Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 5 Articles
There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in\nprehospital research due to the complex context, posing unique challenges for research, development, and evaluation.\nThe present paper argues for the potential of simulation for prehospital research, e.g., through the development of an\nadvanced simulation-based prehospital research laboratory. However, the prehospital context is different from other\nhealthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation\nwidth (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to\nsimulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between\nthese features and the prehospital research problems and context presents great potential to improve and\nfurther prehospital research....
Background:Effective medications for treating alcohol use disorders (AUD) are available but underutilized. Multiple\nbarriers to their provision have been identified, and optimal strategies for addressing and overcoming barriers to use\nof medications for AUD treatment remain elusive. We conducted a structured review of published care delivery and\nimplementation studies evaluating interventions that aimed to increase medication treatment for patients with AUD\nto identify interventions and component strategies that were most effective.\nMethods:We reviewed literature through May 2018 and used networking to identify intervention studies with AUD\nmedication receipt reported as a primary or secondary outcome. Studies were identified as care delivery studies,\ncharacterized by patient-level recruitment and willingness to be randomized to candidate treatment options, and\nimplementation studies, characterized by inclusion of all patients treated at sites involved in the study. Each identified\nstudy was independently coded by two investigators for strategies used, guided by a published taxonomy of\nimplementation strategies. All authors reviewed coding discrepancies and revised codes based on consensus. After\nreaching internal consensus, we solicited feedback from lead investigators on studies to code additional strategies.\nWe reviewed implementation strategies used across studies to assess their relationship with medication receipt, as\nwell as alcohol use outcomes, as available.\nResults:Nine studies were identified: four RCTs of care delivery interventions, four quasi-experimental evaluations of\nlarge-scale implementation interventions, and one quasi-experimental evaluation of a targeted single-site implementation\nintervention. Implementation strategies used were variable across studies; no strategy was universally used.\nEffects of the interventions on receipt of AUD pharmacotherapy and alcohol use outcomes also varied. Three of four\ncare delivery interventions resulted in increased receipt of AUD medications, but only one of these three improved\nalcohol use outcomes. One large-scale and one single-site implementation intervention were associated with\nincreased AUD medication receipt, and these studies did not assess alcohol use outcomes. Patterns of implementation\nstrategies did not clearly distinguish studies that successfully increased use of pharmacotherapy versus those\nthat did not.\nConclusions:Our review did not reveal strategies most effective for implementing AUD medications. Interventions\ndesigned to overcome identified barriers may have missed the mark, or differences in the intensity or targets of strategies\nmay matter more than differences in strategies. Further research is needed to understand effective implementation\nmethods and to better understand patient-level perspective, preferences and barriers to receipt of medications....
Background:Treatment for opioid use disorder (OUD) is highly effective, yet it remains dramatically underutilized.\nIndividuals with OUD have disproportionately high rates of hospitalization and low rates of addiction treatment. Hospital-\nbased addiction consult services offer a potential solution by using multidisciplinary teams to evaluate patients,\ninitiate medication for addiction treatment (MAT) in the hospital, and connect patients to post-discharge care. We\nare studying the effectiveness of an addiction consult model [Consult for Addiction Treatment and Care in Hospitals\n(CATCH)] as a strategy for engaging patients with OUD in treatment as the program rolls out in the largest municipal\nhospital system in the US. The primary aim is to evaluate the effectiveness of CATCH in increasing post-discharge initiation\nand engagement in MAT. Secondary aims are to assess treatment retention, frequency of acute care utilization\nand overdose deaths and their associated costs, and implementation outcomes.\nMethods:A pragmatic trial at six hospitals, conducted in collaboration with the municipal hospital system and\ndepartment of health, will be implemented to study the CATCH intervention. Guided by the RE-AIM evaluation\nframework, this hybrid effectiveness-implementation study (Type 1) focuses primarily on effectiveness and also measures\nimplementation outcomes to inform the interventionâ??s adoption and sustainability. A stepped-wedge cluster\nrandomized trial design will determine the impact of CATCH on treatment outcomes in comparison to usual care\nfor a control period, followed by a 12-month intervention period and a 6- to 18-month maintenance period at each\nhospital. A mixed methods approach will primarily utilize administrative data to measure outcomes, while interviews\nand focus groups with staff and patients will provide additional information on implementation fidelity and barriers to\ndelivering MAT to patients with OUD.\nDiscussion:Because of their great potential to reduce the negative health and economic consequences of\nuntreated OUD, addiction consult models are proliferating in response to the opioid epidemic, despite the absence of\na strong evidence base. This study will provide the first known rigorous evaluation of an addiction consult model in a\nlarge multi-site trial and promises to generate knowledge that can rapidly transform practice and inform the potential\nfor widespread dissemination of these services...
Background: Access to trusted health information has contribution to improve maternal and child health\noutcomes. However, limited research to date has explored the perceptions of communities regarding credible\nmessenger and messaging in rural Ethiopia. Therefore, this study aimed to explore sources of trusted maternal\nhealth information and preferences for the mode of delivery of health information in Jimma Zone, Ethiopia; to\ninform safe motherhood implementation research project interventions.\nMethod: An exploratory qualitative study was conducted in three districts of Jimma Zone, southwest of Ethiopia, in\n2016. Twelve focus group discussions (FGDs) and twenty-four in-depth interviews (IDIs) were conducted among\npurposively selected study participants. FGDs and IDIs were conducted in the local language, and digital voice\nrecordings were transcribed into English. All transcripts were read comprehensively, and a code book was\ndeveloped to guide thematic analysis. Data were analyzed using Atlas.7.0.71 software.\nResult: Study Participants identified as Health Extension Workers (HEWs) and Health Development Army (HDA) as\ntrusted health messengers. Regarding communication channels, participants primarily favored face-to-face/\ninterpersonal communication channels, followed by mass media and traditional approaches like community\nconversation, traditional songs and role play.\nIn particular, the HEW home-to-home outreach program for health communication helped them to build trusting\nrelationships with community members; However, HEWs felt the program was not adequately supported by the\ngovernment.\nConclusion: Health knowledge transfer success depends on trusted messengers and adaptable modes. The\nfindings of this study suggest that HEWs are a credible messenger for health messaging in rural Ethiopia, especially\nwhen using an interpersonal message delivery approach. Therefore, government initiatives should strengthen the\nexisting health extension packages by providing in-service and refresher training to health extension workers....
Background and objectives: High mortality and healthcare costs area associated with\nventilator-associated pneumonia (VAP) due to Acinetobacter baumannii (A.baumannii). The data\nconcerning the link between multidrug-resistance of A.baumannii strains and outcomes remains\ncontroversial. Therefore, we aimed to identify the relation of risk factors for ventilator -associated\npneumonia (VAP) and mortality with the drug resistance profiles of Acinetobacter baumannii\n(A.baumannii) and independent predictors of in-hospital mortality. Methods: A retrospective ongoing\ncohort study of 60 patients that were treated for VAP due to drug-resistant A.baumannii in medicalsurgical\nintensive care units (ICU) over a two-year period was conducted. Results: The proportions\nof multidrug-resistant (MDR), extensively drug-resistant (XDR), and potentially pandrug-resistant\n(pPDR) A.baumannii were 13.3%, 68.3%, and 18.3%, respectively. The SAPS II scores on ICU\nadmission were 42.6, 48.7, and 49 (p = 0.048); hospital length of stay (LOS) prior to ICU was 0, one,\nand two days (p = 0.036), prior to mechanical ventilation (MV)-0, 0, and three days (p = 0.013), and\ncarbapenem use prior to VAP-50%, 29.3%, and 18.2% (p = 0.036), respectively. The overall inhospital\nmortality rate was 63.3%. In MDR, XDR, and pPDR A.baumannii VAP groups, it was 62.5%,\n61.3%, and 72.7% (p = 0.772), respectively. Binary logistic regression analysis showed that female\ngender (95% OR 5.26; CI: 1.21â??22.83), SOFA score on ICU admission (95% OR 1.28; CI: 1.06â??1.53)\nand RBC transfusion (95% OR 5.98; CI: 1.41â??25.27) were all independent predictors of in-hospital\nmortality. Conclusions: The VAP risk factors: higher SAPS II score, increased hospital LOS prior to\nICU, and MV were related to the higher resistance profile of A.baumannii. Carbapenem use was\nfound to be associated with the risk of MDR A.baumannii VAP. Mortality due to drug-resistant\nA.baumannii VAP was high, but it was not associated with the A.baumannii resistance profile. Female\ngender, SOFA score, and RBC transfusion were found to be independent predictors of in -hospital\nmortality....
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