuenca ◽

Arturo Cadena-Fernández ◽

...

Keyword(s):

Mechanical Ventilation ◽

Systemic Disease ◽

Invasive Mechanical Ventilation ◽

Area Under The Curve ◽

Lactic Dehydrogenase ◽

Total Sample ◽

Adverse Outcomes ◽

Predictive Score ◽

Neutrophil Lymphocyte Ratio ◽

Predictive Variables

Background Coronavirus disease 2019 (COVID-19) is a systemic disease that can rapidly progress into acute respiratory failure and death. Timely identification of these patients is crucial for a proper administration of health-care resources. Objective To develop a predictive score that estimates the risk of invasive mechanical ventilation (IMV) among patients with COVID-19. Study design Retrospective cohort study of 401 COVID-19 patients diagnosed from March 12, to August 10, 2020. The score development cohort comprised 211 patients (52.62% of total sample) whereas the validation cohort included 190 patients (47.38% of total sample). We divided participants according to the need of invasive mechanical ventilation (IMV) and looked for potential predictive variables. Results We developed two predictive scores, one based on Interleukin-6 (IL-6) and the other one on the Neutrophil/Lymphocyte ratio (NLR), using the following variables: respiratory rate, SpO2/FiO2 ratio and lactic dehydrogenase (LDH). The area under the curve (AUC) in the development cohort was 0.877 (0.823–0.931) using the NLR based score and 0.891 (0.843–0.939) using the IL-6 based score. When compared with other similar scores developed for the prediction of adverse outcomes in COVID-19, the COVID-IRS scores proved to be superior in the prediction of IMV. Conclusion The COVID-IRS scores accurately predict the need for mechanical ventilation in COVID-19 patients using readily available variables taken upon admission. More studies testing the applicability of COVID-IRS in other centers and populations, as well as its performance as a triage tool for COVID-19 patients are needed.

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Trail Conditions and Community Use: Utilizing Geospatial Video to Guide the Adoption of a Spatial-Temporal Trail Audit Tool (STAT)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168741 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8741

Author(s):

Carissa Smock ◽

Naomi Carlson ◽

Chelsey Kirkland

Keyword(s):

Rural Communities ◽

Mixed Method ◽

Qualitative Data ◽

Phase 1 ◽

Video Camera ◽

Neighborhood Environment ◽

Composite Score ◽

Audit Tool ◽

All Cause Mortality ◽

Spatial Video

Physical activity (PA), associated with all-cause mortality, morbidity, and healthcare costs, improves vitamin D absorption, immune response, and stress when completed outdoors. Rural communities, which experience PA inequities, rely on trails to meet PA guidelines. However, current trail audit methods could be more efficient and accurate, which geospatial video may support. Therefore, the study purpose was (1) to identify and adopt validated instruments for trail audit evaluations using geospatial video and a composite score and (2) to determine if geospatial video and a composite score motivate (influence the decision to use) specific trail selection among current trail users. Phase 1 used a mixed-method exploratory sequential core design using qualitative data, then quantitative data for the development of the Spatial-temporal Trail Audit Tool (STAT). Geospatial videos of two Northeast Ohio trails were collected using a bicycle-mounted spatial video camera and video analysis software. The creation of STAT was integrated from Neighborhood Environment Walkability Scale (NEWS), Walk Score, and Path Environment Audit Tool (PEAT) audit tools based on four constructs: trail accessibility, conditions, amenities, and safety. Scoring was determined by three independent reviewers. Phase 2 included a mixed-method convergent core design to test the applicability of STAT for trail participant motivation. STAT has 20 items in 4 content areas computing a composite score and was found to increase trail quality and motivation for use. STAT can evaluate trails for PA using geospatial video and a composite score which may spur PA through increased motivation to select and use trails.

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INFECTION CONTROL PRACTICES

The Professional Medical Journal ◽

10.29309/tpmj/18.4957 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1933-1936

Author(s):

Imran Samejo ◽

Gotam Das ◽

Muhammad Haseeb Rana ◽

Muhammad Waqar Hussain

Keyword(s):

Infection Control ◽

Control Measure ◽

Financial Burden ◽

Infection Control Measure ◽

Cross Sectional Study ◽

Laboratory Work ◽

Cross Sectional ◽

The Social ◽

B Virus ◽

Study Setting

Objectives: The aim of this study was to assess the knowledge and infection control practices among private dental laboratories in Karachi. Study Design: Cross sectional study. Setting: Private Dental Laboratories of Karachi. Period: 01st September 2017 to 01st February 2018. Materials and Methods: A pre structured questionnaire comprised of 09 questions regarding infection control was used to collect the data. A total 35 questionnaires were given to dental technicians. 29 questionnaires were obtained out of 35 distributed (response rate: 83%). Statistical Package for the Social Sciences (SPSS) version 17.0 was used for data analysis. Results: Gloves were not worn by 76% of respondents while receiving the clinical items. Protective eyeglasses and protective face shield were not worn by 38% and 13% of respondents respectively during laboratory work. Few 13% of respondents were vaccinated against the hepatitis b virus. Clinical items were disinfected by 17% of respondents if not disinfected by dental clinic. Laboratory work was not disinfected by 90% of respondents before sending to clinic. Pumice slurry and water of pressure pot were changed by 6% and 6% respectively. Regarding infection control measure impose financial burden, 83% of respondents were agreed. Conclusion: The knowledge and practices of infection control were poor and below acceptable standards in private dental laboratories.

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Increased Involvement of Klebsiellapneumoniae and Enterococcusfaecium in Healthcare-Associated Infections of Intensive Care Units in Taiwan

Healthcare ◽

10.3390/healthcare9101349 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1349

Author(s):

Yu-Ren Lin ◽

Yen-Yue Lin ◽

Chia-Peng Yu ◽

Ya-Sung Yang ◽

Chun-Gu Cheng ◽

...

Keyword(s):

Intensive Care ◽

Infection Control ◽

Intensive Care Units ◽

Enterococcus Faecium ◽

Healthcare Providers ◽

Incidence Density ◽

Healthcare Associated Infections ◽

Chi Square ◽

Control Protocols ◽

Healthcare Associated

Background: Healthcare-associated infections (HAIs) cause increases in length of stay, mortality, and healthcare costs. A previous study conducted in Taiwan obtained similar results to those reported in Korea and Japan in 2015. Changes in microorganisms have been noted in recent years. Understanding the recent condition of HAIs in intensive care units (ICUs) can enable healthcare providers to develop effective infection control protocols to reduce HAIs. Methods: We used the Taiwan Nosocomial Infection Surveillance System to evaluate the incidence densities of HAIs, the proportions of causative pathogens, and the proportions of antimicrobial resistance (AMR). The Poisson regression model was constructed to incidence density, and the chi-square test was used to assess proportion. Results: The incidence density of HAIs decreased 5.7 to 5.4 per 1000 person-days. However, the proportions of Klebsiella pneumoniae and Enterococcus faecium significantly increased. In addition, the proportions of carbapenem-resistant K. pneumoniae and vancomycin-resistant Enterococcus faecium significantly increased over time. Conclusion: Analysis of the microorganisms involved in HAIs in ICUs showed elevated proportions of K. pneumoniae and E. faecium with AMR. Infection control protocols have been implemented for several years and require improvements regarding environmental cleanliness and medical staff prevention.

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Supporting population mental health and wellness during the COVID-19 pandemic in Canada: protocol for a sequential mixed-method study

BMJ Open ◽

10.1136/bmjopen-2021-052259 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052259

Author(s):

Tracie Risling ◽

Courtney Carlberg ◽

Iman Kassam ◽

Tyler Moss ◽

Patricia Janssen ◽

...

Keyword(s):

Mental Health ◽

Advisory Committee ◽

Mixed Method ◽

Text Messaging ◽

Negative Impact ◽

Phase 1 ◽

Well Being ◽

Mixed Method Study ◽

Digital Resources ◽

Overall Acceptability

IntroductionThe global COVID-19 pandemic has reported to have a negative impact on the mental health and well-being of individuals around the world. Mental health system infrastructure, primarily developed to support individuals through in-person care, struggled to meet rising demand for services even prior to COVID-19. With public health guidelines requiring the use of physical distancing during the pandemic, digital mental health supports may be one way to address the needs of the population. Despite this, barriers exist in promoting and supporting access to existing and emerging digital resources. Text messaging may address some of these barriers, extending the potential reach of these digital interventions across divides that may separate some vulnerable or disadvantaged groups from essential mental health supports. Building on an existing knowledge synthesis project identifying key digital resources for improved mental health, this research will establish low-tech connections to assess need and better match access to services for those who need it most. The aim of this study is to codesign a customised two-way texting service to explore need and better align access to mental health supports for Canadians located in Saskatchewan during the COVID-19 pandemic.Methods and analysisThis study will be completed in Saskatchewan, Canada. For this project, the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will be used to support three phases of a sequential mixed-method study. An advisory committee of Saskatchewan residents will guide this work with the study team. A 10-week service will be launched to connect individuals with appropriately suited digital mental health interventions through the use of text messaging. In phase 1, implementation and prototyping will be conducted with collaborative codesign for key elements related to features of an enrolment survey and initial messaging content. Phase 2 will focus on advancing the effectiveness of the service using quantitative user data. In phase 3, an embedding approach will be used to integrate both qualitative and quantitative data collected to understand the overall acceptability, satisfaction and perceived benefit of the text messaging service. Thematic analysis and descriptive statistics will be used as analytic methods.Ethics and disseminationThis study has received approval from the Research Ethics Board at the University of Saskatchewan. A knowledge dissemination plan has been developed that includes traditional academic approaches such as conference presentations, and academic publications, as well as mainstream approaches such as social media, radio and dissemination through the advisory committee.

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Perception of the healthcare professionals towards the current trauma and emergency care system in Kabul, Afghanistan: a mixed method study

BMC Health Services Research ◽

10.1186/s12913-020-05845-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Umerdad Khudadad ◽

Wafa Aftab ◽

Asrar Ali ◽

Nadeem Ullah Khan ◽

Junaid Razzak ◽

...

Keyword(s):

Emergency Care ◽

Trauma Care ◽

Mixed Method ◽

Healthcare Providers ◽

Trauma Management ◽

Policy Makers ◽

Hospital Managers ◽

Care Services ◽

Emergency Care System ◽

Care System

Abstract Background Trauma and injury contribute to 11% of the all-cause mortality in Afghanistan. The study aimed to explore the perceptions of the healthcare providers (pre and in-hospital), hospital managers and policy makers of the public and private health sectors to identify the challenges in the provision of an effective trauma care in Kabul, Afghanistan. Methods A concurrent mixed method design was used, including key-informant interviews (healthcare providers, hospital managers and policy makers) of the trauma care system (N = 18) and simultaneous structured emergency care system assessment questionnaire (N = 35) from July 15 to September 25, 2019. Interviews were analyzed using content analysis approach and structured questionnaire data were descriptively analyzed. Results Four themes were identified that describe the challenges: 1) pre-hospital care, 2) cohesive trauma management system, 3) physical and human resources and 4) stewardship. Some key challenges were found related to scene and transportation care, in-hospital care and emergency preparedness within the wider trauma care system. Less than 25% of the population is covered by the pre-hospital ambulance system (n = 23, 65.7%) and there is no communication process between health care facilities to facilitate transfer (n = 28, 80%). Less than 25% of patients with an injury requiring emergent surgery have access to surgical care in a staffed operating theatre within 2 h of injury (n = 19, 54.2%) and there is no regular assessment of the ability of the emergency care system to mobilize resources (human and physical) to respond to disasters, and other large-scale emergencies (n = 28, 80%). Conclusion This study highlighted major challenges in the delivery of trauma care services across Kabul, Afghanistan. Systematic improvement in the workforce training, structural organization of the trauma care system and implementing externally validated clinical guidelines for trauma management could possibly enhance the functions of the existing trauma care services. However, an integrated state-run trauma care system will address the current burden of traumatic injury more effectively within the wider healthcare system of Afghanistan.

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