scholarly journals Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care): A Nationwide Observational Study Protocol (Preprint)

2020 ◽  
Author(s):  
Annemarei Ranta ◽  
Stephanie Thompson ◽  
Matire Louise Ngarongoa Harwood ◽  
Dominique Ann-Michele Cadilhac ◽  
Peter Alan Barber ◽  
...  
Keyword(s):  
New Zealand ◽  
Data Collection ◽  
Observational Study ◽  
Focus Groups ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Cost Efficacy ◽  
Nationwide Observational Study ◽  
The Impact

BACKGROUND Stroke systems of care differ between larger urban and smaller rural settings and it is unclear to what extent this may impact on patient outcomes. Ethnicity influences stroke risk factors and care delivery and patient outcomes in non-stroke settings. Little is known about the impact of ethnicity on post-stroke care especially in Māori and Pacific populations. OBJECTIVE To describe the study protocol for the Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care) Study METHODS This large nationwide observational study assesses the impact of rurality and ethnicity on best practice stroke care access and outcomes involving all 28 New Zealand hospitals caring for stroke patients capturing every stroke patient admitted to hospital during the 2017-2018 study period. In addition, it explores current access barriers through consumer focus groups, and consumer, carer, clinician, manager, and policy maker surveys. It also assesses economic impact of care provided at different types of hospitals and to different ethnicities, as well as exploring cost-efficacy of individual interventions and care bundles. Finally it compares manual study data collection to routine health administrative data, and explores the feasibility of developing outcome models using only administrative data and the cost-efficacy of using additional manually collected registry data. Sample size estimates: Part 1a - 2,400 participants to identify a 10% difference between up to four geographic sub-groups at 90% power with alpha 0.05 and 10-20% loss to follow-up. Part 1b - 7,645 to include an estimated 850 Māori and 419 Pacific patients to provide >90% and >80% power respectively. Part 2 – fifty patient/carer surveys, forty provider surveys, and ten focus groups to achieve saturation of themes. Study outcome(s): Main outcome is modified Rankin Score at 3 months (mRS). Secondary outcomes include mRS, EQ-5D-3L, stroke recurrence, vascular events, death, and readmission at 3, 6, and 12 months as well as cost of care and themes around access barriers. RESULTS The study is underway with national and institutional ethics approval in place, 2,379 patients recruited for part 1a, 6,837 for part 1b, ten focus groups conducted, and 70 surveys completed. Data collection is essentially completed including follow-up assessment, however, primary and secondary analyses, data linkage, data validation, and health economics analysis still underway. CONCLUSIONS The methods of this study may provide the basis for future epidemiological studies to guide care improvements in other countries and populations.

scholarly journals The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study

2022 ◽  
Vol 20 ◽  
pp. 100358
Author(s):  
Stephanie G. Thompson ◽  
P. Alan Barber ◽  
John H. Gommans ◽  
Dominique A. Cadilhac ◽  
Alan Davis ◽  
...  
Keyword(s):  
New Zealand ◽  
Observational Study ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Care Access ◽  
Nationwide Observational Study ◽  
The Impact

The Impact of Ethnicity on Stroke Care Access and Outcomes: A New Zealand Nationwide Observational Study

2021 ◽  
Author(s):  
Stephanie G. Thompson ◽  
P. Alan Barber ◽  
John H. Gommans ◽  
Dominique A. Cadilhac ◽  
Alan Davis ◽  
...  
Keyword(s):  
New Zealand ◽  
Observational Study ◽  
Stroke Care ◽  
Care Access ◽  
Nationwide Observational Study ◽  
The Impact

scholarly journals Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care): A Nationwide Observational Study Protocol (Preprint)

10.2196/25374 ◽  
2020 ◽  
Author(s):  
Annemarei Ranta ◽  
Stephanie Thompson ◽  
Matire Louise Ngarongoa Harwood ◽  
Dominique Ann-Michele Cadilhac ◽  
Peter Alan Barber ◽  
...  
Keyword(s):  
New Zealand ◽  
Observational Study ◽  
Study Protocol ◽  
Stroke Care ◽  
Nationwide Observational Study

Abstract 1122‐000242: Effect of Covid‐19 on Stroke Treatment in Australia and New Zealand

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ela Machiroutu
Keyword(s):  
New Zealand ◽  
Stroke Care ◽  
Small Subset ◽  
Stroke Patients ◽  
Secondary Research ◽  
Stroke Treatment ◽  
Survey Tool ◽  
Early Adoption ◽  
Survey Responses ◽  
The Impact

Introduction : In general, compared to the rest of the world, the impact of Covid‐19 in the Australia and New Zealand regions has been minimal and this may be attributed to their early adoption of social distancing, stable governments, national wealth and geographic isolation. However, this research was designed to validate this perception amongst the stakeholders. Methods : This research included: primary and secondary research. First, secondary research about Covid‐19 and stroke treatment and Australia and New Zealand in particular was conducted and compiled in a Google spreadsheet. Research sources include Stroke Foundation, Brain Foundation, and World Meters. Data collected included the number of stroke and Covid‐19 cases in Australia and New Zealand as well as a list of stakeholders with their contact information. The stakeholders included neurosurgeons, hospitals, neurologists, interventionists, and vascular surgeons. A survey tool and an interview questions were prepared next. The survey request was emailed to stakeholders, requesting the stakeholders for an interview and survey response. Over the following weeks, survey results came in and interviews were conducted. Since only a small subset of stakeholders responded to the survey (6 survey responses and 4 interviews), this study must be considered to be primarily qualitative in nature. The interviews were conducted online using Zoom. After the interviews, I replayed the interviews and took notes of important details. Results : The survey showed that 83% of the doctors worked in a hospital that had a separate stroke unit and that they perform mechanical thrombectomies most often as a treatment for stroke. Most of the doctors suggested that the stroke numbers have not changed significantly since Covid‐19. Yet, 50% of the doctors said that there had been delays in admitting stroke patients. One third believed Covid‐19 may have made an impact on mortality of stroke patients. One of the interviewees revealed that the main barriers to access to stroke care are the time it takes to treat the patient, fewer locations that treat strokes or perform mechanical thrombectomy, and patients’ reluctance to go to the hospital during the pandemic. Another confirmed that she did think there had been delays due to Covid‐19. Conclusions : Counter to widespread perception, Covid‐19 pandemic DID worsen many barriers for stroke treatment in Australia and New Zealand. These regions have insufficient stroke centers and these are not spread out widely enough for accessibility. Stroke deaths have increased during the Covid‐19 pandemic. Barriers such as time, accessibility, and the patient’s fear of hospitals have affected stroke treatment during the pandemic. Several measures can alleviate the impact: stroke awareness is critical. Every hospital needs to have the ability to assess and treat stroke. Hospitals must run simulations to practice and prepare for different scenarios that they could encounter when dealing with stroke patients. In conclusion, stroke treatment has been affected by the Covid‐19 pandemic and it is critical to minimize and overcome these barriers as stroke is one of the leading causes of death in Australia and New Zealand.

Abstract P274: Relationship Between Stroke Quality Metrics and Patient Outcomes: A Systematic Review

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Carol J Parker ◽  
Mathew J Reeves
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Evidence Base ◽  
Quality Metrics ◽  
Care Quality ◽  
Stroke Recurrence ◽  
The Impact ◽  
The Relationship

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

Homeschooling in Mexico With Educational Platforms

2021 ◽  
pp. 123-138
Author(s):  
Liliana Ramírez Vera ◽  
Ma. Guadalupe Veytia Bucheli
Keyword(s):  
Latin America ◽  
Data Collection ◽  
Literature Review ◽  
Communication Technology ◽  
Problem Statement ◽  
Online Programs ◽  
Academic Activities ◽  
The Impact ◽  
Collection Methods

This chapter reports on a research project on the homeschooling phenomenon in Mexico and how parents perceive the use of online programs to undertake academic activities with their children. It is in this space that this chapter is located, as it explores the changes to the phenomenon of homeschooling and the impact communication technology and, more specifically, of national and international educational platforms have had on the processes of follow-up and accreditation in Mexico and Latin America. In what follows, this chapter explores the situation in Mexico in particular and Latin America more broadly. It begins by exploring the problem statement and the question guiding this chapter. It then undertakes a literature review, from which it ascertains a theoretical lens and methodology. The data collection methods and the data are then outlined. Then, data are analysed.

Effect of In Situ High-Fidelity Simulation Training on the Emergency management of Pneumonia (INSTEP): a mixed-methods study

2018 ◽  
Vol 4 (4) ◽  
pp. 190-195 ◽  
Author(s):  
Owain Michael Leng ◽  
Charlotte Rothwell ◽  
Annamarie Buckton ◽  
Catherine Elmer ◽  
Jan Illing ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Simulation Education ◽  
Audit Data ◽  
Semistructured Interviews ◽  
The Impact

BackgroundThe patient safety agenda has propelled the rise of simulation education, but relatively few evaluations of simulation-based educational interventions have focused on patient outcomes.ObjectiveTo evaluate the impact of an in situ, high-fidelity simulation teaching intervention on the management of community-acquired pneumonia in the ambulatory care unit of a district general hospital.MethodsThis study used a mixed-methods approach to evaluate the impact of a programme of 10 in situ high-fidelity simulation education sessions delivered to a total of 10 junior doctors, nine nurses and seven healthcare assistants. Participants were tasked with managing a manikin simulating a patient with pneumonia in real time in a working clinical area. Subsequent structured debrief emphasised key themes from the national guidelines on pneumonia management. The intervention was evaluated through an immediate feedback form, follow-up semistructured interviews by independent qualitative researchers that underwent content analysis and triangulation with audit data on compliance with national pneumonia guidelines before and after the simulation intervention.ResultsThe in situ simulation intervention was valued by participants both in immediate written feedback and in follow-up semistructured interviews. In these interviews, 17 of 18 participants were able to identify a self-reported change in practice following the simulation intervention. Furthermore, most participants reported observing a change in the clinical practice of their colleagues following the training. Collected audit data did not show a statistically significant change in compliance with the guidelines for the management of pneumonia.ConclusionThis study found evidence of a change in both self-reported and observed clinical practice following a simulation intervention, supporting expert opinion that simulation education can impact clinician behaviours and patient outcomes in complex clinical scenarios. Furthermore, this feasibility study provides a transferrable method to evaluate the real-world impact of simulation education that merits further investigation through an appropriately powered study.

Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer™ Amulet™ Occluder Observational Study

EP Europace ◽  
2020 ◽  
Author(s):  
Xavier Freixa ◽  
Boris Schmidt ◽  
Patrizio Mazzone ◽  
Sergio Berti ◽  
Sven Fischer ◽  
...  
Keyword(s):  
Observational Study ◽  
Ischaemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Serious Adverse Events ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up. Methods and results We compared subjects aged <70, ≥70 and <80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) <70 years old, 491 subjects (45.1%) ≥70 and <80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects <70, ≥70 and <80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age. Conclusions Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.

scholarly journals How Hands-On Pain Skills Intensive Trainings Complement ECHO Pain and Opioid Management Programs: A Program Evaluation with the Indian Health Service

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1769-1778
Author(s):  
Joanna G Katzman ◽  
Kathleen Gygi ◽  
Robin Swift ◽  
George Comerci ◽  
Snehal Bhatt ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Health Service ◽  
Focus Groups ◽  
Indian Health Service ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Indian Health ◽  
Hands On ◽  
The Impact

Abstract Objective To evaluate the impact of Pain Skills Intensive trainings (PSIs) as a complement to the Indian Health Service (IHS) and the Chronic Pain and Opioid Management TeleECHO Program (ECHO Pain) collaboration. Design On-site PSIs conducted over two to three days were added to complement ECHO Pain at various IHS areas to enhance pain skills proficiency among primary care teams and to expand the reach of ECHO collaboration to ECHO nonparticipants. Setting This evaluation focuses on two PSI trainings offered to IHS clinicians in Albuquerque, New Mexico, and Spokane, Washington, in 2017. Methods The mixed-methods design comprises CME surveys and focus groups at the end of training and 12 to 18 months later. Quality of training and perceived competence were evaluated. Results Thirty-eight participants attended the two PSI workshops. All provided CME survey results, and 28 consented to use of their postsession focus group results. Nine clinicians participated in the virtual follow-up focus groups. IHS clinicians rated the PSIs highly, noting their hands-on and interdisciplinary nature. They reported above-average confidence in their skills. Follow-up focus groups indicated they were pursuing expanded options for their patients, consulting other clinicians, serving as pain consultants to their peers, and changing prescribing practices clinic-wide. However, rurality significantly limits access to ancillary and complementary services for many. Clinicians reported the need for additional training in integrating behavioral health into their practice. Conclusions Hands-on pain skills and information on medication-assisted treatment (MAT) are critical to the successful treatment of chronic pain and opioid use disorder. The PSIs provide clinicians with critical competencies in assessment and screening, pain management, and communication skills, complementing required IHS training and telementoring from ECHO Pain.

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