ASPIRE for excellence in curriculum development.

The objective of the ASPIRE award programme of the International Association for Health Professions Education is to go beyond traditional accreditation processes. Working in partnership with the ASPIRE Academy, the programme aims to encourage and support excellence in health professions education, in part by showcasing and exemplifying best practices. Each year ASPIRE award applications received from institutions across the globe describe their greatest achievements in a variety of areas, one of which is curriculum development, where evaluation of applications is carried out using a framework of six domains. These are described in this paper as key elements of excellence, specifically, Organisational Structure and Curriculum Management; Underlying Educational Strategy; Content Specification and Pedagogy; Teaching and Learning Methods and Environment; Assessment, Monitoring and Evaluation; Scholarship. Using examples from the content of submissions of three medical schools from very different settings that have been successful in the past few years, achievements in education processes and outcomes of institutions around the world are highlighted in ways that are relevant to their local and societal contexts.

Survivor voices: co-learning, re-connection, and healing through community action research and engagement (CARE).

This article describes the Trauma Healing Project (THP: www.http//healingattention.org), the Survivor Voices study (n = 351), and the complementary nature of community- campus partnerships (CCP) and community-based participatory action research methodology (PAR). Survivor Voices-a random digit telephone survey developed by, conducted, analyzed, and disseminated by survivors of abuse and violence, university researchers, and students-was designed to learn from survivors about what hurt and about what helped with regard to how people responded to their trauma, and what they recommend for trauma healing. We feature our CCP, including challenges faced, how we have addressed those challenges, and profile our current findings. We describe how PAR and CCPs can be very useful tools toward the development of a community-wide effort to reduce violence and support trauma healing.

A health impact assessment on the construction phase of a major hospital redevelopment.

A prospective health impact assessment (HIA) was conducted to identify potential health impacts arising from the planned redevelopment of Liverpool Hospital, a major teaching hospital in New South Wales, Australia. A multidisciplinary team of health professionals oversaw the HIA and a core project team led by population health practitioners conducted the HIA using a structured, stepwise process. Methods used to gather data for the identification of impacts were a literature review, development of a population profile and consultation with stakeholders. A range of positive and negative health impacts were identified and an assessment matrix was used to prioritise the health impacts and develop recommendations for the proponents of the redevelopment plan. The HIA added value to the planning process for the hospital redevelopment, increasing capacity to conduct future HIAs.

Burden of illness in venous thromboembolism in critical care: a multicenter observational study.

PURPOSE: The frequency of clinically diagnosed venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE) in medical-surgical critically ill patients is unclear. The objectives of this study were to estimate the prevalence and incidence of radiologically confirmed DVT and PE in medical-surgical intensive care unit (ICU) patients and to determine the impact of prophylaxis on the frequency of these events. MATERIALS AND METHODS: In a retrospective observational cohort study in 12 adult ICUs, we identified prevalent cases (diagnosed in the 24 hours preceding ICU admission up to 48 hours post-ICU admission) and incident cases (diagnosed 48 hours or more after ICU admission and up to 8 weeks after ICU discharge) of upper or lower limb DVT or PE. Deep venous thrombosis was diagnosed by compression ultrasound or venogram. Each DVT was classified as clinically suspected or not clinically suspected in that the latter was diagnosed by scheduled screening ultrasonography. Pulmonary embolism was diagnosed by ventilation-perfusion lung scan, computed tomography pulmonary angiography, echocardiography, electrocardiography, or autopsy. RESULTS: Among 12,338 patients, 252 (2.0%) patients had radiologically confirmed DVT or PE and another 47 (0.4%) had possible DVT or PE. Prevalent DVTs were diagnosed in 0.4% (95% confidence interval [CI], 0.3%-0.5%) of patients and prevalent PEs were diagnosed in 0.4% (95% CI, 0.3%-0.6%). Incident DVTs were diagnosed in 1.0% (95% CI, 0.8%-1.2%) of patients, and incident PEs were diagnosed in 0.5% (95% CI, 0.4%-0.6%). Of patients with incident VTE, 65.8% of cases occurred despite receipt of thromboprophylaxis for at least 80% of their days in ICU. The median (interquartile range) ICU length of stay was similar for patients with DVT (7 [3-17]) and PE (5 [2-8]). For all patients with VTE, ICU mortality was 16.7% (95% CI, 12.0%-21.3%) and hospital mortality was 28.5% (95% CI, 22.8%-34.1%). CONCLUSIONS: Venous thromboembolism appears to be an apparently infrequent, but likely underdiagnosed problem, occurring among patients receiving prophylaxis. Findings suggest the need for increased suspicion among clinicians, renewed efforts at thromboprophylaxis, and evaluation of superior prevention strategies.

Decision-making in the ICU: perspectives of the substitute decision-maker.

OBJECTIVE: To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making. DESIGN: Prospective, multicenter, cohort study. SETTING: Six Canadian university-affiliated ICUs. PATIENTS AND PARTICIPANTS: We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h. INTERVENTION: None. MEASUREMENTS AND RESULTS: A group consisting of 1,123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared decision-making process. Factors contributing the most to satisfaction with decision-making included: complete satisfaction with level of health care the patient received, completeness of information received, and feeling supported through the decision-making process. Satisfaction with decision-making varied significantly across sites. CONCLUSIONS: In this multicenter observational study, we found that most substitute decision-makers for ICU patients wanted to share decision-making responsibility with physicians and that, overall, they were satisfied with their decision-making experience. Adequate communication, feeling supported, and achieving the appropriate level of care for their family member were key determinants of satisfaction with decision-making in the ICU.

Family satisfaction with care in the intensive care unit: results of a multiple center study.

OBJECTIVE: To determine the level of satisfaction of family members with the care that they and their critically ill relative received. DESIGN: Prospective cohort study. SETTING: Six university-affiliated intensive care units across Canada. METHODS: We administered a validated questionnaire to family members who made at least one visit to intensive care unit patients who received mechanical ventilation for >48 hrs. We obtained self-rated levels of satisfaction with 25 key aspects of care related to the overall intensive care unit experience, communication, and decision making. For family members of survivors, the questionnaire was administered while the patient was still in the hospital. For family members of nonsurvivors, the questionnaire was mailed out to the family member 3-4 wks after the patient's death. MAIN RESULTS: A total of 891 family members received questionnaires; 624 were returned (70% response rate). The majority of respondents were satisfied with overall care and with overall decision making (mean +/- sd item score, 84.3 +/- 15.7 and 75.9 +/- 26.4, respectively). Families reported the greatest satisfaction with nursing skill and competence (92.4 +/- 14.0), the compassion and respect given to the patient (91.8 +/- 15.4), and pain management (89.1 +/- 16.7). They were least satisfied with the waiting room atmosphere (65.0 +/- 30.6) and frequency of physician communication (70.7 +/- 29.0). The variables significantly associated with overall satisfaction in a regression analysis were completeness of information received, respect and compassion shown to the patient and family member, and the amount of health care received. Satisfaction varied significantly across sites. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their critically ill relative in the intensive care unit. Efforts to improve the nature of interactions and communication with families are likely to lead to improvements in satisfaction.