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Showing results for tags 'Research'.
Found 953 results
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Content ArticleThe Patient-Centered Outcomes Research Institute (PCORI) is an independent, non-profit research organisation that seeks to empower patients and others with actionable information about their health and healthcare choices. It funds comparative clinical effectiveness research (CER), which compares two or more medical treatments, services, or health practices to help patients and other stakeholders make better informed decisions. The PCORI Strategic Plan provides a roadmap for its activities in the years ahead as they pursue their vision and mission. Developed with extensive stakeholder input, the Plan articulates a refined focus on generating patient-centered evidence that has the greatest positive impact on health outcomes.
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Content ArticlePeripherally inserted central catheters (PICCs) are medical devices often used for medium-to-long-term intravenous therapy, but they are often associated with morbid and potentially lethal complications. This multi-centre study in the journal Plos One aimed to identify barriers and facilitators to implementing evidence-based appropriateness criteria to improve PICC safety and patient outcomes in a pay-for-performance model. The authors found that structured quality improvement (QI) efforts led to sustained PICC appropriateness and improved patient safety. These interventions included a multidisciplinary vascular access committee, clear targets, local champions and support from an online education toolkit.
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Content ArticleThe Covid-19 pandemic has led to the reorganisation of healthcare services to limit the transmission of the virus and deal with the sequelae of infection. This reorganisation had a detrimental effect on cardiovascular services, with reductions in hospitalisations for acute cardiovascular events and the deferral of all but the most urgent interventional procedures and operations. Aortic stenosis (AS) is the most common form of valvular heart disease. Once stenosis is severe, symptoms follow and the prognosis is poor, with 50% mortality within 2 years of symptom onset. Thus, timely treatment is of paramount importance. There was a large decline procedural activity to treat severe AS during the COVID-19 pandemic. As we move into an era of ‘living with’ COVID-19, plans must urgently be put in place to best manage the additional waiting list burden for treatment of severe AS. In this study, Stickels et al. used mathematical methods to examine the extent to which additional capacity to provide treatment of severe AS should be created to clear the backlog and minimise deaths of people on the waiting list.
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Content ArticleHealthcare can be risky. Adverse events carry a high cost – both human and financial – for health systems around the world. So in an effort to improve safety, many health systems have looked to learn from high-risk industries. The aviation and nuclear industries, for example, have excellent safety records despite operating in hazardous conditions. And increasingly, the tools and procedures these industries use to identify hazards are being adopted in healthcare. One prominent example involves the Hierarchy of Risk Controls (HoC) approach, which works by ranking the methods of controlling risks based on their expected effectiveness. According to HoC, the risks at the top are presumed to be more effective than those at the bottom. The ones at the top typically rely less on human behaviour: for example, a new piece of technology is considered to be a stronger risk control than training staff. This article looks more deeply at the (HoC) approach to explore its usefulness and effectiveness in healthcare. To investigate this issue, a team of social scientists examined the risk controls introduced by four hospital teams in England and Scotland after they had identified hazards in their systems.
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Content ArticleWomen are four times as likely to die after childbirth in Britain as in Scandinavian countries, a study published in the BMJ from Diguisto et al. has found. The authors compared maternal mortality in eight countries (France, Italy, UK, Denmark, Finland, the Netherlands, Norway, and Slovakia) with enhanced surveillance systems. They found that UK had the second-highest death rate, with one in 10,000 mothers dying within six weeks of giving birth, only slightly less than in Slovakia, the worst performing. Norway has the lowest maternal death rates in Europe, at one in 37,000. In Denmark, the second-best performing country, one in 29,000 died. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.
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Content ArticleCancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years.
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Content ArticleLong-term health sequelae of COVID-19 are a major public health concern. However, evidence on Long Covid is still limited, particularly for children and adolescents. Using comprehensive healthcare data on approximately 46% of the German population, Roesller et al. investigated post-COVID-19-associated morbidity in children/adolescents and adults.
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Content ArticleIn this study, Aniza Ismail and Norhani Mazrah Khalid assessed the baseline level and mean score of every domain of patient safety culture among healthcare professionals at a cluster hospital in Malaysia and identifed the determinants associated with patient safety culture. The study found that healthcare professionals at the cluster hospital showed unsatisfactory patient safety culture levels. Most of the respondents appreciated their jobs, despite experiencing dissatisfaction with their working conditions. The priority for changes should involve systematic interventions to focus on patient safety training, address the blame culture, improve communication, exchange information about errors and improve working conditions.
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Content ArticleClinical trials are the foundation of modern medicine, but regulators, doctors and patients often do not get to see the full picture about how safe and effective drugs and treatments are. The results of around half of all clinical trials remain hidden and there are international efforts to resolve this issue; even government agencies often lack access to the information they need to decide whether treatments are safe and effective. The paper analyses six case studies in which lack of transparency in medical research has directly harmed patients, taxpayers and/or investors. It illustrates how these harms could have been avoided through three simple solutions promoted by the AllTrials campaign: trial registration, results posting, and full disclosure of trial reports.
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Content ArticleWorldwide, most Caesarean sections (CS) are performed under neuraxial anaesthesia. However, neuraxial anaesthesia can fail and intraoperative breakthrough pain can occur. The aim of this study from Roofthooft et al. was to evaluate the incidence of breakthrough pain in consecutive CS and to describe the potential risk factors for breakthrough pain. In a two centre, prospective audit all CS performed under neuraxial anesthesia were included and the occurrence of breakthrough pain as well as all possible risk factors of breakthrough pain were recorded as well as the alternative anesthetic strategy.
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Content ArticleThe aim of this study was to measure the impact of post-acute sequelae of COVID-19 (PASC) on quality of life, mental health, ability to work and return to baseline health in an Irish cohort. It found that patients with PASC reported prolonged, multi-system symptoms which can significantly impact quality of life, affect ability to work and cause significant disability. Dedicated multidisciplinary, cross specialty supports are required to improve outcomes of this patient group.
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Content ArticleThis report by the US non-profit organisation the Emergency Care Research Institute (ECRI) was commissioned by the US Food and Drug Administration (FDA) to determine the safety profile of polypropylene (PP) mesh used in a variety of surgical procedures. ECRI performed a comprehensive literature search and systematic review to identify the current state of knowledge about how patients' bodies respond to PP mesh.
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Content Article
In this blog, Kath Sansom, founder of the Sling the Mesh campaign, unpacks the findings of a medical device performance study into polypropylene mesh published by the Emergency Care Research Institute (ECRI) in the US. The document highlights significant gaps in evidence about the risk of complications associated with polypropylene (PP) surgical mesh. -
Content ArticleAppreciative Inquiry (AI) is a research approach that aims to create practical and collaborative change by taking participants through an in-depth exploration of their organisation, team or role. This article in the European Journal of Midwifery reflects on the process of using AI in a study that explored staff wellbeing in a UK maternity unit. The authors share key lessons to help others decide whether AI will fit their research aims, and highlight issues in its design and application.
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Content ArticleEvidence suggests that full implementation of the WHO surgical safety checklist across NHS operating theatres is still proving a challenge for many surgical teams. The aim of the current study from Charles Vincent and colleagues was to assess patients’ views of the checklist, which have yet to be considered and could inform its appropriate use, and influence clinical buy-in.
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Content ArticleSocial prescribing is a way of linking people with complex needs to non-medical supports in the community. There are different models of social prescribing, ranging from online signposting services to individual support from a link worker to access community resource. The aim of this study from Kiely et al. was to establish the evidence base for the effects on health outcomes and costs of social prescribing link workers (non-health or social care professionals who connect people to community resources) for people in community settings focusing on people experiencing multimorbidity and social deprivation. The study found that there is an absence of evidence for social prescribing link workers. Policymakers should note this and support evaluation of current programmes before mainstreaming.
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Content ArticleThis joint position statement from The Royal College of Physicians (RCP) and National Institute for Health and Care Research (NIHR) sets out a series of recommendations for making research part of everyday practice for all clinicians. Its recommendations are aimed at stakeholders across the health and care system, with the overall aim of embedding research in clinical practice: Trusts, health boards and integrated care systems (ICSs) Health Education England and NHS England and statutory education bodies and the departments of health in the other UK nations Regulators Funders
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Content ArticleThis German study in the Journal of Patient Safety aimed to analyse the strength of safety measures described in incident reports in outpatient care. 184 medical practices were invited to submit anonymous incident reports to the project team three times in 17 months. The authors coded the incident reports and safety measures, classifying them as as “strong” (likely to be effective and sustainable), “intermediate” (possibly effective and sustainable) or “weak” (less likely to be effective and sustainable). The study found that the proportion of weak measures was high, which indicates that practices need more support in identifying strong patient safety measures.
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Content ArticleIn this blog, Eve Namisango, Programs and Research Manager at the African Palliative Care Association, looks at the importance of patient and public involvement and engagement (PPIE) in palliative care research. She highlights recent work with the Uganda Cancer Society to explore best practices for engaging patients and caregivers and looks at key issues to consider when structuring PPIE in research.
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Content ArticlePatient lead users can be defined as patients or relatives who use their knowledge and experience to improve their own or a relative’s care situation and/or the healthcare system, and who are active beyond what is usually expected. This study in the BMJ Open aimed to explore patient lead users’ experiences and engagement during the early Covid-19 pandemic in Sweden, from 1 June to 14 September 2020. The authors recruited 10 patient lead users living with different long-term conditions and undertook qualitative in-depth interviews with each of them. They found that health systems were not able to fully acknowledge and engage with the resource of patient lead users during the pandemic, event though they could be a valuable resource as a complementary communication channel.
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Content Article
Communication in the operating theatre (14 November 2013)
Patient-Safety-Learning posted an article in Surgery
Communication is extremely important to ensure safe and effective clinical practice. This systematic literature review of observational studies addressing communication in the operating theatre aimed to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews. In all of the studies reviewed, communication was found to affect operating theatre practices. Further detailed observational research is needed to gain a better understanding of how to improve the working environment and patient safety in theatre. -
Content ArticleVideo recording technologies offer a powerful way to document what happens in clinical areas. Cameras, and to a lesser extent, microphones, can be found in a growing number of modern operating rooms in the USA, UK and other parts of the world. While they could be used to create a detailed record of what happens in and around the operating table, this is still rarely being done; the vast majority of operations are still only documented in written operation notes. In this paper, Bezemer et al. discuss using microanalysis of videos from the operating room.
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Content ArticleThe variety of alarms from all types of medical devices has increased from 6 to 40 in the last three decades, with today’s most critically ill patients experiencing as many as 45 alarms per hour. Alarm fatigue has been identified as a critical safety issue for clinical staff that can lead to potentially dangerous delays or non-response to actionable alarms, resulting in serious patient injury and death. To date, most research on medical device alarms has focused on the nonactionable alarms of physiological monitoring devices. While there have been some reports in the literature related to drug library alerts during the infusion pump programming sequence, research related to the types and frequencies of actionable infusion pump alarms remains largely unexplored.
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Content ArticleThis qualitative study in BMC Medicine aimed to improve understanding of the reality of making and sustaining improvements in complex healthcare systems. It focused on understanding the implications of complexity theory, introducing a framework known as Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence). This approach is accompanied by a series of ‘simple rules’ that aim to make complexity navigable (whilst recognising that it will never be simple), providing actionable guidance to both practice and research. The authors concluded that the SHIFT-Evidence framework provides a tool to guide practice and research. The ‘simple rules’ have potential to provide a common platform for academics, practitioners, patients and policymakers to collaborate when intervening to achieve improvements in healthcare.
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Content ArticleThis paper by Professor Paul Bate, Emeritus Professor of Health Services Management at University College London, looks at the importance of considering context in healthcare initiatives. It introduces various frameworks for viewing context and looks at key themes in existing research. It concludes by looking at key questions for future research on context.
