scholarly journals COVID-19 and the Gaping Wounds of South Africa’s Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 691
Author(s):  
Chukwudi A. Nnaji ◽  
Charles S. Wiysonge ◽  
Maia Lesosky ◽  
Hassan Mahomed ◽  
Duduzile Ndwandwe
Keyword(s):  
Implementation Research ◽  
Universal Access ◽  
Immunisation Programme ◽  
Practical Implementation ◽  
Research Approach ◽  
Immunisation Coverage ◽  
Missed Opportunities ◽  
Improvement Interventions ◽  
African Context ◽  
Quality Improvement Interventions

Despite South Africa’s substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.

scholarly journals A process evaluation of the improving wisely intervention: a peer-to-peer data intervention to reduce overuse in surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christine Fahim ◽  
William E. Bruhn ◽  
John G. Albertini ◽  
Marty A. Makary
Keyword(s):  
Process Evaluation ◽  
Improve Patient Care ◽  
Peer To Peer ◽  
Audit And Feedback ◽  
Implementation Quality ◽  
Participant Responsiveness ◽  
Key Informant ◽  
Improvement Interventions ◽  
Perceived Impact ◽  
Quality Improvement Interventions

Abstract Background The Improving Wisely intervention is a peer-to-peer audit and feedback intervention to reduce overuse of Mohs Micrographic Surgery (MMS). The objective of this study was to conduct a process evaluation to evaluate Mohs surgeons’ perceptions of the implementation quality and perceived impact of the Improving Wisely intervention. Methods Surgeons in the Improving Wisely intervention arm, comprised of members of the American College of Mohs Surgeons (ACMS) who co-led the intervention, were invited to complete surveys and key informant interviews. Participants described perceptions of implementation quality (evaluated via dose, quality of implementation, reach and participant responsiveness), perceived impact of the Improving Wisely intervention (evaluated on a 1–5 Likert and qualitatively), and barriers and facilitators to changing surgeons’ clinical practice patterns to reduce Mohs overuse. Results Seven hundred thirty-seven surgeons participated in the survey. 89% were supportive of the intervention. Participants agreed that the intervention would improve patient care and reduce the annual costs of Mohs surgery. Thirty surgeons participated in key informant interviews. 93% were interested in receiving additional data reports in the future. Participants recommended the reports be disseminated annually, that the reports be expanded to include appropriateness data, and that the intervention be extended to non ACMS members. Six themes identifying factors impacting potential MMS overuse were identified. Conclusions Participants were strongly supportive of the intervention. We present the template used to design and implement the Improving Wisely intervention and provide suggestions for specialty societies interested in leading similar quality improvement interventions among their members.

scholarly journals Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e84464 ◽  
Author(s):  
Ignacio Ricci-Cabello ◽  
Isabel Ruiz-Perez ◽  
Antonio Rojas-García ◽  
Guadalupe Pastor ◽  
Daniela C. Gonçalves
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Diabetes Care ◽  
Rural Areas ◽  
Meta Analysis ◽  
Oecd Countries ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

2021 ◽  
Vol 67 (9) ◽  
pp. 14-24
Author(s):  
Jordan Jackson ◽  
Holly Kirkland-Kyhn ◽  
Laura Kenny ◽  
Alana Beres ◽  
Stephanie Mateev
Keyword(s):  
Quality Improvement ◽  
Pediatric Patients ◽  
Wound Care ◽  
Occipital Region ◽  
Provider Education ◽  
Before And After ◽  
Prevention Interventions ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
Hospital Acquired

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

scholarly journals Reducing the Risk of Harm from Medication Errors in Children

2013 ◽  
Vol 6 ◽  
pp. HSI.S10454 ◽  
Author(s):  
Daniel R. Neuspiel ◽  
Melissa M. Taylor
Keyword(s):  
Medication Errors ◽  
Health Care Providers ◽  
Adverse Drug Events ◽  
Chronic Illnesses ◽  
Future Research ◽  
Care Providers ◽  
Pediatric Age Group ◽  
Improvement Interventions ◽  
Communication Ability ◽  
Quality Improvement Interventions

Medication errors affect the pediatric age group in all settings: outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies.

Evaluation of lexicon- and syntax-based negation detection algorithms using clinical text data

2017 ◽  
Vol 13 (4) ◽  
Author(s):  
J. Manimaran ◽  
T. Velmurugan
Keyword(s):  
Language Processing ◽  
Patient Discharge ◽  
Computational Time ◽  
Practical Implementation ◽  
Automatic Identification ◽  
Kappa Statistics ◽  
Research Approach ◽  
Clinical Text ◽  
Medical Reports ◽  
Negation Detection

AbstractBackground:Clinical Text Analysis and Knowledge Extraction System (cTAKES) is an open-source natural language processing (NLP) system. In recent development modules of cTAKES, a negation detection (ND) algorithm is used to improve annotation capabilities and simplify automatic identification of negative context in large clinical documents. In this research, the two types of ND algorithms used are lexicon and syntax, which are analyzed using a database made openly available by the National Center for Biomedical Computing. The aim of this analysis is to find the pros and cons of these algorithms.Methods:Patient medical reports were collected from three institutions included the 2010 i2b2/VA Clinical NLP Challenge, which is the input data for this analysis. This database includes patient discharge summaries and progress notes. The patient data is fed into five ND algorithms: NegEx, ConText, pyConTextNLP, DEEPEN and Negation Resolution (NR). NegEx, ConText and pyConTextNLP are lexicon-based, whereas DEEPEN and NR are syntax-based. The results from these five ND algorithms are post-processed and compared with the annotated data. Finally, the performance of these ND algorithms is evaluated by computing standard measures including F-measure, kappa statistics and ROC, among others, as well as the execution time of each algorithm.Results:This research is tested through practical implementation based on the accuracy of each algorithm’s results and computational time to evaluate its performance in order to find a robust and reliable ND algorithm.Conclusions:The performance of the chosen ND algorithms is analyzed based on the results produced by this research approach. The time and accuracy of each algorithm are calculated and compared to suggest the best method.

scholarly journals Comparing Interventions Aimed at Improving Influenza Vaccination Coverage Among Vulnerable Populations: A Systematic Review and Meta-Analysis Protocol

2021 ◽  
Author(s):  
Pei Chen Wu ◽  
Lyn McPherson ◽  
Stephen B Lambert ◽  
Peter Wnukowski-Mtonga ◽  
Nicholas G Lennox ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Random Effects Models ◽  
Vaccination Rates ◽  
Concurrent Control ◽  
Vaccination Recommendations ◽  
Increased Risk ◽  
Improvement Interventions ◽  
High Risk Populations ◽  
Quality Improvement Interventions

ABSTRACTBackgroundInfluenza is a major contributor to global disease burden. Vaccination recommendations specifically target populations at increased risk of serious influenza sequelae. The aim of this study is to conduct a systematic review and meta-analysis to evaluate the effectiveness of different quality improvement interventions to increase vaccination rates in high-risk populations.MethodsRandomized and nonrandomized studies with concurrent control groups will be identified. Interventions to increase vaccination rates will be categorized by strategy type. Overall intervention effects will be calculated using random effects models. Study quality will be assessed using a modified Cochrane Risk of Bias tool.

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