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Activity reporting of Pastoral Care Coordinators (PCCs) is often inadequate within care settings because of suboptimal analog data collection methods. This study aims to render pastoral care activity reporting more efficient through digitizing data collection in pastoral care settings. A one-year feasibility (pilot) study of a digital tool, the "Pastoral Care Activity Tracker" (PCAT) was conducted between June 1, 2020 and May 31, 2021 at HammondCare, an Australian nonprofit healthcare organization. Feasibility was measured using electronic activity logs collected by the tool and user feedback surveys by PCCs. Of the 43 PCCs working in the organization, 42 (97.7%) used the PCAT tool to complete the logging of 66,298 pastoral care activities (M [SD] = 1,578.5 [827.8] activities per PCC). Most activities were logged successfully (98.3%) and took less than one minute (89.5%). Survey responses (n = 20, 46.6%) indicated many PCCs found the PCAT more convenient (n = 15, 75.0%) and easier to use (n = 10, 50.0%) than paper-based method. PCCs found the PCAT to be feasible, favorable, and easier to use for report generation compared to paper-based methods. The feasibility of the PCAT improved pastoral care activity data capture, as perceived by PCCs. [ABSTRACT FROM AUTHOR]

Millions of Australians use the private health system every year. They should receive safe, high-quality, value-based care. However, poor policy and inadequate regulation of medical technology is driving low-value care at great expense to consumers and the broader health system. Key drivers include the Prescribed List of Medical Devices and Human Tissue, gaps in quality and safety controls for devices being used, and marketing and conflicts of interest. All of these should be addressed to reduce low-value care in Australia's private health system, so consumers are protected from harm and limited health budgets are used effectively. What is known about the topic? With health expenditure rising unsustainably, there is a growing focus on ways to reduce low-value care to improve health outcomes and eliminate unnecessary costs. What does this paper add? This paper details drivers of low-value care in Australia's private health system and recommendations to overcome them. Drivers include the Prescribed List of Medical Devices, gaps in safety and quality controls, and conflicts of interest and marketing. What are the implications for practitioners? These insights are relevant to clinicians, researchers, policymakers, consumers and health business leaders with an interest in low-value care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Background: Current evidence shows that medical device‐related pressure injury (MDRPI) has a high prevalence (10%) and incidence (12%), and much research has been done to prevent MDRPI in recent years. However, to our knowledge, there is limited systematic review available on interventions and strategies to prevent MDRPI. Aim: To synthesise research evidence on interventions and strategies used to prevent MDRPI. Methods: This systematic review adhered to the PRISMA Guidelines. We searched six databases including Medline, CINAHL, EMBASE, Cochrane library, Web of Science and ProQuest with no restriction to year of publication. Data were extracted and checked by two authors independently. A narrative summary technique was used to describe the findings. Implementation strategies were grouped into six classifications: dissemination/implementation process/integration/capacity building/sustainability/scale‐up strategies. Results: Twenty‐four peer‐reviewed papers met the inclusion criteria, which comprised of 11 quality improvement projects and 13 original research. Types of devices included respiratory devices (non‐invasive ventilation mask, CPAP/BiPAP mask, endotracheal tube), gastrointestinal/urinary devices and other devices. Interventions used included the use of dressing, hyperoxygenated fatty acids, full‐face mask, training, and/or multidisciplinary education, use of special securement devices or tube holder, repositioning, application of stockinette, early removal and foam ring use. Common implementation strategies included ongoing staff education, audit and standardising documentation or guideline development. Conclusion: Much work on MDRPI prevention strategies has been undertaken. There were a variety of devices reported, however, it is evident that higher quality research is needed. Relevance to clinical practice: Current evidence shows that interventions including use of dressing or special securement device, repositioning, and training/multidisciplinary education can be beneficial for MDRPI prevention. High‐quality research, such as randomised controlled trials are needed to test the effectiveness of the interventions and their implementation strategies. No patient or public contribution. [ABSTRACT FROM AUTHOR]

The use of digital twins (DTs) has proliferated across various fields and industries, with a recent surge in the healthcare sector. The concept of digital twin for health (DT4H) holds great promise to revolutionize the entire healthcare system, including management and delivery, disease treatment and prevention, and health well-being maintenance, ultimately improving human life. The rapid growth of big data and continuous advancement in data science (DS) and artificial intelligence (AI) have the potential to significantly expedite DT research and development by providing scientific expertise, essential data, and robust cybertechnology infrastructure. Although various DT initiatives have been underway in the industry, government, and military, DT4H is still in its early stages. This paper presents an overview of the current applications of DTs in healthcare, examines consortium research centers and their limitations, and surveys the current landscape of emerging research and development opportunities in healthcare. We envision the emergence of a collaborative global effort among stakeholders to enhance healthcare and improve the quality of life for millions of individuals worldwide through pioneering research and development in the realm of DT technology. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficiency and acceptance of digital pen and paper technology for real-time clinical data acquisition.Methods: A prospective interventional unblinded study involving consecutive patients in two clinical settings during a defined time-frame was proposed. The first trial was designed as a stress test to evaluate acceptance in a workload-intensive environment. Acceptance was assessed using observations and a satisfaction questionnaire. The second trial was intended to determine the reliability of data acquisition in a controlled environment. Reliability was assessed by comparing the performance of the digital pen against scanner analysis and a double human blinded acquisition.Results: Overall, users were satisfied with the use of the digital pen (median 3 on a Likert-scale (-5, 5)). Without any specific user training, successful data acquisition was greater than 80%. Use of this technology required less adaptation than standard computer devices, and was easy to learn and use. Ergonomic problems shaded the perception of the technology by inducing an increased cognitive load. Digitalized data was missing either because of a bug or due to lack of data validation. The reliability obtained with the digital pen was significantly lower to that obtained with the scanner.Conclusions: Natural technology such as the digital pen proved to be a good tool in stressful clinical environments without interfering with the normal workload or increasing the time for data acquisition. However, in order to improve quality of data acquisition, designing acquisition forms specifically for the use of digital pens is of paramount importance. [ABSTRACT FROM AUTHOR]

This paper aims to highlight how to reduce medication errors through the implementation of human factors science to the design features of medication containers. Despite efforts to employ automation for increased safety and decreased workload, medication administration in hospital wards is still heavily dependent on human operators (pharmacists, nurses, physicians, etc.). Improving this multi-step process requires its being studied and designed as an interface in a complex socio-technical system. Human factors engineering, also known as ergonomics, involves designing socio-technical systems to improve overall system performance, and reduces the risk of system, and in particular, operator, failures. The incorporation of human factors principles into the design of the work environment and tools that are in use during medication administration could improve this process. During periods of high workload, the cognitive effort necessary to work through a very demanding process may overwhelm even expert operators. In such conditions, the entire system should facilitate the human operator's high level of performance. Regarding medications, clinicians should be provided with as many perceptual cues as possible to facilitate medication identification. Neglecting the shape of the container as one of the features that differentiates between classes of medications is a lost opportunity to use a helpful characteristic, and medication administration failures that happen in the absence of such intentional design arise from "designer error" rather than "user error". Guidelines that define a container's shape for each class of medication would compel pharmaceutical manufacturers to be compatible and would eliminate the confusion that arises when a hospital changes the supplier of a given medication. [ABSTRACT FROM AUTHOR]

Assessing medical devices (MDs) raises challenges which require us to reflect on whether current methods are adequate. Major features of devices are: (i) device-operator interaction can generate learning curve effects; (ii) incremental nature of innovation needs to be addressed by careful identification of the alternatives for comparative and incremental cost-effectiveness analysis; and (iii) broader organizational impact in terms of training and infrastructure, coupled with dynamic pricing, requires a more flexible approach to costing. The objective of the MedtecHTA project was to investigate improvements in HTA methods to allow for more comprehensive evaluation of MDs. It consisted of several work packages concerning (i) the available evidence on the currently adopted approaches for regulation and HTA of medical devices; (ii) the geographical variation in access to MDs; (iii) the development of methodological frameworks for conducting comparative effectiveness research and economic evaluation of MDs; and (iv) the organizational impact of MDs. This introductory paper summarizes the main results of the project and draws out the main overarching themes. This supplement represents a comprehensive report of all the main findings of the MedtecHTA project, and it is intended to be the main source for researchers and policy makers wanting information on the project. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Improving the design of technology relies in part, on the reporting of performance failures in existing devices. Healthcare has low levels of formal reporting of performance and failure of medical equipment. This paper examines methods of reporting in the car industry and healthcare and aims to understand differences and identify opportunities for improvement within healthcare. Methods: A literature search was carried out in Pubmed, Medline, Embase, Engineering Village, Scopus. NHS England and MHRA publications and guidelines were also reviewed. Focus was placed on the current system of reporting in both industries, known degree of patient harm, initiating factors, barriers, quality and methods of incident investigation and their validity. The findings were used to compare error reporting system in the two industries. Results: Derivation of healthcare incident data from different sources means the full extent of patient harm is not known. For example, in 2012 there were 13,549 and 38,395 incidents reported by MHRA and NRLS (National Reporting and Learning System) respectively leading to uncertainties on the extent of the problem. The car industry emphasises the role of reporting source in ensuring data quality. Utilising some aspects of this approach might benefit healthcare reporting. These include a specific reporting system that stresses the importance of organisational learning in improving safety and recognises the limitations of root cause analysis. Conclusions: Learning from reporting systems within the car industry may help the healthcare sector improve its own reporting, aiding healthcare performance. [ABSTRACT FROM AUTHOR]

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Purpose – The purpose of this paper is to describe how quality function deployment (QFD) methodology was employed for translating customer needs and expectations into the quality characteristics in a private healthcare setting. This case study illustrates how an existing approach of SERVQUAL and QFD integration can be applied for quality improvement. Design/methodology/approach – Integrating SERVQUAL into QFD to set the success factors to improve quality in the healthcare industry is the main aim of this paper. A privately-held university hospital, within the city of Istanbul in Turkey, was selected as the sampling frame. A SERVQUAL-type of questionnaire was used and a total of 250 questionnaires were distributed and 210 of them were received. Usable responses were 170, comprising a response rate of 68 percent. Findings – From the results of the QFD application it is seen that behavior and attitude of staff has the highest weight score, meaning that when behavior and attitude of staff is improved there will be almost 25 per cent of improvement in the hospital. Another finding was that there is strong relationship among skills of physician, behavior and attitude of staff, and having enough modern equipment. Research limitations/implications – QFD technique is able to provide hospitals with a better understanding of customers' expectations to translate these expectations into appropriate service specifications and perform existing process assessment. Originality/value – The case study was a first attempt to apply this integrative approach to a service sector and thus offers practical and applied information useful to both academicians and practitioners. [ABSTRACT FROM AUTHOR]

Background: Although economic evaluations (EEs) have been increasingly applied to medical devices, little discussion has been conducted on how the different health realities of specific populations may impact the application of methods and the ensuing results. This is particularly relevant for pediatric populations, as most EEs on devices are conducted in adults, with specific aspects related to the uniqueness of child health often being overlooked. This study provides a review of the published EEs on devices used in paediatrics, assessing the quality of reporting, and summarising methodological challenges. Methods: A systematic literature search was performed to identify peer-reviewed publications on the economic value of devices used in paediatrics in the form of full EEs (comparing both costs and consequences of two or more devices). After the removal of duplicates, article titles and abstracts were screened. The remaining full-text articles were retrieved and assessed for inclusion. In-vitro diagnostic devices were not considered in this review. Study descriptive and methodological characteristics were extracted using a structured template. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist was used to assess the quality of reporting. A narrative synthesis of the results was conducted followed by a critical discussion on the main challenges found in the literature. Results: 39 full EEs were eligible for review. Most studies were conducted in high-income countries (67%) and focused on high-risk therapeutic devices (72%). Studies comprised 25 cost-utility analyses, 13 cost-effectiveness analyses and 1 cost-benefit analysis. Most of the studies considered a lifetime horizon (41%) and a health system perspective (36%). Compliance with the CHEERS 2022 items varied among the studies. Conclusions: Despite the scant body of evidence on EEs focusing on devices in paediatrics results highlight the need to improve the quality of reporting and advance methods that can explicitly incorporate the multiple impacts related to the use of devices with distinct characteristics, as well as consider specific child health realities. The design of innovative participatory approaches and instruments for measuring outcomes meaningful to children and their families should be sought in future research. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to understand how the Wyoming Quit Tobacco Program (WQTP) is used by its subscribers and to better understand how WQTP might be connected to WQTP outcomes. Design/methodology/approach Provider intake and program use data corresponding to the May 2010 to March 2012 enrollment period ( n=6,168) were used. All program flows were constructed using frequencies and crosstabs, based on an initial theoretical model prepared by the program provider. Data were adjusted based on analysis that explored all possible uses beyond those specified by the provider's theoretical model. Findings Although the authors could replicate the structure - the theoretical model constructed by the provider - the authors were not able to replicate all relationships between program components. The authors also found that most individuals signed up and used web-based services. Only a few individuals finished their treatment regimens in the way they were designed to be used by the program. Originality/value This is the first case study to use a program flow method to investigate an entire comprehensive tobacco cessation program structure and delivery. [ABSTRACT FROM AUTHOR]

Decisions about the adoption of medical interventions are informed by evidence on their costs and effects. For a range of reasons, evidence relating to medical devices may be limited. The decision to adopt a device early in its life cycle when the evidence base is least mature may impact on the prospects of acquiring further evidence to reduce uncertainties. Equally, rejecting a device will result in no uptake in practice and hence no chance to learn about performance. Decision options such as 'only in research' or 'approval with research' can overcome these issues by allowing patients early access to promising new technologies while limiting the risks associated with making incorrect decisions until more evidence or learning is established. In this paper, we set out the issues relating to uncertainty and the value of research specific to devices: learning curve effects, incremental device innovation, investment and irrecoverable costs, and dynamic pricing. We show the circumstances under which an only in research or approval with research scheme may be an appropriate policy choice. We also consider how the value of additional research might be shared between the manufacturer and health sector to help inform who might reasonably be expected to conduct the research needed. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact. By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this paper was to evaluate how uncertainty has been accounted for in the cost-effectiveness analyses (CEAs) submitted by manufacturers to the French National Authority for Health (HAS) and to identify recurring concerns in these submissions.Methods: We used a cross-sectional design to evaluate manufacturers' submissions from the beginning of the evaluation process in October 2013 to the end of May 2015 (n = 28). The sources of uncertainty attached to these CEAs were categorized and assessed. Relevant data were extracted independently by two assessors.Results: Adherence to the HAS reference case was generally considered to be acceptable. Methodological uncertainty and parameter uncertainty were the sources of uncertainty that were most frequently explored by manufacturers. The quality of reporting of deterministic sensitivity analysis and probabilistic sensitivity analysis varied substantially across submissions, with a frequent lack of justification of the plausible range of parameter point estimates in 12 submissions (43 %). Structural uncertainty was explored much less frequently. Concerns related to omission of either important clinical events or relevant health states or extrapolation of the effects of the technology beyond the time horizon of the clinical trials were identified in 16 submissions (57 %).Conclusions: This study presented a characterization of the treatment of uncertainty for the first 28 manufacturers' submissions to the HAS. This work identified important concerns regarding the exploration of sources of uncertainty. The findings may help manufacturers to improve the quality of their submissions and may provide useful insights for extending guidelines on uncertainty analysis in CEAs submitted to the HAS. [ABSTRACT FROM AUTHOR]

This paper describes and discusses the role of unmet needs in the innovation of new medical technologies using the National Institute for Health Research Devices for Dignity (D4D) Healthcare Technology Co-operative as a case study. It defines an unmet need, providing a spectrum of classification and discusses the benefits and the challenges of identifying unmet need and its influence on the innovation process. The process by which D4D has captured and utilized unmet needs to drive technology innovation is discussed and examples given. It concludes by arguing that, despite the challenges, defining and reviewing unmet need is a fundamental factor in the success of medical technology innovation. [ABSTRACT FROM PUBLISHER]

The implementation of an effective quality management system has always been considered a principal method for a manufacturer to maintain and improve its product and service quality. Globally many regulatory authorities incorporate quality management system as one of the mandatory requirements for the regulatory control of high-risk medical devices. The present study aims to analyze the GMP enforcement experience in Taiwan between 1998 and 2013. It describes the regulatory implementation of medical device GMP requirement and initiatives taken to assist small and medium-sized enterprises in compliance with the regulatory requirement. Based on statistical data collected by the competent authority and industry research institutes, the present paper reports the growth of Taiwan local medical device industry after the enforcement of GMP regulation. Transition in the production, technologies, and number of employees of Taiwan medical device industry between 1998 and 2013 provides the competent authorities around the world with an empirical foundation for further policy development. [ABSTRACT FROM AUTHOR]

Background: Central venous catheters are used frequently in the intensive care unit (ICU). However, there is an associated morbidity, mortality and cost derived from their infectious and mechanical complications. The Scottish Patient Safety Programme (SPSP) has developed a multi faceted care bundle, with the aim of reducing catheter-related blood stream infections. Aim: This paper aims to identify and describe the experience and challenges in implementing the SPSP central line insertion bundle in one adult ICU, in a large inner city teaching hospital. Interventions:'Plan-Do-Study-Act' cycles, checklists for insertion and a standardized trolley were adopted to implement the central line insertion bundle in clinical practice. Conclusion/Implications: Improving the reliability of the central line insertion bundle has reduced infections. Key steps in the process were setting clear aims and ensuring staff understand the change process and measurement of results. This is fundamental to the success of any quality improvement process. [ABSTRACT FROM AUTHOR]

Despite infrastructure and capacity challenges in Africa, significant development has been made in the number of laboratories supporting immunological and safety studies required for large-scale HIV/AIDS vaccine or intervention trials. In Uganda, cohorts participating in HIV intervention trials are often recruited from rural areas. To avoid transporting samples from intervention trial areas over long distances (120 km) to central laboratories in Entebbe, we set up a standardized peripheral blood mononuclear cells (PBMCs) processing laboratory at a field station in Masaka, southwest Uganda. The laboratory was well equipped and enrolled into the International AIDS Vaccine Initiative (IAVI) Quality Assurance (QA) program. Staff was trained in laboratory techniques and Good Clinical Laboratory Practice (GCLP). The laboratory received IAVI and GCLP accreditation in 2008. In this paper we describe the process and achievements of measures taken to overcome challenges, to build staff capacity, and to optimize the quality of the cells yielded. [ABSTRACT FROM AUTHOR]

In April 2008, the Building and Construction Authority of Singapore releases design guide BC 1: 2008 to the industry and alternative steel materials which are manufactured to non-BS standards are now permitted in building structural steelworks designed to BS 5950. This paper examines the BC 1 requirements for material performance and quality assurance vis-á-vis the use of such alternative steel materials in design. A list of certified alternative steel materials complying with the minimal essential material performance requirements is compiled. These certified materials are treated as per normal without any restriction or downgrading in design if they are produced by steel mills who can meet the quality assurance requirements. Emphasis is now placed on our stockholders and traders to source and import into Singapore steel materials from audited mills that have in place stringent factory production control system and proper mill test certification. All key stakeholders - manufacturers, stockholders, traders, auditors, fabricators and engineers have a duty and are expected to play a role in maintaining quality in material usage in Singapore's steel construction industry. [ABSTRACT FROM AUTHOR]

In this paper a new navigation system, KIN-Nav, developed for research and used during 80 anterior cruciate ligament (ACL) reconstructions is described. KIN-Nav is a user-friendly navigation system for flexible intraoperative acquisitions of anatomical and kinematic data, suitable for validation of biomechanical hypotheses. It performs real-time quantitative evaluation of antero-posterior, internal-external, and varus-valgus knee laxity at any degree of flexion and provides a new interface for this task, suitable also for comparison of pre-operative and post-operative knee laxity and surgical documentation. In this paper the concept and features of KIN-Nav, which represents a new approach to navigation and allows the investigation of new quantitative measurements in ACL reconstruction, are described. Two clinical studies are reported, as examples of clinical potentiality and correct use of this methodology. In this paper a preliminary analysis of KIN-Nav's reliability and clinical efficacy, performed during blinded repeated measures by three independent examiners, is also given. This analysis is the first assessment of the potential of navigation systems for evaluating knee kinematics. [ABSTRACT FROM AUTHOR]

The authors have previously reported on the laboratory development of the Acrobot Navigation System for accurate computer-assisted hip resurfacing surgery. This paper describes the findings of using the system in the clinical setting and including the improvements that have been made to expedite the procedure. The aim of the present system is to allow accurate planning of the procedure and precise placement of the prosthesis in accordance with the plan, with a zero intraoperative time penalty in comparison to the standard non-navigated technique. At present the navigation system is undergoing final clinical evaluation prior to a clinical study designed to demonstrate the accuracy of outcome compared with the conventional technique. While full results are not yet available, this paper describes the techniques that will be used to evaluate accuracy by comparing pre-operative computed tomography (CT)-based plans with post-operative CT scans. Example qualitative clinical results are included based on visual comparison of the plan with post-operative X-rays. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the technical aspects of the Naval Dosimetry Center (NDC) quality programme. The Navy has been formally monitoring personnel for occupational exposure to ionising radiation since at least 1946. The current system, the DT-702/PD, is the Harshaw 8840 holder and 8841 card. New card and holder checks are performed to verify that the correct LiF elements and holder filters are in the correct location and are of the correct composition. Element correction coefficient (ECC) magnitude and repeatability are also verified. Several quality assurance parameters are checked by a specially designed shipping machine. Calibration cards are used to calibrate each reader and quality control cards are inserted throughout a group of field cards to verify reader operation during the read process. The success of the programme is measured by annual proficiency tests administered by the National Voluntary Laboratory Accreditation Programme and Pacific Northwest National Laboratories. [ABSTRACT FROM AUTHOR]

Background: With the advent of the Fédération Internationale de Football Association (FIFA) World Cup 2022 in Qatar, all healthcare systems were gearing up for an influx of patients. The Hamad Medical Corporation Ambulance Service (HMCAS) has also refined its patient supply chain (SC) processes to improve ambulance turnaround times (ATATs) at the emergency departments (EDs). International ambulance services (AS) are complex, and these ambulances are equipped with approximately 500 individual items, which include various types of medical consumables and equipment used during emergencies. By organizing individual medical items into stock units called "pre-packs", according to the needs of the patients and type of clinical interventions, the inventory or stock-taking time of items stored in ambulances can be significantly reduced. Implementing reduced inventory lists of items and standardized pre-pack storage across the ambulance fleet has significantly improved the efficiency and accuracy of ambulance checking, restocking, and recovery time, improving overall ATAT at the ED. Aim: This study evaluates the staff's perceived impact of modular pre-pack kits on ambulance restocking processes and ED ATAT. Methods: In this cross-sectional study, a fit-for-purpose survey was designed and distributed to all operational staff at HMCAS. The survey aims to assess HMCAS staff's opinions about the implemented LEAN pre-pack system. Cronbach's alpha was calculated to assess the reliability of the survey. The Mann-Whitney U-test was conducted to compare if there was a difference between the group's opinions. The Shewhart control chart was created to monitor the impact of the implemented intervention on the ATAT at the ED. IBM-SPSS® (Statistical Package for Social Sciences) Version 26 was utilized for data analysis. Results: A group of 287 employees with different backgrounds participated and completed the survey. The Cronbach's alpha was equal to 0.739, indicating a satisfactory level of reliability of the Mann-Whitney U-test. The descriptive analysis and the Shewhart chart revealed that most staff found that the pre-pack concept helped improve LEAN restocking processes, access to clinical applications, and ambulance checks. Overall, this concept matched the international benchmarks for turnaround time. Conclusion: The pre-pack concept promoted easy and quick processing of clinical applications, restocking procedures, and ambulance checks, and this positively impacted the ATAT at the ED. Further, it improved responses to emergency calls and enhanced access to effective care for patients. This approach also simplified the tasks above when many locum staff is employed on a short-term basis to cover mega-events such as the FIFA World Cup. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a symposium on wound cleansing held at the Wounds UK annual conference in Harrogate, England on November 14, 2016 is presented. Topics include reduction of risk of healthcare-related infection, prevention and management of biofilms in chronic wounds, and efficacy of Prontosan in wound cleansing.

In recent years, X-ray irradiators have been introduced as an alternative to gamma irradiators due to the problems with the acquisition, transport and security of radioactive sources. Self-shielded low energy X-ray irradiators (such as the RS 2400) were developed to complement and eventually replace gamma sources. These irradiators are quite suitable for sterilizing insects for SIT applications, as well as for research on quarantine treatments of food and phytosanitary applications. During the irradiation of an agricultural product the absorbed dose inside the canister must be controlled to ensure that the desired effect is achieved without deleteriously affecting the product. The focus of this paper is to describe the Dose Assurance Service offered by the Insect Pest Control Laboratory of the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture using an alanine-EPR dosimetry system as a transfer standard for low energy X-radiation. All the administrative and technical issues are now finalized and the dose assurance service is ready for operation. The purpose of this Service is to help facilities using such irradiators to check the quality of their dosimetry systems. [ABSTRACT FROM AUTHOR]

The Assistive Technology Device Outcomes Research (ATDOR) checklist was developed as a reporting guideline for researchers to enhance the quality of research in this field. The checklist contains 13 items that cover outcome domains unique to assistive technology devices (ATDs). The ATDOR was intended to be an adjunct to existing publication guidelines for outcomes research. The aim of this investigation was to examine the ability of the ATDOR checklist to identify strengths and weaknesses in ATD outcomes research publications that may not be detected using another publication guideline designed for outcomes research. Twenty original ATD outcome studies were scored using the Template for Intervention Description and Replication (TIDieR) checklist, and the ATDOR in two evaluation rounds. In the first round, articles were scored using the TIDieR alone. In the second round, they were scored using the TIDieR and ATDOR together. The difference in percentage scores between the two evaluation rounds was examined using the Wilcoxon signed rank-sum test for paired data. There was a statistically significant difference in the percentage scores between the two evaluation rounds (Wilcoxon statistic = 10, Z = −3.547, p<.000). When used alongside the TIDieR, the ATDOR adds significant value to evaluations of reporting quality on assistive technology outcomes research. As this field continues to grow, researchers are invited to join in efforts to standardise reporting to promote healthier outcomes for ATD users. Reporting guidelines that evaluate research studies enhance their reporting quality and promote healthier outcomes for ATD users. The Assistive Technology Device Outcomes Research (ATDOR) checklist was shown to be a useful tool for achieving a minimum standard of reporting in the field of assistive technology. As the field of assistive technology continues to explore different methodologies, ongoing efforts to develop and update reporting guidelines are necessary in order to capture the future needs of this research area. [ABSTRACT FROM AUTHOR]

Aim and Objective: To examine intensive care unit (ICU) nurses' knowledge, perceptions and prevention performance about medical device‐related pressure injuries (MDRPIs). Background: Prevention of MDRPIs has been an important part of nursing care, and there is a limited number of studies on nurses' level of knowledge or perception about MDRPIs. Design: This study was designed as a cross‐sectional survey and conducted according to STROBE Guidelines. Method: The data of the study were collected with the Nurse Information Form and the MDRPI Knowledge Assessment Questionnaire. In the first phase, the psychometric properties of the questionnaire were evaluated (content validity, internal consistency and test‐retest). A pilot study was conducted with 20 nurses for the test‐retest phase. These nurses were excluded from the general sample. Results: The study was conducted with 142 ICU nurses. The average percent knowledge score of ICU nurses on MDRPIs was 68.4%. In the survey, the highest rate of correct response was found in the expressions about MDRPIs skin assessment (83.6%), and the lowest was in those about follow‐up (50.8%). There was no significant relationship between the total score and age, work experience and specialties (p >.05 for each). However, scores were significantly higher in females than males (65.5 vs. 47.8, p =.020) and in those with a postgraduate degree than those with a bachelor's degree (81.8 vs. 57.9, p =.008). Conclusions: Our study demonstrated that nurses do not have sufficient perception of MDRPIs. The findings of the study can be used to improve nursing policies and practices in acute care settings. Additional studies will be needed with nurses and healthcare professionals working in different clinical settings. Relevance to the clinical practice: This study demonstrates the nurses' need for more knowledge about MDRPIs and will help inform healthcare institutions and their management teams in developing programs and improving protocols to reduce the incidence of MDRPIs. [ABSTRACT FROM AUTHOR]

Objectives The present work examined the surface conditions and various other physical properties of sterilised single-use stainless steel acupuncture needles from two of the most popular brands widely used in many countries. Methods Scanning electron microscope (SEM) images were taken for 10 randomly chosen needles from each brand. Further SEM images were taken after each of these needles underwent a standard manipulation with an acupuncture needling practice gel. A comparison of forces and torques during the needling process was also carried out. Results The SEM images revealed significant surface irregularities and inconsistencies at the needle tips, especially for needles from one of the two brands. Metallic lumps and small, loosely attached pieces of material were observed on the surfaces of some needles. Some of the lumps and pieces of material seen on the needle surfaces disappeared after the acupuncture manipulation. If these needles had been used on patients, the metallic lumps and small pieces of material could have been deposited in human tissues, which could have caused adverse events such as dermatitis. Malformed needle tips might also cause other adverse effects including bleeding, haematoma/ bruising, or strong pain during needling. An off-centre needle tip could result in the needle altering its direction during insertion and consequently failing to reach the intended acupuncture point or damaging adjacent tissues. Conclusions These findings highlight the need for improved quality control of acupuncture needles, with a view to further enhancing the safety and comfort of acupuncture users. [ABSTRACT FROM AUTHOR]

The medical device package design and packaging process are critical steps for the production and distribution of terminally sterilized medical devices. Guidance on design validation and process validation is widely available, but guidance on changes that require revalidation activities is relatively limited. This paper reviews guidance from the harmonized medical packaging standard adopted by European Committee for Standardization (CEN) and International Organization for Standardization (ISO) EN ISO 11607, European Notified Bodies, and the US Food and Drug Administration's Center for Devices and Radiological Health (CDRH) on revalidation of packaging. Based upon these guidances, potential changes to the package and packaging process are categorized and reviewed. [ABSTRACT FROM AUTHOR]

Background: Flexible nasolaryngoscopy is an essential component of the otolaryngological physical exam. Historically, the ability to create and share video recordings of these endoscopic exams has been limited by poor mobility of fixed endoscopy towers. The advent of smartphone endoscope adapters has allowed physicians to create and share video recordings of endoscopy in a wide variety of locations that would not have previously been feasible. This paper sought to review the literature on the effect of smartphone endoscope adapters on patient care, patient satisfaction, and resident learning. Methods: This systematic review was conducted according to PRISMA guidelines. A systematic literature search was performed for all relevant English language studies (1946–2017) using Ovid MEDLINE, PubMed, and EMBASE. The study protocol was registered with the PROSPERO database. Results: A total of 91 abstracts were identified and screened by two independent reviewers. Based on inclusion and exclusion criteria, three studies were selected and subjected to full-text extraction as well as quality assessment. These studies demonstrated high diagnostic accuracy and quality of smartphone adapter-recorded videos, and a benefit of these devices on resident education. Due to the heterogeneity of included studies' methods and measures, a meta-analysis was not possible, so a qualitative synthesis of the literature results was performed. Conclusion: Despite a paucity of data on the subject, the present study provided a comprehensive review of the literature, and suggested overall high diagnostic accuracy, quality, and enhancement of resident education with the use of smartphone endoscope adapters for flexible nasolaryngoscopy. Trial registration: CRD42018086714. [ABSTRACT FROM AUTHOR]

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The article presents the discussion on introduction of a new Sterile Barrier System (SBS) constituting a significant change to the instrumentation circuit. Topics include decision having implications for the entire workflow patterns of the nursing personnel in the operating room (OR); and risk of perforation while using sheet packaging being reduced by fitting edge protection aids.

Background: During laser-induced fragmentation, differences in assessing the intraoperative results can depend on the individual characteristics of the laser system used.Methods: Laser parameters like pulse energy and repetition rate, the penetration depth in silicon tissue, and the laser beam width on photographic paper were determined for three different clinical laser systems.Results: Pulse energy and repetition rate were subject to variations depending on the laser system employed. Significant differences between the three devices were found for penetration depth in silicon and interaction.Conclusions: Further investigations to ascertain the ablation threshold and fragmentation rate can be based on these findings. Intraoperative assessment of the lithotripsy results should take technical aspects of the laser equipment, stone consistency, and the surgeon's experience into consideration. [ABSTRACT FROM AUTHOR]

A wide range of continence products is available, and this paper focuses on products to prevent incontinence (such as urinals and commodes) and to contain or manage urinary incontinence (such as absorbent pads, penile sheaths and urethral catheters). Drawing on results from published clinical evaluations at the Continence Product Evaluation Network at UCL and at other centres, the strengths and limitations of the major categories of incontinence products currently on the market are reviewed. It is concluded that, although products for continence have improved considerably over the last 20 years, there is considerable scope for the designer and engineer to improve on current products. [ABSTRACT FROM AUTHOR]

Capillary electrophoresis (CE) has been used for the separation and analysis of a number of dyes and some related intermediates. Unprecedented high resolution separations were achieved using this new technique. Methods are described for the analysts of some basic, reactive and acid dyes, and the potential for separating disperse dyes and pigments is discussed. A method for the analysis of inorganic anions is also demonstrated. In addition to excellent separations, other benefits of this novel technique over more conventional forms of analysis (such as HPLC) include extremely low running costs, simple operations and method development and excellent reproducibility. Moreover, the separation of such a wide variety of compounds, as shown in this study, means that CE is an attractive tool for the dye manufacturing and dye using industries at large. INSET: About the Competition. [ABSTRACT FROM AUTHOR]

Current international standards require pre-clinical testing of joint replacements under a standard walking cycle, with a standard patient, and with correctly positioned prostheses. These conditions do not replicate the wide variation in wear rates found with a wider range of conditions clinically. In this paper the effect of rotational and translational mal-positioning of the components of ceramic-on-ceramic and metal-on-metal hip prostheses on wear is reported. An elevated level of wear was found with translational mal-positioning and microseparation in ceramic-on-ceramic bearings, while a substantially elevated level of wear was found with both translational and rotational mal-positioning in metal-on-metal bearings. [Copyright &y& Elsevier]

Background: The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick.Methods: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns.Results: The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems.Conclusions: Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions. [ABSTRACT FROM AUTHOR]

Objectives: Tracheostomy care in leading pediatric hospitals is both multidisciplinary and comprehensive, including generalized care protocols and thorough family training programs. This level of care is more difficult in resource-limited settings lacking developed healthcare infrastructure and tracheostomy education among nursing and resident staff. The objective of this study was to improve pediatric tracheostomy care in resource-limited settings. Methods: In collaboration with a team of otolaryngologists, respiratory therapists, tracheostomy nurses, medical illustrators, and global health educators, image-based tracheostomy education materials and low-cost tracheostomy care kits were developed for use in resource-limited settings. In addition, a pilot study was conducted, implementing the image-based tracheostomy pamphlet, manual suctioning device and low-cost ambulatory supply kit ("Go-Bags"), within a low-fidelity simulated training course for nurses and residents in Kigali, Rwanda. Results: An image-based language and literacy-independent tracheostomy care manual was created and published on OPENPediatrics, an open-access online database of clinician-reviewed learning content. Participants of the training program pilot study reported the course to be of high educational and practical value, and described improved confidence in their ability to perform tracheostomy care procedures. Conclusions: Outpatient tracheostomy care may be improved upon by implementing image-based tracheostomy care manuals, locally-sourced tracheostomy care kits, and tailored educational material into a low-fidelity simulated tracheostomy care course. These materials were effective in improving technical skills and confidence among nurses and residents. These tools are expected to improve knowledge and skills with outpatient tracheostomy care, and ultimately, to reduce tracheostomy-related complications. [ABSTRACT FROM AUTHOR]

Introduction: Planning in the field of medical tourism is of particular importance. The main objective of this research was to identify and analyze the factors affecting the growth of medical tourism in Iran. It could be a small step toward promoting entrepreneurship and increasing non-oil revenues in the country. Methods: Studies published in the Persian and English language during the years 2006-2019 in Science Direct, ProQuest, Springer, Medline, Scopus, Ovid, and SID databases were reviewed, and the findings were then compared. Results: A total of 75 articles out of 2631 unique publications were included in this study. Most articles reported studies performed for all patients, including the whole country (Iran) (n=22, 30%), Shiraz only (n=11, 15%), Tehran only (n=11, 15%), Mashhad only (n=6, 8%), Isfahan only (n=5, 6%), and Ardabil only (n=4, 5%). Conclusion: Given the history of Iranian hospitals in attracting foreign patients and the analysis of their status, there are many limitations in achieving a proper standing in the medical tourism industry. Strategies offered by various managers and authorities in tourism can lead to increased attraction of medical tourists to public and private hospitals in Shiraz, relying on the capabilities and potential of Shiraz and its health sectors, including climate and nature, cultural and historical attractions, renowned practitioners, advanced equipment, facilities, and methods, and thereby generating more foreign exchange earnings and employment. [ABSTRACT FROM AUTHOR]

Introduction: In recent decades, medical devices (MDs) have increasingly become an integral part of patient care. However, when it comes to designing and appraising economic models, researchers typically follow pharmaceutical templates (e.g. CHEERS) to assess their economic viability. This study evaluates the generalizability of four device-specific criteria, as recommended by the recent MedtechHTA project, of learning curve, incremental innovation, dynamic pricing, and organizational impact with a broader group of MDs including diagnostics and implantables. The purpose was to determine the applicability of these criteria to a broader range of MDs.Areas Covered: We determined the extent to which these criteria could be applied to each device type and attempted to identify common themes. We performed a literature search using PubMed and Google of a range of devices to understand the clinical significance, operation, and economic viability.Expert Opinion: Our findings suggest that the four characteristics are not applicable to all device types. Prior evaluation of a device's intrinsic properties (such as longevity and device location) and its FDA risk classification could help to indicate the applicability of the criteria. Documenting this process when assessing the additional four criteria on the CHEERS checklist would improve the transparency of future economic evaluations. [ABSTRACT FROM AUTHOR]

The efficiency of a smart cabinet with RFID technology to improve the information about inventory management for cardiothoracic surgery as well as for time savings, was assessed in a large reference hospital. In a 6-month study, the implemented operational RFID process (StocKey® Smart Cabinet) consisted of: i) product reception, registration and labelling in the general warehouse; ii) product storage in the cabinet and registered as inputs by radiofrequency; iii) products registered as outputs as required for surgery; iv) product assignment to a patient in the operating room; and v) return of products not used to the cabinet. Stock-outs, stock mismatches, urgent restocking, assignment of high-value medical products to patients, and time allocated by the supervisory staff to the stock management, were assessed on a monthly basis. 0% stock-outs and 0% stock mismatches using RFID were observed during the study. Monthly percentages of products requiring urgent restocking ranged from 0% to 13.3%. No incorrect assignments to patients of surgery products or prostheses were detected. The percentage of correct assignments increased from 36.1%–86.1% to 100% in the first 4–5 months. The total average time allocated by the supervisory staff to the whole logistic chain was reduced by 58% (995 min with the traditional manual system vs. 428 min with RFID). The RFID system showed the ability to monitor both the traceability and consumption per patient of high-value surgery products as well as contributed to significant time savings. [ABSTRACT FROM AUTHOR]

Introduction: The long-term clinical results and postoperative complications of laser in situ keratomileusis (LASIK) and two types of posterior phakic intraocular lens (ICL: implantable Collamer lens, STAAR) were compared. Over various follow-up periods (LASIK, 12 years; ICL V4, 8 years; and Hole ICL, 5 years), previous studies have reported safety indexes of 1.09 ± 0.21, 1.13 ± 0.23, and 1.15 ± 0.25, respectively. The efficacy indexes were 0.67 ± 0.37, 0.83 ± 0.36, and 1.00 ± 0.29, respectively. The changes in the spherical equivalent from the first or third postoperative month to last-observation period were −0.74 ± 0.99, −0.32 ± 0.73 and −0.17 ± 0.41 D, respectively. This review also discusses postoperative complications, and explains refractive surgery issues in consideration of patient's future quality of vision. Areas covered: This review focused on articles summarizing the latest long-term clinical outcomes. Some figures and tables were newly created using previous long-term clinical reports by the author. Expert commentary: Refractive surgeries specifically on healthy eyes can improve the patient's quality of life. Therefore, it is not desirable to experience a decrease in the postoperative optical quality or to have unnecessary long-term complications. Posterior phakic IOL is the most preferable surgical procedure for patients with high myopia. [ABSTRACT FROM AUTHOR]

Aim: To characterize resources to safely mobilize different types of hospitalized patients. Background: Current approaches to determine nurse–patient ratios do not always include information regarding the specific demands of patients who require extra resources to mobilize. Workflows must be designed with knowledge of resource requirements to integrate patient mobility into the daily nursing team care plan. Methods: Nurse‐led mobility sessions were evaluated on two adult hospital units, which consisted of nurse–patient encounters focused on patient mobility only. The resources assessed for each session were time‐to‐mobilize patient, time‐to‐document, need for additional staff support, and the need for assistive devices. Mobility sessions were also categorized by patient ambulation status, level of mobility limitations (low, medium and high) and diagnosis. Results: In 212 total mobility sessions, the median time‐to‐mobilize and time‐to‐document were 7.75 and 1.27 min, respectively. Additional staff support was required for 87% and 92% of patients with medium and high mobility limitations, respectively. All patients with low mobility limitations ambulated, and only 14% required additional staff. Ambulating patients with high mobility limitations was the most time‐intensive (median 12.55 min). Ambulating stroke patients required one additional staff and an assistive device in 92% and 69% of the sessions, respectively. Conclusion: This study describes the resources associated with mobilizing inpatients with different levels of mobility impairments and diagnoses. Implications for Nursing Management: These results could assist nursing management with facilitating appropriate daily nurse–patient ratios and justify the need for assistive devices and staff support to safely mobilize patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: Community‐dwelling older people were involved in the testing of a fall detection device to improve its utilisation and acceptance in everyday life. Background: The usability of alerting devices remains unsatisfactory, as they are scarcely utilised by older people, despite wide recognition of the importance of rapid assistance after a fall. Moreover, the time a person remains on the floor negatively impacts the severity of fall consequences. However, it is unclear how to increase alerting device utilisation in everyday life. Therefore, older people were involved in this research to consider their perspective during prototype development. Design: A qualitative focus group study was conducted, following a real field testing approach, underpinned by the theoretical framework "Medical Device Technology Development Process." Methods: Fifteen community‐dwelling older people tested the prototype in daily living over a period of nine days. Different means of involvement were exploited such as "user seminars" or "discussion with users." On day 9, data were collected using focus groups and analysed with qualitative content analysis. Results: The participants' perspectives yielded positive aspects of the prototype along with aspects requiring improvement. They indicated that technical requirements are essential. They also revealed that a minimal change in daily routines, support for physical activity and independent living and the inclusion of trusted contact persons could lead to wider use of the alerting device. Conclusions: Involving users is crucial in gaining a deeper understanding of aspects influencing utilisation of an alerting device. The study revealed that usability is influenced both by technical requirements as well as habits and personal preferences. This finding is vital, as habits and personal preferences can only be identified through the involvement of target users. Relevance to clinical practice: The study provides key insights for health practitioners interested in promoting the use of an alerting device in community‐dwelling older people. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the impact of a World Health Organization Safe Childbirth Checklist coaching-based intervention (BetterBirth Program) on availability and procurement of essential childbirth-related supplies.Design: Matched pair, cluster-randomized controlled trial.Setting: Uttar Pradesh, India.Participants: 120 government-sector health facilities (60 interventions, 60 controls). Supply-availability surveys were conducted quarterly in all sites. Coaches collected supply procurement sources from intervention sites.Interventions: Coaching targeting implementation of Checklist with data feedback and action planning.Main Outcome Measures: Mean supply availability by study arm; change in procurement sources for intervention sites.Results: At baseline, 6 and 12 months, the intervention sites had a mean of 20.9 (95% confidence interval (CI): 20.2-21.5); 22.4 (95% CI: 21.8-22.9) and 22.1 (95% CI:21.4-22.8) items, respectively. Control sites had 20.8 (95% CI: 20.3-21.3); 20.9 (95% CI: 20.3-21.5) and 21.7 (95% CI: 20.8-22.6) items at the same time-points. There was a small but statistically significant higher availability in intervention sites at 6 months (difference-in-difference (DID) = 1.43, P < 0.001), which was not seen by 12 months (DID = 0.37, P = 0.53). Greater difference between intervention and control sites starting in the bottom quartile of supply availability was seen at 6 months (DID = 4.0, P = 0.0002), with no significant difference by 12 months (DID = 1.5, P = 0.154). No change was seen in procurement sources with ~5% procured by patients with some rates as high as 29% (oxytocin).Conclusions: Implementation of the BetterBirth Program, incorporating supply availability, resulted in modest improvements with catch-up by control facilities by 12 months. Supply-chain coaching may be most beneficial in sites starting with lower supply availability. Efforts are needed to reduce reliance on patient-funding for some critical medications.Trial Registration: ClinicalTrials.gov #NCT02148952; Universal Trial Number: U1111-1131-5647. [ABSTRACT FROM AUTHOR]

Objective  To reduce nonactionable oximeter alarms by 80% without increasing time infants were hypoxemic (oxygen saturation [SpO 2 ] ≤ 80%) or hyperoxemic (SpO 2  > 95% while on supplemental oxygen). Study Design  In 2015, a multidisciplinary team at Connecticut Children's Medical Center initiated a quality improvement project to reduce nonactionable oximeter alarms in two referral neonatal intensive care units (NICUs). Changes made through improvement cycles included reduction of the low oximeter alarm limit for specific populations, increased low alarm delay, development of postmenstrual age-based alarm profiles, and updated bedside visual reminders. Manual alarm tallies and electronic SpO 2 data were collected throughout the project. Results  Alarm tallies were collected for 158 patient care hours with SpO 2 data available for 138 of those hours. Mean number of total nonactionable alarms per patient per hour decreased from 9 to 2 (78% decrease) and the mean number of nonactionable low alarms per patient per hour decreased from 5 to 1 (80% decrease). No change was noted in the balancing measures of percentage time with SpO 2  ≤ 80% (mean 4.3%) or SpO 2  > 95% (mean 23.7%). Conclusion  Through small changes in oximeter alarm settings, including revision of alarm limits, alarm delays, and age-specific alarm profiles, our NICUs significantly reduced nonactionable alarms without increasing hypoxemia. [ABSTRACT FROM AUTHOR]

Background: Supportive supervision of infection prevention and control (IPC) practices was one of a range of interventions employed at the county level in the control of the world’s most deadly Ebola virus disease outbreak that affected Liberia during 2013–2016. Methods: Datasets generated from four consecutive assessment visits to 25 health facilities in Maryland County, in Liberia, were analysed. Information on IPC practices was obtained by interview, direct observation and completion of a standardised assessment tool. For each of the IPC fields assessed, a score < 50% was graded poor, 50–75% as fair, while > 75% was rated as good. Results: Before the intervention, the first assessment (baseline) indicated that the majority of the health facilities scored low in terms of isolation facilities, IPC administration, supply and equipment, personnel and staffing, triage and waste management. Following the application of supportive supervision and monitoring, all the facilities recorded moderate to good performance in all the fields during the fourth round of assessment, except for isolation facilities, which scored low. Conclusion: Supportive supervision and monitoring of healthcare facilities appeared to have contributed to the improvement in IPC standards and compliance during the Ebola outbreak as demonstrated in this small-scale study and should be sustained as a core component of IPC programs, particularly in prolonged outbreak situations. [ABSTRACT FROM AUTHOR]

Problem: A lack of proper water, sanitation, and hygiene (WASH) infrastructure and poor hygiene practices reduce the preparedness and response of health care facilities (HCFs) in low-income countries to infection and disease outbreaks. According to a World Bank Service Provision Assessment conducted in 2007, only 28% of HCFs in Rwanda had water access throughout the year supplied by tap and 58% of HCFs provided functioning latrines.1 This evaluation of services and infrastructure in HCFs in Rwanda indicates that targets for WASH in-country need to be enhanced. Objectives: To present a case study of the causes and management of sepsis during delivery that led to the death of a 27-year-old woman, and propose a WASH protocol to be implemented in HCFs in Rwanda. Methods: The state of WASH services used by staff, caregivers, and patients in HCFs was assessed in 2009 in national evaluations conducted by the Ministry of Infrastructure of Rwanda. Site selection was purposive, based on the presence of both water and power supply. Direct observation was used to assess water treatment, presence and condition of sanitation facilities and sterile equipment in the delivery room, provision of soap and water, gloves, alcohol-based hand rub, and WASH-related record keeping. Results: All healthcare facilities met Ministry policies for water access, but WHO guidelines for environmental standards, including for water quality, were not fully satisfied. Conclusions: The promotion and provision of low-cost technologies that enable improvedWASH practices could help to reduce high rates of morbidity and mortality due to infection in low-income countries. [ABSTRACT FROM AUTHOR]

Abstract: With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient‐reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long‐term macro‐ and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long‐term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient‐reported outcomes is leading to diabetes care delivery becoming more patient‐centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life. [ABSTRACT FROM AUTHOR]