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Using existing data from clinical registries to support clinical trials and other prospective studies has the potential to improve research efficiency. However, little has been reported about staff experiences and lessons learned from implementation of this method in pediatric cardiology.
We describe the process of using existing registry data in the Pediatric Heart Network Residual Lesion Score Study, report stakeholders’ perspectives, and provide recommendations to guide future studies using this methodology.
The Residual Lesion Score Study, a 17-site prospective, observational study, piloted the use of existing local surgical registry data (collected for submission to the Society of Thoracic Surgeons-Congenital Heart Surgery Database) to supplement manual data collection. A survey regarding processes and perceptions was administered to study site and data coordinating center staff.
Survey response rate was 98% (54/55). Overall, 57% perceived that using registry data saved research staff time in the current study, and 74% perceived that it would save time in future studies; 55% noted significant upfront time in developing a methodology for extracting registry data. Survey recommendations included simplifying data extraction processes and tailoring to the needs of the study, understanding registry characteristics to maximise data quality and security, and involving all stakeholders in design and implementation processes.
Use of existing registry data was perceived to save time and promote efficiency. Consideration must be given to the upfront investment of time and resources needed. Ongoing efforts focussed on automating and centralising data management may aid in further optimising this methodology for future studies.
Sex-specific diagnostic cut-offs may improve the test characteristics of high-sensitivity troponin assays for the diagnosis of myocardial infarction (MI). The objective of this study was to quantify test characteristics of sex-specific cut-offs of a single, high-sensitivity cardiac troponin T (hs-cTnT) assay for 7-day MI in patients with chest pain.
This observational cohort study included consecutive emergency department (ED) patients with suspected cardiac chest pain from four Canadian EDs who had an hs-cTnT assay performed within 60 minutes of ED arrival. The primary outcome was MI at 7 days. We quantified test characteristics (sensitivity, negative predictive value [NPV], likelihood ratios and proportion of patients ruled out) for multiple combinations of sex-specific, rule-out cut-offs. We calculated the net reclassification index compared to universal rule-out cut-offs.
In 7,130 patients (3,931 men and 3,199 women), the 7-day MI incidence was 7.38% among men and 3.78% among women. Optimal sex-specific cut-offs (<8 ng/L for men and <7 ng/L for women) had a 98.5% sensitivity for MI and ruled out MI in 55.8% of patients. This would enable an absolute increase in the proportion of patients who were able to be ruled out with a single hs-cTnT of 13.2% to 22.2%, depending on the universal rule-out concentration used as a comparator.
Sex-specific hs-cTnT cut-offs for ruling out MI at ED arrival may improve classification performance, enabling more patients to be safely ruled out at ED arrival. However, differences between sex-specific and universal cut-off concentrations are within the variation of the assay, limiting the clinical utility of this approach. These findings should be confirmed in other data sets.
Since the appearance of the two previous editions of Mental Health Outcome Measures (first published by Springer Verlag in 1996, with a second edition published by the Royal College of Psychiatrists in 2001), there have been several intriguing developments in the field. First, an even wider range of important outcome domains are now measurable using well standardised instruments than were measurable before. Second, a greater emphasis upon positive outcomes has evolved (for example referring to the concept of recovery) among researchers, service users and clinicians. Third, the voice of the service user/consumer is now centre stage to a much greater extent than in earlier years. This third edition refers to these three core themes throughout its pages. Nevertheless, the fundamentals remain unchanged, namely:
• the scales used must have known and strong psychometric properties (Chapter 2)
• evidence (both qualitative and quantitative) needs to be ascertained from the most rigorously scientifically designed studies (Chapter 3), taking into account the complexity of the intervention (Campbell et al, 2000, 2007; Tansella et al, 2006)
• in many outcome studies, symptom and social domains (such as quality of life and employment) need to be assessed concurrently (Chapters 5, 8, 9, 11, 13, 14 and 16)
• scales need to be applicable and relevant to a wide of settings to allow valid international comparisons (Chapter 17)
• an inclusive approach to the whole range of mental disorders is required, so that people are included whose conditions have sometimes been excluded from care, such as personality disorders (Chapter 15).
At the same time, a clear trend is now identifiable not so much to look at mental disorders in terms of their producing chronicity, impairment and severe disability but instead to emphasise the hope of recovery (Chapter 4). Central to this view is the participation of service users in research (Chamberlin, 2005) and a more nuanced approach to potential collaboration between people disclosing experience of mental illness, and others, in the development and use of outcome measures (Sweeney et al, 2009).
In this paper we consider Grassmannians in arbitrary characteristic. Generalizing Kapranov’s well-known characteristic-zero results, we construct dual exceptional collections on them (which are, however, not strong) as well as a tilting bundle. We show that this tilting bundle has a quasi-hereditary endomorphism ring and we identify the standard, costandard, projective and simple modules of the latter.
Using galvanostatic pulse deposition, we studied the factors influencing the quality of electroformed Bi1–xSbx nanowires with respect to composition, crystallinity, and preferred orientation for high thermoelectric performance. Two nonaqueous baths with different Sb salts were investigated. The Sb salts used played a major role in both crystalline quality and preferred orientations. Nanowire arrays electroformed using an SbI3-based chemistry were polycrystalline with no preferred orientation, whereas arrays electroformed from an SbCl3-based chemistry were strongly crystallographically textured with the desired trigonal orientation for optimal thermoelectric performance. From the SbCl3 bath, the electroformed nanowire arrays were optimized to have nanocompositional uniformity, with a nearly constant composition along the nanowire length. Nanowires harvested from the center of the array had an average composition of Bi0.75Sb0.25. However, the nanowire compositions were slightly enriched in Sb in a small region near the edges of the array, with the composition approaching Bi0.70Sb0.30.
This article examines the large interstate variation in levels of unconventional gas development in the U.S. states. The following hypotheses are advanced to predict whether a state will be predisposed toward development: (H1) the availability of unconventional gas reserves; (H2) the availability of infrastructure to support development; (H3) a recent history of conventional oil and gas development; (H4) Republican party control of the Governor's office and state legislature; (H5) relatively low sensitivity to environmental issues; (H6) regulatory systems that treat UGD as a variant of conventional gas development; (H7) a pressing need for economic benefits as indicated by state and local measures of household income, unemployment and poverty; (H8) and public opinion supportive of development. To various degrees, each of the hypotheses is supported but important exceptions and surprises are uncovered in the qualitative and semi-quantitative analyses. Future research should continue the effort to explain the variation of development by expanding the geographical scope of inquiry and enlarging the sample of jurisdictions.
The balanced care model proposes that a comprehensive mental health system needs to include both community-and hospital-based care. The model is based on a structured review of scientific evidence, and is also informed by the experience of experts active in mental health system change in many countries worldwide.
Contact precautions are a cornerstone of infection prevention but have also been associated with less healthcare worker (HCW) contact and adverse events. We studied how contact precautions modified HCW behavior in 4 acute care facilities.
Prospective cohort study.
Participants and Setting.
Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus.
Trained observers performed “secret shopper” monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods.
A total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions (2.78 vs 4.37 visits per hour; P< .001 ) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; P = .02). Patients on contact precautions tended to have fewer visitors (23.6% fewer; P = .08). HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions; P< .001).
Contact precautions were found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at exit, while exposing patients on contact precautions to less HCW contact, less visitor contact, and potentially other unintended outcomes.
If you don't know where you're going, any road will take you there.
Every commercial kitchen must operate using a sound basis for costing and control of raw materials such as food, cleaning, wages and overheads. The principles are the same whether the food service is run at a hospital, aged-care home, institution, take-away shop or restaurant. The capacity of a restaurant to make a profit, make a fair financial return on the investment and reward the effort involved is very much dependent upon effective control of the day-to-day running costs. Likewise, hospitals, aged-care facilities and other food services need to operate within strict financial budgets.
Effective cost control has been described as the identification and regulation of operating costs. These will be influenced by the style and systems of service to be offered. Food and labour costs make up the largest proportion of operating costs. In this chapter we examine food cost.
An acceptable budget for food is calculated by costing menus and recipes. This involves choosing suppliers carefully after reviewing all the options. Suppliers need to know the purchasing standards that are required for the food. These will describe quality, size, colour, fat content, age and origin (organic or halal, for example). Is the supplier able to offer continuity of supply at an acceptable price? Does the supplier stock a range of food items needed for the menu? Buying from a large number of suppliers makes it difficult to build relationships, takes time attending to deliveries and increases accounting costs.