Patients’ perspective on supposedly patient-relevant process and outcome parameters: a cross-sectional survey within the ‘PRO patients study’

Background To be able to make informed choices based on their individual preferences, patients need to be adequately informed about treatment options and their potential outcomes. This implies that studies measure the effects of care based on parameters that are relevant to patients. In a previous scoping review, we found a wide variety of supposedly patient-relevant parameters that equally addressed processes and outcomes of care. We were unable to identify a consistent understanding of patient relevance and therefore aimed to develop an empirically based concept including a generic set of patient-relevant parameters. As a first step we evaluated the process and outcome parameters identified in the scoping review from the patients’ perspective. Methods We conducted a cross-sectional survey among German general practice patients. Ten research practices of Witten/Herdecke University supported the study. During a two-week period in the fall of 2020, patients willing to participate self-administered a short questionnaire. It evaluated the relevance of the 32 parameters identified in the scoping review on a 5-point Likert scale and offered a free-text field for additional parameters. These free-text answers were inductively categorized by two researchers. Quantitative data were analyzed using descriptive statistics. Bivariate analyses were performed to determine whether there are any correlations between rating a parameter as highly relevant and patients’ characteristics. Results Data from 299 patients were eligible for analysis. All outcomes except ‘sexuality’ and ‘frequency of healthcare service utilization’ were rated important. ‘Confidence in therapy’ was rated most important, followed by ‘prevention of comorbidity’ and ‘mobility’. Relevance ratings of five parameters were associated with patients’ age and gender, but not with their chronic status. The free-text analysis revealed 15 additional parameters, 12 of which addressed processes of care, i.e., ‘enough time in physician consultation’. Conclusion Patients attach great value to parameters addressing processes of care. It appears as though the way in which patients experience the care process is not less relevant than what comes of it. Relevance ratings were not associated with chronic status, but few parameters were gender- and age-related. Trial registration Core Outcome Measures in Effectiveness Trials Initiative, registration number: 1685.

Reducing infantile anemia: insight on patterns of process and outcome indicators by ethnicity and socioeconomic class during a 10-year intervention program and 5 years after

Background In 2005, Clalit Health Services (CHS), the largest health maintenance organization in Israel, initiated an intervention program aimed at reducing the prevalence rate of infantile anemia (IA). This study evaluated the progress made during the intervention (2005–2014) and its yield 5 years after it ended (2019). Methods The CHS database was retrospectively reviewed twice yearly from 2005 to 2014 for repetitive samples of children aged 9 to 18 months regarding the previous half-year interval, and a single sample in 2019. Data were collected on gender, ethnicity (Jewish/non-Jewish), socioeconomic class (SEC; low/intermediate/high), hemoglobin testing (yes/no), and hemoglobin level (if tested). Excluded were infants with documented or suspected hemoglobinopathy. Results At study initiation, the rate of performance of hemoglobin testing was 54.7%, and the IA prevalence rate was 7.8%. The performance rate was lower in the Jewish than the non-Jewish subpopulation. The low-SEC subpopulation had a similar hemoglobin testing rate to the high-SEC subpopulation but double the IA prevalence rate. Overall, by the end of the intervention (2014), the performance rate increased to 87.5%, and the AI prevalence rate decreased to 3.4%. In 2019, there was little change in the performance rate from the end of the intervention (88%) and the IA prevalence was further reduced to 2.7%. The non-Jewish and low-SEC subpopulations showed the most improvement which was maintained and even bettered 5 years after the intervention ended. Conclusions The 10-year IA intervention program introduced by CHS in 2005 led to a reduction in IA prevalence rate to about 3.5% in all sub-populations evaluated. By program end, the results in the weaker subpopulations, which had the highest prevalence of IA at baseline, were not inferior to those in the stronger subpopulations. We recommended to the Israel Ministry of Health to adopt the intervention countrywide, and we challenge other countries to consider similar interventions.

Risk classification in a pediatric service: evaluation of the structure, process, and outcome

ABSTRACT Objectives: to evaluate a pediatric risk evaluation and classification service in the aspects of structure, process, and outcome. Methods: a cross-sectional, descriptive, and exploratory study in which qualitative data complement the results. Data collection by non-participant observation, interview, and consultation of medical records. Results: we observed two hundred and four visits. The service works in a makeshift room and without privacy. The nurses did not use various materials/equipment available for evaluation, rarely performed a physical examination, used the interview most of the time, and did not consult the protocol. Parents/companions received no information, and medical records showed incomplete records. Nurses classified 69.1% of the children as non-emergency. The most frequent outcome of the visits was discharge. Conclusions: the service showed weaknesses in the physical structure, in the risk classification process, and the outcomes, but it presents a good resolution in the assistance. We recommend a revision in the protocol used and sensitize nurses about the work process and communication with parents/companions.

The Impact of Multisensory Stimulation of Biological Organs in Dysarthria Patients as Articulation Skills Rehabilitation

Every human being tries to communicate what he wants to say to whatever or whomever he wants. Dysarthria is a condition in which the muscles in humans that are active when speaking become weak or difficult to control. Problems or speech disorders experienced by a child with dysarthria are obstacles to children's social and personal adjustment. Schoolchildren who mispronounce the words will feel ashamed and alien from others. This problem motivates the presence of Multisensory Stimulation therapy to help improve and even restore speech problems or disorders experienced by children with dysarthria. This study tries to explain the impact of Multisensory Stimulation therapy and then evaluates the results of the application of Multisensory Stimulation therapy to children with dysarthria. The study that took five sufferers as the object of this study used a hybrid approach that mutually used a qualitative and quantitative perspective. The type of research used is classroom action research. This study concluded that the participants' enthusiasm greatly influenced the process and outcome of therapy.

Design and Implementation of a novel Weekend Elective Paediatric Surgery Program to Reduce COVID-19 Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends – Extra Lists (ORRACLE-Xtra) (Preprint)

BACKGROUND The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the healthcare system. Ramp down of surgical services led to significant backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends – Extra Lists (ORRACLE-Xtra). OBJECTIVE Our overall goals were to increase patient access to surgery (and reduce the waitlist), improve operating room efficiencies, and optimize parent and staff experience. METHODS Using the DMAIC framework (define, measure, analyze, improve, control), we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescence of the COVID-19 pandemic and defined process and outcome measures based on provincial targets of out of window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period resulting in a 5 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the weekends. RESULTS ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period resulting in a 5 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the weekends. CONCLUSIONS Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. CLINICALTRIAL N/A

Spatializing the Image

<p>Modern society has become ocular-centric as a result of technological development making the production and distribution of images easier than ever before. This ocular bias extends to architecture. Rather than resisting the increasingly ocular-centric nature of our social-media driven culture, this research aims to find new methods for designing space which incorporate a tactile process. This process simultaneously focuses on the creation of marketable perspectives. Through this research I advocate for tactility in the design process to evoke spatial awareness of the image. This research portfolio operates through a design-led research methodology where knowledge is uncovered by designing. Hundreds of models were produced and critically reflected upon in terms of both their process and outcome. The research culminates with the development of a design process centred on using architectural models as design tools. Referred to as devices, these models are spatial systems that are able to be manipulated by hand to alter the composition of a perspective view. Although focusing on the image, the physicality of the devices implicate spatial awareness in the design process ensuring the design is considered in both two and three dimensions. A design for the proposed Kapiti Island Biosecurity Gateway Centre formed an architectual testing ground which was used to evalute the design process developed in this research. Influenced by the design process the architecture itself also became an optical device. The resulting design controls and composes views through concealing, revealing, superimposing, aligning and framing particular elements. The final outcome provides visitors with a choreographed journey of highly considered perspective compositions</p>

Spatializing the Image

<p>Modern society has become ocular-centric as a result of technological development making the production and distribution of images easier than ever before. This ocular bias extends to architecture. Rather than resisting the increasingly ocular-centric nature of our social-media driven culture, this research aims to find new methods for designing space which incorporate a tactile process. This process simultaneously focuses on the creation of marketable perspectives. Through this research I advocate for tactility in the design process to evoke spatial awareness of the image. This research portfolio operates through a design-led research methodology where knowledge is uncovered by designing. Hundreds of models were produced and critically reflected upon in terms of both their process and outcome. The research culminates with the development of a design process centred on using architectural models as design tools. Referred to as devices, these models are spatial systems that are able to be manipulated by hand to alter the composition of a perspective view. Although focusing on the image, the physicality of the devices implicate spatial awareness in the design process ensuring the design is considered in both two and three dimensions. A design for the proposed Kapiti Island Biosecurity Gateway Centre formed an architectual testing ground which was used to evalute the design process developed in this research. Influenced by the design process the architecture itself also became an optical device. The resulting design controls and composes views through concealing, revealing, superimposing, aligning and framing particular elements. The final outcome provides visitors with a choreographed journey of highly considered perspective compositions</p>

THINK BIG, act small

<p>Porirua City is twenty minutes north of Wellington, New Zealand’s capital. The city is fifty years young and is home to the youngest demographic in the country. The city is culturally diverse but lacks a clear architectural representation of this cultural diversity. The city has developed around a beautiful harbour but the waterfront is underutilised in the city’s urban design. THINK BIG, act small proposes a design strategy that re-invents Porirua City’s urban future by bringing people back to its neglected water-edge. The proposition explores how design as process and outcome can empower a community for the future of a city through spatial agency and social engagement. The thesis explores the designer’s role in this process as landscape architect, architect, and social activist. A series of large, medium and small scale interventions are proposed. The Strategy is presented in three parts: 1. The Toolkit: a kit of architectural ideas designed to re-think the city’s urban environment around its relationship to water. These ideas can be deployed over time. 2. Two Temporary Projects: two small interventions from The Toolkit are tested in Porirua. An art installation and a community pop-up space are used to initiate conversations around the future of the city with people of the city. 3. The Big Move: a series of design moves, both big and small, are proposed as a composite vision for the future of Porirua. The proposition includes outcomes from the community pop-up space. The Big Move proposes a constructed wetland park, a series of blue-green streets, public pools, and housing. The aim is to establish new ecosystems that ease flooding, improve water quality, provide catalyst areas for economic growth, and create new social spaces for the city. The design aims to draw the harbour into the city. Polynesian and Maori attitudes towards land and water are integrated in the design: land is boundless and water is a bridge. A park, Te Awaura Park, is proposed as a ‘soft’ edge to the city’s existing boundary. The narrative of the park expresses the neighbourhood characterstics unique to each suburb in Porirua. The park aims to create a true local space, a space celebrating the city’s people.</p>