Informing best practice for conducting morbidity and mortality reviews: a literature review.

Objective Preventable hospital mortality is a critical public health issue, particularly when mortalities are associated with events that are preventable. Mortality and morbidity reviews (MMRs) provide a rigorous, systematic, open, collaborative and transparent review process for clinicians to examine areas of improvement. The aim of the present review was to explore the evidence for best practice when conducting MMRs. Methods Searches of published and grey literature from 2009 to February 2016 were conducted. This period was selected to update a previous review. Inclusion and exclusion criteria was established a priori and based on the Population-Intervention-Comparison-Outcome (PICO) framework. Specific search terms were generated and used to identify relevant articles, with reference lists and citing articles also screened for inclusions. Titles and abstracts were screened and duplicates removed. Study details regarding setting, study design, reported outcomes, tool type, clinicians present and the timing of MMRs were extracted and summarised. Results After screening, 31 documents were included in the present review: 20 peer-reviewed articles and 11 items from the grey literature. Specific outcomes reported included mortality rates, satisfaction, education, cost and quality of care. The most common features of MMRs included timing, leadership, attendees, case presentation format, terms of reference, agenda and governance. Conclusions MMRs decrease gross mortality rates and are effective in identifying and engaging clinicians in system improvements. MMRs should not focus on the actions of individuals, rather on education and/or quality improvement. MMRs should consist of a multidisciplinary team following a structured presentation format with an analysis of error process including actions to be followed-up. Further, it is possible for a single standardised MMR to be implemented hospital wide. What is known about the topic? MMRs are conducted in a variety of clinical settings to educate clinicians and improve patient care. What does this paper add? This review updates a previous review published in 2009 and summarises current evidence around morbidity and mortality reviews. This review also provides a framework for a standardised MMR to be implemented hospital wide. What are the implications for practitioners? This summary of the evidence can be used to guide the development, formation or conduct of MMRs in any healthcare setting.

Musculoskeletal stiffness during hopping and running does not change following downhill backwards walking.

Eccentric contractions that provide spring energy can also cause muscle damage. The aim of this study was to explore leg and vertical stiffness following muscle damage induced by an eccentric exercise protocol. Twenty active males completed 60 minutes of backward-walking on a treadmill at 0.67 m/s and a gradient of - 8.5° to induce muscle damage. Tests were performed immediately before; immediately post; and 24, 48, and 168 hours post eccentric exercise. Tests included running at 3.35 m/s and hopping at 2.2 Hz using single- and double-legged actions. Leg and vertical stiffness were measured from kinetic and kinematic data, and electromyography (EMG) of five muscles of the preferred limb were recorded during hopping. Increases in pain scores (over 37%) occurred post-exercise and 24 and 48 hours later (p < 0.001). A 7% decrease in maximal voluntary contraction occurred immediately post-exercise (p = 0.019). Changes in knee kinematics during single-legged hopping were observed 168 hours post (p < 0.05). No significant changes were observed in EMG, creatine kinase activity, leg, or vertical stiffness. Results indicate that knee mechanics may be altered to maintain consistent levels of leg and vertical stiffness when eccentric exercise-induced muscle damage is present in the lower legs.

The interday reliability of ankle, knee, leg, and vertical musculoskeletal stiffness during hopping and overground running.

A number of methods are used to measure lower extremity musculoskeletal stiffness, but there is a paucity of research examining the reliability of these techniques. Therefore, we investigated the reliability of vertical, leg, knee, and ankle stiffness during overground running and hopping in 20 active men. Participants were required to run on a 10 m overground runway at 3.83 m/s (actual; 3.35 ± 0.12 m/s) and to hop in place at 2.2 Hz (actual; 2.37 ± 0.03 Hz), and at a self-selected frequency (actual; 2.05 ± 0.12 Hz) and at 2.2 Hz (actual; 2.39 ± 0.04 Hz). Reliability was determined using the intraclass correlation coefficient, coefficient of variation, mean differences, and Cohen's effect sizes. There was good reliability for vertical stiffness, moderate reliability for leg stiffness, and poor reliability for knee and ankle stiffness during the running task. Similar results were observed during the 2.2 Hz hopping tasks, with good reliability displayed for vertical stiffness and poor reliability for ankle and knee stiffness. In conclusion, our results suggest that vertical stiffness is a reliable measure when running at 3.83 m/s and hopping at 2.2 Hz.

Agreement between force and deceleration measures during backward somersault landings.

This study examined the agreement between force platform and inertial measurement unit (IMU) measures of backward somersault landings. Seven female gymnasts performed three trials, taking off from a 90 cm vaulting box and using competition landing technique. Two force platforms (1000 Hz) covered with a 6.4 cm thick carpeted landing surface measured the ground reaction forces. One inertial measurement unit (500 Hz) fixed on the second thoracic vertebra measured peak resultant deceleration of the gymnast. Measurement agreement between vertical and resultant peak force measures, and resultant peak force and peak deceleration was assessed using mean differences, Pearson's correlation, and Cohen's effect size (ES) statistics. There was perfect measurement agreement between vertical and resultant peak forces (R = 1.0, p < 0.001; ES = 0.005), but only moderate measurement agreement between resultant peak force and peak resultant deceleration (Mean Difference = -2.16%, R = 0.4, p = ns; ES = 0.121). Backward somersault landings can be assessed using either uni-axial or tri-axial force platforms to measure ground impact load/force, as the landing movements are almost purely vertical. However, force measures are not the same as peak resultant decelerations from IMUs which give an indication of impact shock. Landing load/shock measures are potentially important for injury prevention.