National Development and Implementation of a Democratized Disruptive Behavior Reporting System in Health Care.

INTRODUCTION: Workplace disruptive behavior/ violence (WDBV) is underreported in health care. This study evaluated a 7-year implementation of the Disruptive Behavior Reporting System (DBRS), the most robust consolidated WDBV reporting system developed in the United States within the Veterans Health Administration (VHA). METHODS: After implementation of the system, implementation success was measured in real time by number of reports, types of staff entering reports, time to review the reports and time between when the incident occurred and report entry. RESULTS: Over the seven years since implementation, there has been a significant increase in reporting within DBRS with more than 50,000 reports in fiscal year (FY) 2021 up from 0 to 2014. Types of staff reporting increased to 67 from 54. The median number of days to review events in FY19 Q2 was 4.79 days and the report latency has almost completely disappeared. DISCUSSION: DBRS was designed to democratize reporting so staff can report WDBV anytime and anywhere playing a large role in the successful implementation. The increase in total number of reported events is an indication of the success of the system as it captures data historically lost due to underreporting. CONCLUSION: DBRS development and implementation showcases how information systems can empower front-line personnel to voice behavioral safety concerns.

Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020.

INTRODUCTION: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. PATIENTS AND METHODS: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. RESULTS: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90-4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63-26.43) per 100,000 and 17.14% (95% CI: 12.98-21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96-9.77) per 100,000 and 6.91% (95% CI: 5.15-8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. CONCLUSION: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.

Primary stroke prevention worldwide: translating evidence into action.

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.

Development, implementation and user experience of the Veterans Health Administration (VHA) dialysis dashboard.

BACKGROUND: Adults with end-stage renal disease (ESRD) requiring chronic dialysis continue to suffer from poor health outcomes and represent a population rightfully targeted for quality improvement. Electronic dashboards are increasingly used in healthcare to facilitate quality measurement and improvement. However, detailed descriptions of the creation of healthcare dashboards are uncommonly available and formal inquiry into perceptions, satisfaction, and utility by clinical users has been rarely conducted, particularly in the context of dialysis care. Therefore, we characterized the development, implementation and user experience with Veterans Health Administration (VHA) dialysis dashboard. METHODS: A clinical-quality dialysis dashboard was implemented, which displays clinical performance measures (CPMs) for Veterans with ESRD receiving chronic hemodialysis at all VHA facilities. Data on user experience and perceptions were collected via an e-mail questionnaire to dialysis medical directors and nurse managers at these facilities. RESULTS: Since 2016 the dialysis dashboard reports monthly on CPMs for approximately 3000 Veterans receiving chronic hemodialysis across 70 VHA dialysis facilities. Of 141 dialysis medical directors and nurse managers, 61 completed the questionnaire. Sixty-six percent of respondents did not find the dashboard difficult to access, 64% agreed that it is easy to use, 59% agreed that its layout is good, and the majority agreed that presentation of data is clear (54%), accurate (56%), and up-to-date (54%). Forty-eight percent of respondents indicated that it helped them improve patient care while 12% did not. Respondents indicated that they used the dialysis dashboard for clinical reporting (71%), quality assessment/performance improvement (QAPI) (62%), and decision-making (23%). CONCLUSIONS: Most users of the VHA dialysis dashboard found it accurate, up-to-date, easy to use, and helpful in improving patient care. It meets diverse user needs, including administrative reporting, clinical benchmarking and decision-making, and quality assurance and performance improvement (QAPI) activities. Moreover, the VHA dialysis dashboard affords national-, regional- and facility-level assessments of quality of care, guides and motivates best clinical practices, targets QAPI efforts, and informs and promotes population health management improvement efforts for Veterans receiving chronic hemodialysis.

Projected climate and agronomic implications for corn production in the Northeastern United States.

Corn has been a pillar of American agriculture for decades and continues to receive much attention from the scientific community for its potential to meet the food, feed and fuel needs of a growing human population in a changing climate. By midcentury, global temperature increase is expected to exceed 2°C where local effects on heat, cold and precipitation extremes will vary. The Northeast United States is a major dairy producer, corn consumer, and is cited as the fastest warming region in the contiguous U.S. It is important to understand how key agronomic climate variables affect corn growth and development so that adaptation strategies can be tailored to local climate changes. We analyzed potential local effects of climate change on corn growth and development at three major dairy locations in the Northeast (Syracuse, New York; State College, Pennsylvania and Landisville, Pennsylvania) using downscaled projected climate data (2000-2100) from nine Global Climate Models under two emission pathways (Representative Concentration Pathways (RCP) 4.5 and 8.5). Our analysis indicates that corn near the end of the 21st century will experience fewer spring and fall freezes, faster rate of growing degree day accumulation with a reduction in time required to reach maturity, greater frequencies of daily high temperature ≥35°C during key growth stages such as silking-anthesis and greater water deficit during reproductive (R1-R6) stages. These agronomic anomalies differ between the three locations, illustrating varying impacts of climate change in the more northern regions vs. the southern regions of the Northeast. Management strategies such as shifting the planting dates based on last spring freeze and irrigation during the greatest water deficit stages (R1-R6) will partially offset the projected increase in heat and drought stress. Future research should focus on understanding the effects of global warming at local levels and determining adaptation strategies that meet local needs.

Lack of glyphosate resistance gene transfer from Roundup Ready soybean to Bradyrhizobium japonicum under field and laboratory conditions.

A field study was conducted at the Russell E. Larson Agricultural Research Center to determine the effect of transgenic glyphosate-resistant soybean in combination with herbicide (Roundup) application on its endosymbiont Bradyrhizobium japonicum. DNA of bacteroids from isolated nodules was analysed for the presence of the transgenic 5-enolpyruvylshikimate-3-phosphate synthase (CP4-EPSPS) DNA sequence using polymerase chain reaction (PCR). To further assess the likelihood that the EPSPS gene may be transferred from the Roundup Ready (RR) soybean to B. japonicum, we have examined the natural transformation efficiency of B. japonicum strain 110spc4. Analyses of nodules showed the presence of the transgenic EPSPS DNA sequence. In bacteroids that were isolated from nodules of transgenic soybean plants and then cultivated in the presence of glyphosate this sequence could not be detected. This indicates that no stable horizontal gene transfer (HGT) of the EPSPS gene had occurred under field conditions. Under laboratory conditions, no natural transformation was detected in B. japonicum strain 110spc4 in the presence of various amounts of recombinant plasmid DNA. Our results indicate that no natural competence state exists in B. japonicum 110spc4. Results from field and laboratory studies indicate the lack of functional transfer of the CP4-EPSPS gene from glyphosate-tolerant soybean treated with glyphosate to root-associated B. japonicum.