A scoping review of the methodological approaches used in retrospective chart reviews to validate adverse event rates in administrative data.

Patient safety is a key quality issue for health systems. Healthcare acquired adverse events (AEs) compromise safety and quality; therefore, their reporting and monitoring is a patient safety priority. Although administrative datasets are potentially efficient tools for monitoring rates of AEs, concerns remain over the accuracy of their data. Chart review validation studies are required to explore the potential of administrative data to inform research and health policy. This review aims to present an overview of the methodological approaches and strategies used to validate rates of AEs in administrative data through chart review. This review was conducted in line with the Joanna Briggs Institute methodological framework for scoping reviews. Through database searches, 1054 sources were identified, imported into Covidence, and screened against the inclusion criteria. Articles that validated rates of AEs in administrative data through chart review were included. Data were extracted, exported to Microsoft Excel, arranged into a charting table, and presented in a tabular and descriptive format. Fifty-six studies were included. Most sources reported on surgical AEs; however, other medical specialties were also explored. Chart reviews were used in all studies; however, few agreed on terminology for the study design. Various methodological approaches and sampling strategies were used. Some studies used the Global Trigger Tool, a two-stage chart review method, whilst others used alternative single-, two-stage, or unclear approaches. The sources used samples of flagged charts (n = 24), flagged and random charts (n = 11), and random charts (n = 21). Most studies reported poor or moderate accuracy of AE rates. Some studies reported good accuracy of AE recording which highlights the potential of using administrative data for research purposes. This review highlights the potential for administrative data to provide information on AE rates and improve patient safety and healthcare quality. Nonetheless, further work is warranted to ensure that administrative data are accurate. The variation of methodological approaches taken, and sampling techniques used demonstrate a lack of consensus on best practice; therefore, further clarity and consensus are necessary to develop a more systematic approach to chart reviewing.

Factors associated with assistive technology prescription and acceptance in motor neurone disease.

PURPOSE: The risk of delaying assistive technology (AT) prescription and implementation has significant implications on the safety and quality of life of people with Motor Neurone Disease (PwMND). This study aims to explore the barriers and enablers of AT prescription and implementation identified by PwMND and clinicians. METHODS: A qualitative study using semi-structured focus groups with clinicians and in-depth interviews with PwMND. Sixteen clinicians and ten PwMND were recruited. Thematic analysis was completed and results were compared and discussed to reach an agreement on the final themes. RESULTS: Three main factors were identified - PwMND, Clinician and Extrapersonal. For PwMND, personal characteristics, such as mindset, was the strongest enabler and inability to accept diagnosis and AT was the key barrier. For Clinician, communication approach was both the most identified enabler and barrier. For Extrapersonal, the availability of interactive education of AT was the strongest enabler and long wait time was a significant barrier. CONCLUSION: Our study identified themes that clinicians could have an impact on, such as, providing interactive education, engaging PwMND and their support network, and ongoing upskilling of clinicians working in this field. Themes identified that were beyond the control of clinicians were personal characteristics, acceptance and support networks. It highlights the importance for clinicians to be flexible with their communication approach to accommodate the needs of PwMND in the acceptance of AT.

There are many factors that may influence a person with Motor Neurone Disease's decision about Assistive Technology (AT) and not all are within the control of clinicians.It is important for clinicians to be reflective of the situation and barriers they encounter, and recognise their limits and what they can act on.For clinicians looking after people with Motor Neurone Disease (PwMND), it is important to develop your knowledge continuously, consider setting up an AT library, and engage PwMND and their support network in care decision making.

Long-term horizontal vocal directivity of opera singers: effects of singing projection and acoustic environment.

Vocal directivity refers to how directional the sound is that comes from a singer's mouth, that is, whether the sound is focused into a narrow stream of sound projecting in front of the singers or whether it is spread out all around the singer. This study investigates the long-term vocal directivity and acoustic power of professional opera singers and how these vary among subjects, among singing projections, and among vastly different acoustic environments. The vocal sound of eight professional opera singers (six females and two males) was measured in anechoic and reverberant rooms and in a recital hall. Subjects sang in four different ways: (1) paying great attention to intonation; (2) singing as in performance, with all the emotional connection intended by the composer; (3) imagining a large auditorium; and (4) imagining a small theatre. The same song was sung by all singers in all conditions. A head and torso simulator (HATS), radiating sound from its mouth, was used for comparison in all situations. Results show that individual singers have quite consistent long-term average directivity, even across conditions. Directivity varies substantially among singers. Singers are more directional than the standard HATS (which is a physical model of a talking person). The singer's formant region of the spectrum exhibits greater directivity than the lower-frequency range, and results indicate that singers control directivity (at least, incidentally) for different singing conditions as they adjust the spectral emphasis of their voices through their formants.