Do guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review.

OBJECTIVES: To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. METHODS: Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE 'Guideline Quality Checklist', and mapping of the supporting evidence. RESULTS: Fifteen guidelines were identified: asthma (n=7) and type 1 diabetes mellitus (n=7), CF (n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration (n=15), chronic condition self-management education (n= 17), clinicians' skills (n= 4); personalized action plans (n=3), problem-solving (n=2); and the assessment of children's chronic condition self-management needs (n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool (n=2), and adolescence (n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines' recommendations was poor; only 14 out of 57 journals listed as evidence were concordant. DISCUSSION: Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools.

Reducing Nosocomial Infections in Surgical ICUs in Sri Lanka: Co-Creating a Safety Culture Using an eHealth Intervention.

Nosocomial infections are a major public health risk more prevalent among vulnerable patients in intensive care units of lower and lower-middle income countries. Despite advances in health care, the prevalence of nosocomial infections is alarming. The reasons for these infections are multifactorial and include organisational, cultural and individual factors. This paper discusses the findings associated with research undertaken in six surgical intensive care units in Sri Lanka to evaluate the impact of an eHealth system prototype in contributing to the improvement of hand hygiene compliance and thereby reduction of nosocomial infections. Key findings include the necessity of reconsidering the way of calculating nosocomial infection rates, the importance of coupling interventions to feedbacks on outcomes and the role of the leaders as role models in inculcating positive behaviours.

User Centred Design and Nosocomials in Surgical ICUs: A Mobile Application for Peer Monitoring and Training in Hand Hygiene.

Nosocomial infections are a global public health risk. In low and middle-income countries the problem is acute with very high infection rates commonly contributing to poor patient outcomes including mortality. Organisational, cultural, and individual factors have been identified in these high rates, with poor hand hygiene compliance amongst clinicians a major risk factor. New approaches to achieving clinician behaviour change are required. User-centred approaches have proven effective to engage and support changes in clinician behaviours through the use of electronic tools. This paper reports on the experience of co-designing and implementing a mobile application with clinicians to enhance hand hygiene compliance. The peer monitoring and training supported by the application aims to directly contribute to evidence on reductions in infection rates in two surgical ICUs in Sri Lanka.

Reducing Nosocomial Infections: A User-centered Approach to Developing an eHealth system for Sri Lankan ICUs.

Nosocomial infections are a health concern in hospitals both in developed and developing countries. Immuno-compromised patients in intensive care units (ICU) have been identified as being particularly vulnerable. However, despite numerous interventions, infection rates remain high and antibiotic resistance is now of global concern. In Sri Lanka, higher than anticipated infection rates appear linked to a range of factors including hierarchical work flow, poor surveillance feedback and health staff attitudes and awareness. By deploying a user-centered approach to understanding these factors this research-in-progress will develop and evaluate the capacity of an eHealth system to contribute to reduction of nosocomial infections in Sri Lankan ICUs.

Challenges in predicting health needs and disease patterns - a case study on the implementation of an electronic hospital separation record in Sri Lanka.

This paper presents analysis and insights arising from the pilot implementation of a national electronic hospital separation record system in Sri Lanka. The paper reveals that while a successful technical implementation has been achieved, numerous socio-technical challenges remain. The paper provides a tangible example of the difficulties faced by developing countries when being encouraged to rush to introduce national e-health systems. Critically, over-confidence in the accuracy, validity and inviolability of electronic data poses real challenges for local and national decision-making around prediction of disease patterns and health needs.