Development, implementation and evaluation of the digital transformation of renal services in Wales: the journey from local to national.

BACKGROUND: Treatment for people with kidney disease is often associated with complicated combinations of medicines. Logistical challenges with traditiona paper-based prescribing means that these patients are particularly susceptible to medication-relation errors and harm. AIM: To improve the quality of care that people with kidney disease receive across Wales through a Value-Based digital transformation programme. SETTING: Renal units within the National Welsh Renal Clinical Network (WRCN). DEVELOPMENT: A novel Electronic Prescribing & Medicines Administration (EPMA) system, integrated into a patient care record and linked to a patient portal was developed in South West Wales (SWW) region of the WRCN, enabled by the Welsh Government (WG) Efficiency Through Technology Fund. National upscale was enabled through the WG Transformation Fund. IMPLEMENTATION: EPMA was designed and rolled out initially in SWW region of the WRCN (2018). A dedicated delivery team used the blueprint to finalise and implement a strategy for successful national roll-out eventually across all Wales (completed 2021). EVALUATION: A multi-factorial approach was employed, as both the technology itself and the healthcare system within which it would be introduced, were complex. Continuous cycles of action research involving informal and formal qualitative interviews with service-users ensured that EPMA was accessible and optimally engaging to all target stakeholders (patients and staff). Results confirmed that EPMA was successful in improving the quality of care that people with kidney disease receive across Wales, contributed to Value-Based outcomes, and put people who deliver and access care at the heart of transformation. CONCLUSION: Key findings of this study align directly with the national design principles to drive change and transformation, put forward by the WG in their plan for Health and Social Care: prevention and early intervention; safety; independence; voice; seamless care.

Ventilator-associated pneumonia surveillance using two methods.

BACKGROUND: Ventilator-associated pneumonia surveillance is used as a quality indicator due to concerns that some cases may be preventable and may contribute to mortality. Various surveillance criteria exist for the purposes of national reporting, but a large-scale direct comparison has not been conducted. METHODS: A prospective cohort study applied two routinely used surveillance criteria for ventilator-associated pneumonia from the European Centre for Disease Control and the American Centers for Disease Control to all patients admitted to two large general intensive care units. Diagnostic rates and concordance amongst diagnostic events were compared. FINDINGS: A total of 713 at-risk patients were identified during the study period. The European surveillance algorithm returned a rate of 4.6 cases of ventilator-associated pneumonia per 1000 ventilation days (95% confidence interval 3.1-6.6) and the American surveillance system a rate of 5.4 (3.8-7.5). The concordance between diagnostic events was poor (Cohen's Kappa 0.127 (-0.003 to 0.256)). CONCLUSIONS: The algorithms yield similar rates, but the lack of event concordance reveals the absence of inter-algorithm agreement for diagnosing ventilator-associated pneumonia, potentially undermining surveillance as an indicator of care quality.

Effects of nematicide placement on nematode populations and soybean yields.

Four methods of placement of DBCP (l,2-dibromo-3-chloropropane) and a single method of application of ethoprop (0-ethyl S,S-dipropyl phosphorodithioate) wexe compared in each of two areas for control of nematodes on soybeans. One area was a Marlboro sand infested with Hoplolaimus columbus. The other area was a Fuquay loamy sand infested with Meloidogne incognita. Soybean yields were increased and numbers of H. columbus in the row 0-20 cm deep were decreased similarly by all methods of DBCP application in Marlboro soil. All DBCP treatments increased the average soybean yields and decreased numbers of M. incognita larvae in the row 0-20 cm deep in the Fuquay soil. Average root-knot indices were reduced by all DBCP treatments except with placement 40 cm deep beneath the row. Similarly, placement of all or part of the DBCP 20 cm deep and 13 cm to either side of the row resulted in greater average yields than placement of the DBCP 40 cm deep. Apparently, control of M. incognita is more critical 0-20 cm deep than 20-40 cm deep for increasing soybean yields. DBCP did not control H. columbus as effectively as it did M. incognita. Control of H. columbus and M. incognita was not obtained at 0-20-cm and 20-40-cm depths 30 cm and 45 cm from the row regardless of the method used to apply DBCP. H. columbus and M. incognita were controlled more effectively and soybean yields were higher with DBCP at 13.6 kg a.i./ha than with ethoprop at 4.5 kg a.i./ha.

Dynamics of Concomitant Field Populations of Hoplolaimus columbus and Meloidogyne incognita.

From the fall of 1968 through the summer of 1973, a Georgia cotton field with a lengthy history of the Cotton Stunt Disease Complex was sampled for the presence of plant parasitic nematodes. Although Meloidogyne incognita was recovered on all sampling dates, concomitant populations of Hoplolaimus columbus were not recovered until the spring of 1970. During the succeeding four growing seasons, the population density and horizontal distribution of H. columbus increased, and H. columbus replaced M. incognita as the predominant phytopathogenie species. A second Georgia cotton field containing concomitant populations of H. columbus and M. incognita was observed from the fall of 1971 through the summer of 1973. In this case the horizontal distribution of both species remained relatively constant and the population density of H. columbus increased steadily. In both locations, the presence of either H. columbus or M. incognita significantly inhibited the presence of the concomitant species. In general, however, the initial spring or final fall population densities of H. columbus or M. incognita had no significant influence on the population density of the concomitant species, The data are also discussed in relation to the biological significance of H. columbus in the southeastern coastal plain.