'This has given me the peace of mind I needed': ethnographic insights into Barrett's oesophagus screening using the capsule sponge test.

In 2021 and 2022, researchers carried out an implementation trial that considered how the capsule sponge test might be used to screen for Barrett's oesophagus using a mobile clinic in East Anglia. This paper offers insights from 15 months of ethnographic fieldwork studying the trial. It aims to highlight the value of the test in offering reassurance to worried patients, particularly to those with a family history of oesophageal adenocarcinoma. It also considers the variety of aims people held for the capsule sponge test, including the hope that it would address their symptoms of acid reflux, and the conflict that sometimes emerged as a result. The second half of the paper uses fieldwork carried out in virtual support groups for people with Barrett's oesophagus to explore experiences postdiagnosis, which sometimes were defined by fear of future cancers. It describes notable differences between the care offered to people with morphological risk conditions like Barrett's oesophagus and the care given to those with genetic risk conditions, including the provision of genetic counselling. More broadly, the paper highlights a tension between patient-centred and risk-centred medicine that is likely to grow as healthcare services continue to shift towards preventative approaches.

The Role of Robotics in Meeting Institutional Goals: A Unified Strategy to Facilitate Program Excellence.

PURPOSE: The rapid expansion of robotic surgical equipment necessitates a review of the needs and challenges faced by hospitals introducing robots for the first time to compete with experienced institutions. The aim of this study was to analyze the impact of robotic surgery on our hospital compared to open and laparoscopic surgery, examine internal transformations, and assess regional, domestic, and international implications. METHODS: A retrospective review was conducted of electronic medical records (EMRs) from 2019 to 2022 at Inha University Hospital, including patients who underwent common robotic procedures and equivalent open and laparoscopic operations. The study investigated clinical and operational performance changes in the hospital after the introduction of robotic technology. It also evaluated the operational effectiveness of robot implementation in local, national, and international contexts. To facilitate comparison with other hospitals, the data were transmitted to Intuitive Surgical, Inc. for analysis. The study was conducted in compliance with domestic personal information regulations and received approval from our Institutional Review Board. RESULTS: We analyzed EMR data from 3,147 patients who underwent surgical treatment. Over a period of 3.5 years, the adoption of robotic technology in a hospital setting significantly enhanced the technical skills of all professors involved. The introduction of robotic systems led to increased patient utilization of conventional surgical techniques, as well as a rise in the number of patients choosing robotic surgery. This collective trend contributed to an overall increase in patient numbers. This favorable evaluation of the operational effectiveness of our hospital's robot implementation in the context of local, national, and global factors is expected to positively influence policy changes. CONCLUSION: Stakeholders should embrace data science and evidence-based techniques to generate valuable insights from objective data, assess the health of robot-assisted surgery programs, and identify opportunities for improvement and excellence.

Dutch Translation and Psychometric Evaluation of the Person-Centered Primary Care Measure.

PURPOSE: Person-centered care is foundational to good quality primary care and has positive effects on health outcomes and patient satisfaction. The Person-Centered Primary Care Measure (PCPCM) is a recently developed, patient-reported survey able to assess person-centeredness and has demonstrated strong validity and reliability. Little is known, however, about the feasibility of the PCPCM in non-English-speaking settings. We aimed to translate the questionnaire into Dutch, psychometrically evaluate the translated version, and ensure its feasibility for patients in Dutch primary care. METHODS: We translated the PCPCM into Dutch using forward-backward translations. We conducted psychometric evaluations to ensure its feasibility among Dutch-speaking primary care patients, with special attention to low literacy populations. Next, we assessed structural validity, convergent validity using the Quality of Care Through the Patient's Eyes (QUOTE) questionnaire, and internal consistency in a cross-sectional study in primary care. RESULTS: Translation and adaptation for low literacy populations required 4 iterations. In 4 general practices, 205 patients completed the survey. Confirmatory factor analyses could not confirm the 1-factor solution. The 3-factor solution was found to be a more optimal fit: comprehensiveness of care, personal relation, and contextual care. Internal reliability was high (Cronbach's α were 0.82, 0.73, and 0.86, respectively). We found a strong correlation between the total PCPCM and QUOTE scores (Spearman's ρ = 0.65, P <.001), indicating good convergent validity. CONCLUSION: The Dutch version of the PCPCM has acceptable validity and reliability for measuring person-centeredness in primary care among Dutch-speaking populations including those with low literacy.

A Cross-Sectional Study on the Assessment of Service Quality and User Satisfaction of a Community Support Program in a Region of Taiwan.

This study aims to assess the service quality and user satisfaction of a community support program (CSP) in a specific administrative region of Taiwan. Employing a cross-sectional design, data were collected from 450 CSP users in the region via a questionnaire. Statistical analyses, including descriptive analysis, ANOVA, and Scheffe's Test, were conducted using SPSS 22.0. The findings reveal that users aged 70-79 years with primary education, as well as those with demand or unknown demand for long-term care, reported the highest level of satisfaction with CSP services (mean = 4.5, SD = 0.7, p < 0.05). The study underscores the influence of user characteristics and their understanding of the services on satisfaction levels. These insights provide clear direction for policymakers in shaping the future of CSPs, emphasizing the importance of addressing user needs and enhancing awareness and the utilization of available services.

Patients' and specialists' perspectives on health care quality and on people living with HIV health-related quality of life in Spain: a cross-sectional survey.

Spain was close to meeting the 90-90-90-treatment target set by UNAIDS. However, data on health care quality regarding people with HIV and their health-related quality of life (HRQoL) after the COVID-19 pandemic onset is scarce. By considering the perspective of people with HIV and HIV specialists, we aimed to determine some aspects of the quality of care in Spain, such as access to health resources or satisfaction with primary and speciality care, and assess people with HIV health-related quality of life. Ex post facto cross-sectional surveys were administered to 502 people with HIV and 101 HIV clinicians. Unmet needs related to healthcare system and healthcare resources access and to antiretroviral treatment administered by hospital pharmacies were detected. There was also room for improvement in the primary care service delivery and in various aspects concerning people's with HIV HRQoL. About one-fourth of them experienced stigmatisation in the healthcare setting, which was significantly related to HRQoL. Women, heterosexual participants and those with problems accessing the healthcare system scored poorer in the HRQoL scales. Moreover, according to our data, HIV specialists did not seem to be fully aware of patients' with HIV needs and overestimated their HRQoL.

Correlation Between Hospital Rates of Survival to Discharge and Long-term Survival for In-hospital Cardiac Arrest: Insights from Get With The Guidelines®-Resuscitation Registry.

AIM: Given challenges in collecting long-term outcomes for survivors of in-hospital cardiac arrest (IHCA), most studies have focused on in-hospital survival. We evaluated the correlation between a hospital's risk-standardized survival rate (RSSR) at hospital discharge for IHCA with its RSSR for long-term survival. METHODS: We identified patients ≥65 years of age with IHCA at 472 hospitals in Get With The Guidelines®-Resuscitation registry during 2000-2012, who could be linked to Medicare files to obtain post-discharge survival data. We constructed hierarchical logistic regression models to compute RSSR at discharge, and 30-day, 1-year, and 3-year RSSRs for each hospital. The association between in-hospital and long-term RSSR was evaluated with weighted Kappa coefficients. RESULTS: Among 56,231 Medicare beneficiaries (age 77.2±7.5 years and 25,206 [44.8%] women), 10,536 (18.7%) survived to discharge and 8,485 (15.1%) survived to 30 days after discharge. Median in-hospital, 30-day, 1-year, and 3-year RSSRs were 18.6% (IQR, 16.7%-20.4%), 14.9% (13.2%-16.7%), 10.3% (9.1%-12.1%), and 7.6% (6.8%-8.8%), respectively. The weighted Kappa coefficient for the association between a hospital's RSSR at discharge with its 30-day, 1-year, and 3-year RSSRs were 0.72 (95% CI, 0.68-0.76), 0.56 (0.50-0.61), and 0.47 (0.41-0.53), respectively. CONCLUSIONS: There was a strong correlation between a hospital's RSSR at discharge and its 30-day RSSR for IHCA, although this correlation weakens over time. Our findings suggest that a hospital's RSSR at discharge for IHCA may be a reasonable surrogate of its 30-day post-discharge survival and could be used by Medicare to benchmark hospital performance for this condition without collecting 30-day survival data.

Experience of care from the perspectives of inpatients with palliative care needs: a cross-sectional study using a patient reported experience measure (PREM).

BACKGROUND: Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement. METHODS: Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis. RESULTS: One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment. CONCLUSION: Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research.

Allied health assistant management of people with hip fracture is feasible and may improve patient adherence to hip fracture mobilisation guidelines: a feasibility randomised controlled trial.

OBJECTIVES: Determine the feasibility of allied health assistant (AHA) management of people with hip fracture an acute hospital. DESIGN: Assessor-blind, parallel, feasibility randomised controlled trial with qualitative component. SETTING: Acute orthopaedic ward. PARTICIPANTS: People with surgically-managed hip fracture, who walked independently pre-fracture and had no cognitive impairment. INTERVENTIONS: Rehabilitation from an AHA, under the supervision of a physiotherapist, compared with rehabilitation from a physiotherapist. MAIN OUTCOME MEASURES: Feasibility was evaluated according to focus areas of demand, acceptability, practicality and implementation. Secondary outcomes included estimates of effect of adherence to hip fracture mobilisation guidelines, discharge destination, 30-day readmission, functional activity, and length of stay. RESULTS: Fifty people were allocated to receive rehabilitation from an AHA (n = 25) or physiotherapist (n = 25). AHA rehabilitation had high demand with 60% of eligible participants recruited. Satisfaction with AHA rehabilitation was comparable with physiotherapy rehabilitation (acceptability). The AHA group received an average of 11 min (95% CI 4 to 19) more therapy per day than the physiotherapy group (implementation). The AHA group may have had lower cost of acute care (MD -$3 808 95% CI -7 651 to 35) and adverse events were comparable between groups (practicality). The AHA group may have been 22% (HR 1.22, 95% CI 0.92 to 1.61) more likely to walk on any day and may have had a shorter length of stay (MD -0.8 days, 95% CI -2.3 to 0.7). CONCLUSIONS: AHA management of patients with hip fracture was feasible and may improve adherence to mobilisation guidelines and reduce cost of care and length of stay. CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12620000877987. CONTRIBUTION OF THE PAPER.

A single harmonised pharmacy process to improve clinical trial set-up times.

The UK has fallen from fourth to 10th place in the global ranking for clinical trial activities in the past 6 years. Due to the limited capacity of the clinical trial pharmacy workforce and delays in providing pharmacy approvals, pharmacy has been identified as one of the constraining services that delays the set-up and delivery of clinical trials. To tackle this problem, we developed a single pharmacy review process for multicentre trials across Greater Manchester (GM) and tested its feasibility and implementation in our region. A survey completed by each GM Trust suggests that this harmonised pharmacy review process for multicentre studies would expedite trial set-up time at each pharmacy site and standardise the pharmacy review process in GM. We therefore believe that this harmonised review process could potentially reduce pharmacy set-up time and reposition the UK in the global market for clinical trials.

The effect of support surface on the prevention of pressure injury in acute care settings: A multi-center prospective observational study.

PURPOSE: This study aimed to analyze if a multi-foam core mattress with a laminated cover can reduce the incidence of pressure injuries, compared to an alternating air mattress overlay among critically ill patients in acute settings. DESIGN: Prospective observational study. PARTICIPANTS: and setting: Patients with a Braden scale score ≤16 on intensive care unit admission at five general hospitals in Korea were included in this study between February 2022 and March 2022. METHODS: One hundred and twenty patients in acute settings were enrolled and categorized into two groups: a multi-form core mattress with a laminated cover group (n = 60) and an alternating air mattress overlay group (n = 60). Data were collected for 7 days by wound care nurses. RESULTS: Pressure injury developed at a significantly lower rate in the multi-form core mattress with a laminated cover group (n = 4/60, 6.7 %) than in the alternating air mattress overlay group (n = 25/60, 25.0 %) (P = 0.011). Using a multi-foam core mattress with a laminated cover demonstrated a protective effect against pressure injuries (odds ratio 0.123, 95 % confidence interval 0.024-0.620, P = 0.011). CONCLUSIONS: A multi-foam core mattress with a laminated cover was significantly more effective than an alternating air mattress overlay in preventing pressure injury in critically ill patients.

Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community.

Background: Globally, much work has been done by nonprofit, private, and academic groups to develop best practices for the care of people living with dementia (PLWD), including Alzheimer's disease. However, these best practices reside in disparate repositories and tend to focus on one phase of the patient journey or one relevant group. Objective: To fill this gap, we developed a Dementia Ideal Care Map that everyone in the dementia ecosystem can use as an actionable tool for awareness, policy development, funding, research, training, service delivery, and technology design. The intended audience includes (and not limited to) policymakers, academia, industry, technology developers, health system leaders, clinicians, social service providers, patient advocates, PLWD, their families, and communities at large. Methods: A search was conducted for published dementia care best practices and quality measures, which were then summarized in a visual diagram. The draft diagram was analyzed to identify barriers to ideal care. Then, additional processes, services, technologies, and quality measures to overcome those challenges were brainstormed. Feedback was then obtained from experts. Results: The Dementia Ideal Care Map summarizes the ecosystem of over 200 best practices, nearly 100 technology enablers, other infrastructure, and enhanced care pathways in one comprehensive diagram. It includes psychosocial interventions, care partner support, community-based organizations; awareness, risk reduction; initial detection, diagnosis, ongoing medical care; governments, payers, health systems, businesses, data, research, and training. Conclusions: Dementia Ideal Care Map is a practical tool for planning and coordinating dementia care. This visualized ecosystem approach can be applied to other conditions.

Refining quality measures for electrodiagnostic testing in suspected carpal tunnel syndrome to account for acceptable variations in practice: Expert review process.

INTRODUCTION/AIMS: Using a set of process-of-care quality measures for electrodiagnostic testing in suspected carpal tunnel syndrome (CTS), the research team previously documented large variations in electrodiagnostic testing practices and adherence to quality measures. This study sought to enhance the applicability and validity of the quality measures by integrating acceptable variations in testing practices. METHODS: We recruited 13 expert electrodiagnostic medicine specialists from five specialty societies. The experts iteratively refined five quality measures, and then rated the validity of the refined quality measures (1-9 scale). During this process, the experts reviewed data on adherence to existing quality measures and variations in electrodiagnostic testing practices, and considered recently published quality measures from the American Association of Neuromuscular and Electrodiagnostic Medicine. RESULTS: Three quality measures (electrodiagnostic testing before surgery for CTS, temperature assessment during electrodiagnostic testing, and electrodiagnostic criteria for severe median neuropathy) underwent few refinements and were rated valid (medians 8-9). Two measures (essential components of electrodiagnosis, criteria for interpreting electrodiagnostic tests as median neuropathy) were judged valid (medians 8) after revisions. For these measures, experts' ratings on the recommended components of sensory or mixed nerve conduction studies varied: agreement among the experts about the use of sensory peak latency was greater than for onset latency or sensory velocity. DISCUSSION: This study produced quality measures that provide minimum standards for electrodiagnostic testing for suspected CTS that are more comprehensive and nuanced than prior versions. Future work can assess the feasibility, reliability, and validity of these refined measures in diverse physician practices.

Inpatient Hospice Care in Korea during the COVID-19 Pandemic: A Preliminary Study.

Purpose: This study examined the quality of life (QoL) and quality of care (QoC) in inpatient hospice settings in Korea before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Data were obtained from three institutions that participated in two prospective cohort studies. The primary outcomes measured were the QoL of patients with terminal cancer and their family caregivers (FCs), as well as the QoC as perceived by the FCs. Results: Multivariable regression analysis revealed that during the COVID-19 pandemic, both patients and FCs experienced better QoL than before the pandemic, and FCs reported a higher QoC. Conclusion: Health policymakers should consider our findings when planning for future pandemics.

Assessing regional disparities and vulnerability in stroke care across Gyeonggi Province: A focus on hospital service areas.

BACKGROUND: This study aims to illuminate regional disparities and identify vulnerable areas in stroke care across Gyeonggi Province's hospital service areas. METHODS: Using data from the Korea National Cardio-cerebrovascular Disease Management Commission, we included 4,427 acute stroke patients admitted in 2018 to hospitals within Gyeonggi Province. Our evaluation focused on: 1) stroke care quality indicators, including rates of defect-free care, intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and acute reperfusion therapy (either IVT or EVT); 2) intra-regional treatment rates; and 3) one-year mortality across the province and its 12 hospital service areas. These were compared both with national averages and inter-regionally. Vulnerable areas were pinpointed by evaluating the number of quality indicators falling below the national average and through visual distribution mapping, categorizing each indicator into higher (ranks 1-4), middle (ranks 5-8), and lower (ranks 9-12) tiers. RESULTS: Despite fewer qualified stroke centers and specialists, Gyeonggi Province exhibited higher defect-free care rates (84.6 % vs. 80.7 %), intra-regional treatment rates (57.8 % vs. 51.0 %), and marginally lower one-year mortality (16.2 % vs. 17.3 %) compared to national averages. Notable regional disparities were observed; the highest-performing areas for defect-free care and acute reperfusion therapy exceeded the lowest by 1.4 and 3.3 times, respectively. Nine out of twelve areas fell below the national average for EVT rates, seven for IVT and reperfusion therapy rates, and five for intra-regional treatment rates. Pyeongtaek, with all stroke care quality indicators below the national average coupled with the highest one-year mortality, emerges as a critical area needing improvement in acute stroke care. CONCLUSION: This study not only exposes the regional disparities in stroke care within Gyeonggi Province's hospital service areas but also identifies areas most vulnerable. Consequently, a customized support strategy for these areas is imperative.

Impact of digital health on the quadruple aims of healthcare: A correlational and longitudinal study (Digimat Study).

BACKGROUND: Digital healthcare aims to deliver on the quadruple aim: enhance patient experiences, improve population health, reduce costs and improve provider experiences. Despite large investments, it is unclear how advancing digital health enables these healthcare aims. OBJECTIVE: Our objectives were to: 1) measure the correlation between digital capability and health system outcomes mapped to the quadruple aim, and 2) measure the longitudinal impact of electronic medical record implementations upon health system outcomes. MATERIALS AND METHODS: We undertook two studies: 1) Digital health correlational study investigating the association among healthcare system capability and healthcare aims, and 2) Digital hospital longitudinal study investigating outcomes pre and post electronic medical record implementation. RESULTS: Digital health capability was associated with lower staff turnover. Digitising healthcare services was associated with decreased medication errors, decreased nosocomial infections, increased hospital activity, and a transient increase in staff leave. DISCUSSION: These results suggest positive impacts on the population health and healthcare costs aim, minimal impacts on the provider experience aim and no observed impacts to the patient experience aim. CONCLUSION: These findings should provide confidence to healthcare decision-makers investing in digital health.

Effect of the COVID-19 pandemic on clinical characteristics and outcomes of adult pneumococcal meningitis patients - a Dutch prospective nationwide cohort study.

PURPOSE: To investigate clinical characteristics and outcomes of patients with pneumococcal meningitis during the COVID-19 pandemic. METHODS: In a Dutch prospective cohort, risk factors and clinical characteristics of pneumococcal meningitis episodes occurring during the COVID-19 pandemic (starting March 2020) were compared with those from baseline and the time afterwards. Outcomes were compared with an age-adjusted logistic regression model. RESULTS: We included 1,699 patients in 2006-2020, 50 patients in 2020-2021, and 182 patients in 2021-2023. After March 2020 relatively more alcoholism was reported (2006-2020, 6.1%; 2020-2021, 18%; 2021-2023, 9.7%; P = 0.002) and otitis-sinusitis was less frequently reported (2006-2020, 45%; 2020-2021, 22%; 2021-2023, 47%; P = 0.006). Other parameters, i.e. age, sex, symptom duration or initial C-reactive protein level, remained unaffected. Compared to baseline, lumbar punctures were more frequently delayed (on admission day, 2006-2020, 89%; 2020-2021, 74%; 2021-2022, 86%; P = 0.002) and outcomes were worse ('good recovery', 2020-2021, OR 0.5, 95% CI 0.3-0.8). CONCLUSION: During the COVID-19 pandemic, we observed worse outcomes in patients with pneumococcal meningitis. This may be explained by differing adherence to restrictions according to risk groups or by reduced health care quality.