The Use of Silver Oxynitrate Wound Dressings in the Treatment of Chronic Wounds: A Feasibility Pilot Study.

OBJECTIVE: To evaluate the feasibility and effectiveness of a silver oxynitrate (Ag 7 NO 11 ) dressing on wound healing in patients with stalled chronic wounds. METHODS: A prospective pilot study was conducted to determine the feasibility and effect of using silver oxynitrate dressings within an outpatient setting in Alberta, Canada. A total of 23 patients (12 women and 11 men; mean age, 66.1 ± 13.8 years) with a chronic wound that failed to heal with conventional treatment were included in the study. Wound assessments including the Bates-Jensen Wound Assessment Tool, wound-related pain, wound size, and patient quality of life (QoL) were conducted at baseline, after dressing application for 1 and 2 weeks, and during 4- and 12-week follow-ups. RESULTS: Dressing application at 1 and 2 weeks improved patients' wound healing progression as measured through significantly decreased Bates-Jensen Wound Assessment Tool scores with a more than 10% decrease at 4- and 12-week follow-up ( P < .001). Pain ( P = .004), and QoL psyche subscore ( P = .008) significantly improved at 4-week follow-ups, although wound area, perimeter, and QoL body and everyday subscores were not significantly affected. Wound size was not significantly affected. CONCLUSIONS: The silver oxynitrate dressing may improve healing progression in patients with chronic wounds, enhance patient experience by reducing wound-related pain, and improve patients' mental well-being. Further studies are warranted to elucidate the effect of silver oxynitrate dressings on wound area, perimeter, and volume measurements.

Navigating the Systemic Conditions of a Digital Health Ecosystem in Alberta, Canada: Embedded Case Study.

BACKGROUND: Digital health promises numerous value-creating outcomes. These include improved health, reduced costs, and the creation of lucrative markets, which, in turn, provide high-quality employment, productivity growth, and a climate that attracts investment. For this value creation and capture, the activities of a diverse set of stakeholders within a digital health ecosystem require coordination. However, the antecedents of the coordination needed for an effective digital health ecosystem are not well understood. OBJECTIVE: The purpose of this study was to investigate the systemic conditions of the digital health ecosystem in Alberta, Canada, as critical antecedents to ecosystem coordination from the perspective of the authors as applicants to an innovative digital health funding program embedded within the larger digital health ecosystem of innovators or entrepreneurs, health system leaders, support partners, and funders. METHODS: We employed a qualitative embedded case study of the systemic conditions within the digital health ecosystem in Alberta, Canada (main case) using semistructured interviews with 36 stakeholders representing innovators or entrepreneurs, health system leaders, support partners, and funders (subcases). The interviews were conducted over a 2-month period between May 26 and July 22, 2021. Data were coded for key themes and synthesized around 5 propositions developed from academic publications and policy reports. RESULTS: The findings indicated varying levels of support for each proposition, with moderate support for accessing real problems, data, training, and space for evaluations. However, the most fundamental gap appears to be in ecosystem navigation, in particular, the absence of intermediaries (eg, individuals, organizations, and technology) to provide guidance on the available support services and dependencies among the various ecosystem actors and programs. CONCLUSIONS: Navigating the systemic conditions of the digital health ecosystem is extremely challenging for entrepreneurs, especially those without prior health care experience, and this remains an issue even for those with such experience. Policy interventions aimed at increasing collaboration among ecosystem support providers, along with tools and incentives to ensure coordination, are essential as the ecosystem and those dependent on it grow.

A multi-step approach to developing a health system evaluation framework for community-based health care.

BACKGROUND: Community-based health care (CBHC) is a shift towards healthcare integration and community services closer to home. Variation in system approaches harkens the need for a conceptual framework to evaluate outcomes and impacts. We set out to develop a CBHC-specific evaluation framework in the context of a provincial ministry of health planning process in Canada. METHODS: A multi-step approach was used to develop the CBHC evaluation framework. Modified Delphi informed conceptualization and prioritization of indicators. Formative research identified evaluation framework elements (triple aim, global measures, and impact), health system levels (tiers), and potential CBHC indicators (n = 461). Two Delphi rounds were held. Round 1, panelists independently ranked indicators on CBHC relevance and health system tiering. Results were analyzed by coding agreement/disagreement frequency and central tendency measures. Round 2, a consensus meeting was used to discuss disagreement, identify Tier 1 indicators and concepts, and define indicators not relevant to CBHC (Tier 4). Post-Delphi, indicators and concepts were refined, Tier 1 concepts mapped to the evaluation framework, and indicator narratives developed. Three stakeholder consultations (scientific, government, and public/patient communities) were held for endorsement and recommendation. RESULTS: Round 1 Delphi results showed agreement for 300 and disagreement for 161 indicators. Round 2 consensus resulted in 103 top tier indicators (Tier 1 = 19, Tier 2 = 84), 358 bottom Tier 3 and 4 indicators, non-CBHC measure definitions, and eight Tier 1 indicator concepts-Mortality/Suicide; Quality of Life, and Patient Reported Outcome Measures; Global Patient Reported Experience Measures; Cost of Care, Access to Integrated Primary Care; Avoidable Emergency Department Use; Avoidable Hospitalization; and E-health Penetration. Post Delphi results refined Tier 3 (n = 289) and 4 (n = 69) indicators, and identified 18 Tier 2 and 3 concepts. When mapped to the evaluation framework, Tier 1 concepts showed full coverage across the elements. 'Indicator narratives' depicted systemness and integration for evaluating CBHC. Stakeholder consultations affirmed endorsement of the approach and evaluation framework; refined concepts; and provided key considerations to further operationalize and contextualize indicators, and evaluate CBHC as a health system approach. CONCLUSIONS: This research produced a novel evaluation framework to conceptualize and evaluate CBHC initiatives. The evaluation framework revealed the importance of a health system approach for evaluating CBHC.

The impact of the use of video-based educational interventions on patient outcomes in hospital settings: A scoping review.

OBJECTIVE: To summarize the literature on the impact of video-based educational interventions on patient outcomes in inpatient settings as compared to standard education techniques. METHODS: This review followed a scoping review methodology. English language articles were searched in Pubmed, Medline, Cochrane, and CINAHL databases. Inclusion criteria were: use of video-based educational interventions, and inpatient hospital settings. Abstracts were reviewed and selected according to predetermined criteria, followed by full-text scrutiny. RESULTS: Sixty-two empirical studies were identified, with 38 (61%) reporting a significant positive effect of video-based educational interventions on patient outcomes, compared to control groups (i.e., standard education). Three different types of video-based educational intervention formats were identified: animated presentations, professionals in practice, and patient narratives. Outcome types included: knowledge-based, clinical, emotional, and behavioral, with knowledge-based most prevalent. CONCLUSION: Video-based educational interventions are common in the hospital setting. These interventions are effective at improving short-term health literacy goals, but their impact on behavior or lifestyle modifications is unclear. Their effectiveness also depends on presentation format, timing, and the patient's emotional well-being. PRACTICE IMPLICATIONS: Video-based educational delivery is effective for improving short-term health literacy, however a combination of approaches delivered over an extended period of time may support improving longer-term health outcomes.

Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

BACKGROUND: Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. PURPOSE: To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. METHODS: A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. RESULTS: A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. DISCUSSION: Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration.

How evidence from observing attending physicians links to a competency-based framework.

CONTEXT: Competency-based medical education frameworks are often founded on a combination of existing research, educational principles and expert consensus. Our objective was to examine how components of the attending physician role, as determined by observing preceptors during their real-world work, link to the CanMEDS Physician Competency Framework. METHODS: This is a sub-study of a broader study exploring the role of the attending physician by observing these doctors during their working day. The parent study revealed three overarching elements of the role that emerged from 14 themes and 123 sub-themes: (i) Competence, defined as the execution of traditional physician competencies; (ii) Context, defined as the environment in which the role is carried out, and (iii) Conduct, defined as the manner of acting, or behaviours and attitudes in the role that helped to negotiate the complex environment. In this sub-study, each sub-theme, or 'role-related component', was mapped to the competencies described in the CanMEDS 2005 and 2015 frameworks. RESULTS: Many role-related components from the Competence element were represented in the 2015 CanMEDS framework. No role-related components from the Context element were represented. Some role-related components from the Conduct element were represented. These Conduct role-related components were better represented in the 2015 CanMEDS framework than in the 2005 framework. CONCLUSIONS: This study shows how the real-world work of attending physicians links to the CanMEDS framework and provides empirical data identifying disconnects between espoused and observed behaviours. There is a conceptual gap where the contextual influences of physicians' work and the competencies required to adjust to these influences are missing from the framework. These concepts should be incorporated into learning both broadly, such as through an emphasis on context within curriculum development for the workplace (e.g. entrustable professional activities), and explicitly, through the introduction of novel competencies (e.g. the Conduct role-related components described in this study).

Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review.

BACKGROUND: Though often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment. METHODS: We searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality. RESULTS: We included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted. CONCLUSIONS: With no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.

Medical applications: a database and characterization of apps in Apple iOS and Android platforms.

BACKGROUND: Medical applications (apps) for smart phones and tablet computers are growing in number and are commonly used in healthcare. In this context, there is a need for a diverse community of app users, medical researchers, and app developers to better understand the app landscape. METHODS: In mid-2012, we undertook an environmental scan and classification of the medical app landscape in the two dominant platforms by searching the medical category of the Apple iTunes and Google Play app download sites. We identified target audiences, functions, costs and content themes using app descriptions and captured these data in a database. We only included apps released or updated between October 1, 2011 and May 31, 2012, with a primary "medical" app store categorization, in English, that contained health or medical content. Our sample of Android apps was limited to the most popular apps in the medical category. RESULTS: Our final sample of Apple iOS (n = 4561) and Android (n = 293) apps illustrate a diverse medical app landscape. The proportion of Apple iOS apps for the public (35%) and for physicians (36%) is similar. Few Apple iOS apps specifically target nurses (3%). Within the Android apps, those targeting the public dominated in our sample (51%). The distribution of app functions is similar in both platforms with reference being the most common function. Most app functions and content themes vary considerably by target audience. Social media apps are more common for patients and the public, while conference apps target physicians. CONCLUSIONS: We characterized existing medical apps and illustrated their diversity in terms of target audience, main functions, cost and healthcare topic. The resulting app database is a resource for app users, app developers and health informatics researchers.

Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle.

BACKGROUND: Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience. METHODS: This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. RESULTS: Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. CONCLUSIONS: The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.

Evaluation of a hands-free communication device in an acute care setting: a study of healthcare providers' perceptions of its performance.

Quality medical care hinges on healthcare providers being able to communicate effectively and efficiently. In this study, we examine if healthcare providers' perceptions of the performance of a wireless communication device are consistent with what it is claimed the technology can offer, namely, improved patient safety and quality of care. We used a mixed-methods design where we collected data from a single medical unit. During the qualitative component of the study, we conducted face-to-face interviews to explore healthcare team members' perceptions of the impact of a wireless communication device on their day-to-day patient care activities. Three major improvements were identified from the interview data: more direct and effective communication, improved work efficiency, and enhanced continuity of patient care. The quantitative component consisted of a questionnaire constructed from the major themes extracted from the interviews. Many of the healthcare team members reported that the wireless communication device improved their communication and allowed them to complete their work more efficiently. In addition, the questionnaire findings suggest that both improved communication and work efficiency are correlated with perceptions of improved quality of patient care. Based on the results of this study, this wireless communication device does live up to its aims of enhancing communication, staff efficiency, and improving perceived patient safety.

The effect of a biofeedback-based stress management tool on physician stress: a randomized controlled clinical trial.

BACKGROUND: Physicians often experience work-related stress that may lead to personal harm and impaired professional performance. Biofeedback has been used to manage stress in various populations. OBJECTIVE: To determine whether a biofeedback-based stress management tool, consisting of rhythmic breathing, actively self-generated positive emotions and a portable biofeedback device, reduces physician stress. DESIGN: Randomized controlled trial measuring efficacy of a stress-reduction intervention over 28 days, with a 28-day open-label trial extension to assess effectiveness. SETTING: Urban tertiary care hospital. PARTICIPANTS: Forty staff physicians (23 men and 17 women) from various medical practices (1 from primary care, 30 from a medical specialty and 9 from a surgical specialty) were recruited by means of electronic mail, regular mail and posters placed in the physicians' lounge and throughout the hospital. INTERVENTION: Physicians in the intervention group were instructed to use a biofeedback-based stress management tool three times daily. Participants in both the control and intervention groups received twice-weekly support visits from the research team over 28 days, with the intervention group also receiving re-inforcement in the use of the stress management tool during these support visits. During the 28-day extension period, both the control and the intervention groups received the intervention, but without intensive support from the research team. MAIN OUTCOME MEASURE: Stress was measured with a scale developed to capture short-term changes in global perceptions of stress for physicians (maximum score 200). RESULTS: During the randomized controlled trial (days 0 to 28), the mean stress score declined significantly for the intervention group (change -14.7, standard deviation [SD] 23.8; p = 0.013) but not for the control group (change -2.2, SD 8.4; p = 0.30). The difference in mean score change between the groups was 12.5 (p = 0.048). The lower mean stress scores in the intervention group were maintained during the trial extension to day 56. The mean stress score for the control group changed significantly during the 28-day extension period (change -8.5, SD 7.6; p < 0.001). CONCLUSION: A biofeedback-based stress management tool may be a simple and effective stress-reduction strategy for physicians.