Category: Nevin Manimala

BMJ Open Qual. 2024 Jun 10;13(2):e002731. doi: 10.1136/bmjoq-2023-002731.

ABSTRACT

OBJECTIVE: Our objective was to codesign, implement, evaluate acceptability and refine an optimised antenatal education session to improve birth preparedness.

DESIGN: There were four distinct phases: codesign (focus groups and codesign workshops with parents and staff); implementation of intervention; evaluation (interviews, questionnaires, structured feedback forms) and systematic refinement.

SETTING: The study was set in a single maternity unit with approximately 5500 births annually.

PARTICIPANTS: Postnatal and antenatal women/birthing people and birth partners were invited to participate in the intervention, and midwives were invited to deliver it. Both groups participated in feedback.

OUTCOME MEASURES: We report on whether the optimised session is deliverable, acceptable, meets the needs of women/birthing people and partners, and explain how the intervention was refined with input from parents, clinicians and researchers.

RESULTS: The codesign was undertaken by 35 women, partners and clinicians. Five midwives were trained and delivered 19 antenatal education (ACE) sessions to 142 women and 94 partners. 121 women and 33 birth partners completed the feedback questionnaire. Women/birthing people (79%) and birth partners (82%) felt more prepared after the class with most participants finding the content very helpful or helpful. Women/birthing people perceived classes were more useful and engaging than their partners. Interviews with 21 parents, a midwife focus group and a structured feedback form resulted in 38 recommended changes: 22 by parents, 5 by midwives and 11 by both. Suggested changes have been incorporated in the training resources to achieve an optimised intervention.

CONCLUSIONS: Engaging stakeholders (women and staff) in codesigning an evidence-informed curriculum resulted in an antenatal class designed to improve preparedness for birth, including assisted birth, that is acceptable to women and their birthing partners, and has been refined to address feedback and is deliverable within National Health Service resource constraints. A nationally mandated antenatal education curriculum is needed to ensure parents receive high-quality antenatal education that targets birth preparedness.

PMID:38858078 | DOI:10.1136/bmjoq-2023-002731

BMJ Open Qual. 2024 Jun 10;13(2):e002683. doi: 10.1136/bmjoq-2023-002683.

ABSTRACT

BACKGROUND: Patients determine quality of healthcare by their perception of the gap between the healthcare they experience/receive and that which they expect. This can be influenced by the ability of healthcare staff to adequately communicate information about the healthcare provided. This study assessed the level of relevance of meeting patients’ information needs with respect to their assessment of healthcare quality in a private hospital’s general outpatient department in Ghana.

DESIGN: Study design was cross-sectional using exit self-administered questionnaires among 390 outpatients. Healthcare quality was measured using a modified form of the Service Quality model gap analysis (gap between experience and expectations). A negative gap signifies unmet patient expectations. Microsoft Excel and Stata V.15.0 were used for analysis using t-test and multiple linear regression. A p value ≤0.05 denotes statistical significance.

FINDINGS: The mean percentage of patients’ expectations of quality of healthcare was 87.6% (SE 0.031), while patient experience was 86.0% (SE 0.029), with a significant negative gap of -0.08 (p<0.002). Their highest expectation of the quality of healthcare was for their information needs to be met, with a mean score of 4.44 (SE 0.03). Two of the four items under the information needs dimension that showed no statistically significant gaps were ‘saying all their problems’ (gap=0.00; p<0.9) and ‘explanation of treatment/medications’ (gap=0.01; p<0.6). Those with statistically significant negative gaps were ‘explanation of investigations and procedures’ (gap=-0.18; p<0.0001) and ‘explanation of the diagnoses’ (gap=-0.11; p<0.02), signifying unmet expectations.

CONCLUSIONS: The outpatient’s greatest need for quality healthcare in this study was for their information needs to be met. Providing information on patient diagnoses and investigations are the areas least likely to be adequately communicated to patients.

PMID:38858077 | DOI:10.1136/bmjoq-2023-002683

BMJ Open Qual. 2024 Jun 10;13(2):e002664. doi: 10.1136/bmjoq-2023-002664.

ABSTRACT

INTRODUCTION: Rapid response team (RRT) and code activation events occur relatively commonly in inpatient settings. RRT systems have been the subject of a significant amount of analysis, although this has been largely focused on the impact of RRT system implementation and RRT events on patient outcomes. There is reason to believe that the structured assessment of RRT and code events may be an effective way to identify opportunities for system improvement, although no standardised approach to event analysis is widely accepted. We developed and refined a protocolised system of RRT and code event review, focused on sustainable, timely and high value event analysis meant to inform ongoing improvement activities.

METHODS: A group of clinicians with expertise in process and quality improvement created a protocolised analytic plan for rapid response event review, piloted and then iteratively optimised a systematic process which was applied to all subsequent cases to be reviewed.

RESULTS: Hospitalist reviewers were recruited and trained in a methodical approach. Each reviewer performed a chart review to summarise RRT events, and collect specific variables for each case (coding). Coding was then reviewed for concordance, at monthly interdisciplinary group meetings and ‘Action Items’ were identified and considered for implementation. In any 12-month period starting in 2021, approximately 12-15 distinct cases per month were reviewed and coded, offering ample opportunities to identify trends and patterns.

CONCLUSION: We have developed an innovative process for ongoing review of RRT-Code events. The review process is easy to implement and has allowed for the timely identification of high value improvement opportunities.

PMID:38858076 | DOI:10.1136/bmjoq-2023-002664

Cold Spring Harb Perspect Biol. 2024 Jun 10:a041735. doi: 10.1101/cshperspect.a041735. Online ahead of print.

ABSTRACT

What drives the emergence of new species has fascinated biologists since Darwin. Reproductive barriers to gene flow are a key step in the formation of species, and recent advances have shed new light on how these are established. Genetic, genomic, and comparative techniques, together with improved theoretical frameworks, are increasing our understanding of the underlying mechanisms. They are also helping us forecast speciation and reveal the impact of human activity.

PMID:38858075 | DOI:10.1101/cshperspect.a041735

J Safety Res. 2024 Jun;89:64-82. doi: 10.1016/j.jsr.2024.01.010. Epub 2024 Feb 9.

ABSTRACT

INTRODUCTION: Crash data analyses based on accident datasets often do not include human-related variables because they can be hard to reconstruct from crash data. However, records of crash circumstances can help for this purpose since crashes can be classified considering aberrant behavior and misconduct of the drivers involved.

METHOD: In this case, urban crash data from the 10 largest Italian cities were used to develop four logistic regression models having the driver-related crash circumstance (aberrant behaviors: inattentive driving, illegal maneuvering, wrong interaction with pedestrian and speeding) as dependent variables and the other crash-related factors as predictors (information about the users and the vehicles involved and about road geometry and conditions). Two other models were built to study the influence of the same factors on the injury severity of the occupants of vehicles for which crash circumstances related to driver aberrant behaviors were observed and of the involved pedestrians. The variability between the 10 different cities was considered through a multilevel approach, which revealed a significant variability only for the inattention-related crash circumstance. In the other models, the variability between cities was not significant, indicating quite homogeneous results within the same country.

RESULTS: The results show several relationships between crash factors (driver, vehicle or road-related) and human-related crash circumstances and severity. Unsignalized intersections were particularly related to the illegal maneuvering crash circumstance, while the night period was clearly related to the speeding-related crash circumstance and to injuries/casualties of vehicle occupants. Cyclists and motorcyclists were shown to suffer more injuries/casualties than car occupants, while the latter were generally those exhibiting more aberrant behaviors. Pedestrian casualties were associated with arterial roads, heavy vehicles, and older pedestrians.

PMID:38858064 | DOI:10.1016/j.jsr.2024.01.010

J Safety Res. 2024 Jun;89:41-55. doi: 10.1016/j.jsr.2024.02.005. Epub 2024 Feb 23.

ABSTRACT

INTRODUCTION: Development and implementation of autonomous vehicle (AV) related regulations are necessary to ensure safe AV deployment and wide acceptance among all roadway users. Assessment of vulnerable roadway users’ perceptions on AV regulations could inform policymakers the development of appropriate AV regulations that facilitate the safety of diverse users in a multimodal transportation system.

METHOD: This research evaluated pedestrians’ and bicyclists’ perceptions on six AV regulations (i.e., capping AV speed limit, operating AV in manual mode in the sensitive areas, having both pilot and co-pilot while operating AVs, and three data-sharing regulations). In addition, pedestrians’ and bicyclists’ perceptions of testing AVs in public streets were evaluated. Statistical testing and modeling techniques were applied to accomplish the research objectives.

RESULTS: Compared to the other AV regulations assessed in this research, strong support for AV-related data sharing regulations was identified. Older respondents showed higher approval of AV testing on public roadways and less support for regulating AVs. AV technology familiarity and safe road sharing perceptions with AVs resulted in lower support for AV regulations.

CONCLUSIONS: Policymakers and AV technology developers could develop effective educational tools/resources to inform pedestrians and bicyclists about AV technology reliability and soften their stance, especially on AV regulations, which could delay technology development.

PRACTICAL APPLICATIONS: The findings of this research could be used to develop informed AV regulations and develop policies that could improve pedestrians’ and bicyclists’ attitudes/perceptions on regulating AVs and promoting AV technology deployments.

PMID:38858062 | DOI:10.1016/j.jsr.2024.02.005

J Safety Res. 2024 Jun;89:361-368. doi: 10.1016/j.jsr.2024.03.002. Epub 2024 Apr 14.

ABSTRACT

BACKGROUND: In 2022, suicide ranked as the 11th leading cause of death in the United States with 49,513 deaths. Provisional mortality data from 2022 indicate a 2.8% increase in the number of suicides compared to 2021. This paper examines overall suicide trends, sodium nitrite ingestion as an emerging suicide method, and the role that online forums play in sharing information about suicide methods (including sodium nitrite ingestion).

METHODS: Suicides were identified from CDC’s National Vital Statistics System (2018-July 2023 provisional) multiple cause-of-death mortality files using International Classification of Diseases (ICD), Tenth Revision underlying cause-of-death codes U03, X60-X84, and Y87.0 and T code T50.6 (antidotes and chelating agents). Google search popularity metrics were captured from January 2019 to January 2023. Case reports of sodium nitrite related suicide and suicide attempts (through February 2024) were identified in the medical and forensic literature.

RESULTS: At least 768 suicides involving antidotes and chelating agents (including sodium nitrite) occurred between 2018 and July 2023, set in the context of 268,972 total suicides during that period. Overall, suicides involving antidotes and chelating agents (including sodium nitrite) represent <1% of all suicides, however, numbers are rising.

CONCLUSIONS: Suicide methods are known to change over time. These changes can be influenced by, among other factors, online forums and means accessibility, such as internet purchase availability. CDC remains committed to prevention through comprehensive public health strategies that protect individuals, families, and communities.

PRACTICAL APPLICATIONS: States and community partners might consider leveraging physicians, emergency responders, and other appropriate crisis response groups to disseminate information on sodium nitrite self-poisoning and its antidote, methylene blue. Efforts should be part of a comprehensive public health approach to suicide prevention.

PMID:38858061 | DOI:10.1016/j.jsr.2024.03.002

J Safety Res. 2024 Jun;89:312-321. doi: 10.1016/j.jsr.2024.01.001. Epub 2024 Jan 25.

ABSTRACT

INTRODUCTION: Nurses have a high prevalence of low back pain due to ergonomic hazards in healthcare workplaces. While exercise programs have been suggested as an intervention strategy, the effectiveness of low back pain programs has been inconsistent in the research literature. The purpose of study is to determine the effect of exercise programs to reduce low back pain among nursing staff.

METHODS: A systematic review and meta-analysis was conducted with five databases and systematically searched. Following the PRISMA guidelines, included studies evaluated low back pain relief among nurses or nursing assistants and described the exercise program. Two reviewers independently appraised, extracted, and synthesized all available studies. The study protocol was registered in PROSPERO (CRD42022359511).

RESULTS: A total of 296 articles with 1,355 nursing staff from nine countries were obtained. Nine randomized controlled trials with a moderate to low risk of bias quality were included. Exercise programs had a small but significant effect on low back pain of nursing staff (SMD = -0.48; 95% CI = -0.76 to -0.19; p = 0.03, I² = 62%, p = 0.001). A subgroup analysis of nurses and nursing assistants showed moderate and small effects, respectively (I² = 0% p < 0.0001, SMD -0.73 CI 95% [-0.97 to -0.48], p = 0.76, and I² = 0% p = 0.002, SMD -0.23 CI 95% [-0.38 to -0.08], p < 0.88). Exercise for back and trunk exhibited a moderate effect on low back pain (SMD -0.56 CI 95% [-0.86 to -0.25], p = 0.01, I² = 66%, p < 0.0004). A subgroup analysis comparing age, under 40 years old revealed a moderate effect size (SMD = -0.59; 95% CI = -0.83to -0.35; p = 0.06; I² = 64%, p < 0.0001).

CONCLUSIONS: Exercise programs are an effective treatment to reduce low back pain in nurses and nursing assistants, especially among younger staff.

PRACTICAL APPLICATION: Back and trunk exercise programs should be recommended for nursing staff with low back pain.

PMID:38858055 | DOI:10.1016/j.jsr.2024.01.001

J Safety Res. 2024 Jun;89:306-311. doi: 10.1016/j.jsr.2024.02.001. Epub 2024 Mar 5.

ABSTRACT

INTRODUCTION: Young workers in the United States are injured at higher rates than adults, a trend that has persisted for more than two decades. Despite known risks, young people enter the workforce with little-or-no preparation for the hazards they may face. In 2016, the National Institute for Occupational Safety and Health and American Industrial Hygiene Association developed Safety Matters, a one-hour educational module to raise awareness of workplace safety and health among young people.

METHOD: A pilot project was conducted to evaluate the effectiveness of Safety Matters to positively change workplace safety and health knowledge and attitude scores among a sample of 283 youth in Colorado. Train-the-trainer sessions prepared volunteer safety and health professionals to deliver Safety Matters with fidelity and to conduct the assessment immediately prior to and following the program.

RESULTS: After receiving Safety Matters, participants had statistically significant (p < 0.001) increased scores for both workplace safety and health knowledge (Cohen’s d = 1.12; large effect size) and importance (attitude) (Cohen’s d = 0.51; medium effect size). Although univariate analyses showed knowledge and attitude scores significantly increased for all demographic groups examined, there were statistically significant differences in knowledge scores by participant age (p < 0.01), ethnicity (p < 0.05), and race (p < 0.001) and statistically significant differences in attitude scores by participant race (p < 0.001). However, when race and ethnicity were both used as predictors in a regression model, only race continued to predict statistically significant (p < 0.01) changes in knowledge and attitude.

CONCLUSIONS: This project introduces a promising, community-based model for a one-hour introduction to workplace safety and health on which future, job-specific safety training can be built.

PRACTICAL APPLICATIONS: Safety and health professionals can play a critical role in promoting the health and safety of young workers. Adapting health and safety programs to diverse youth populations may enhance program relevance and receptivity.

PMID:38858054 | DOI:10.1016/j.jsr.2024.02.001

J Safety Res. 2024 Jun;89:299-305. doi: 10.1016/j.jsr.2024.04.003. Epub 2024 May 4.

ABSTRACT

INTRODUCTION: Driver distraction from handheld cellphone use contributes to fatal crashes every year but is underreported in terms of the proportion of crashes attributed to any distraction or cellphone use specifically. Existing methods to estimate the prevalence of cellphone distractions are also limited (e.g., observing drivers stopped at intersections, when crash risk is low). Our study used data from Cambridge Mobile Telematics to estimate the prevalence of drivers’ handheld calls and cellphone manipulation while driving, with “cellphone motion” based on movement recorded by the phones’ gyroscopes used as a surrogate for manipulation.

METHOD: We compared the telematics measures with the National Highway Traffic Safety Administration’s roadside observations of driver electronic device use, and logistic regression tested relationships between regional, legislative, and temporal factors and the odds of cellphone behaviors occurring on a trip or at a given point in time.

RESULTS: Results showed 3.5% of trips included at least one handheld phone call and 33.3% included at least an instance of cellphone motion, with handheld calls occurring during 0.78% of overall trip duration and cellphone motion during 2.4% of trip duration.

CONCLUSIONS: Correspondence between trends in cellphone distractions across regional, legislative, and temporal factors suggest telematics data have considerable utility and appear to complement existing datasets.

PMID:38858053 | DOI:10.1016/j.jsr.2024.04.003