A framework and a measurement instrument for sustainability of work practices in long-term care

<p>Abstract</p> <p>Background</p> <p>In health care, many organizations are working on quality improvement and/or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization.</p> <p>Methods</p> <p>The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N _teams= 63, N _individual= 112). Data were collected not until at least one year had passed after implementation.</p> <p>Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach's alpha coefficient. A long and a short version of the instrument are proposed.</p> <p>Results</p> <p>The χ²- difference test of the -2 Log Likelihood estimates demonstrated that the hierarchical two factor model with routinization and institutionalization as separate constructs showed a better fit than the one factor model (p < .01). Secondly, construct validity of the instrument was strong as indicated by the high factor loadings of the items. Finally, the internal consistency of the subscales was good.</p> <p>Conclusions</p> <p>The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the subscales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.</p

A candidate gene approach identifies an IL33 genetic variant as a novel genetic risk factor for GCA

INTRODUCTION: Increased expression of IL-33 and its receptor ST2, encoded by the IL1RL1 gene, has been detected in the inflamed arteries of giant cell arteritis (GCA) patients. The aim of the present study was to investigate for the first time the potential influence of the IL33 and IL1RL1 loci on GCA predisposition. METHODS: A total of 1,363 biopsy-proven GCA patients and 3,908 healthy controls from four European cohorts (Spain, Italy, Germany and Norway) were combined in a meta-analysis. Six genetic variants: rs3939286, rs7025417 and rs7044343, within the IL33 gene, and rs2058660, rs2310173 and rs13015714, within the IL1RL1 gene, previously associated with immune-related diseases, were genotyped using predesigned TaqMan assays. RESULTS: A consistent association between the rs7025417 polymorphism and GCA was evident in the overall meta-analysis, under both allele (P(MH) = 0.041, OR = 0.88, CI 95% 0.78-0.99) and recessive (P(MH) = 3.40E-03, OR = 0.53, CI 95% 0.35-0.80) models. No statistically significant differences between allele or genotype frequencies for the other IL33 and IL1RL1 genetic variants were detected in this pooled analysis. CONCLUSIONS: Our results clearly evidenced the implication of the IL33 rs7025417 polymorphism in the genetic network underlying GCA

Short- and long-term mortality in males and females with fragility hip fracture in Norway. A population-based study

Andreas P Diamantopoulos,1,2 Mari Hoff,2,3 Inger M Skoie,1 Marc Hochberg,4 Glenn Haugeberg1,2 1Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway; 2Medical Faculty, Department of Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Rheumatology, St Olavs Hospital, Trondheim, Norway; 4Departments of Medicine, Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, USA Background: Hip fracture patients have, in several studies, been shown to have excessive mortality. There is, however, a lack of mortality data, in comparison to incidence data, from the last decade in particular. Objective: To study short- and long-term mortality in a population-based cohort of hip fracture patients over the last decade and compare it to the background population. Patients and methods: Fragility hip fracture patients in the two most southern counties in Norway who experienced fractures in 2004 and 2005 were studied. For each patient, three controls were randomly recruited from the background population matched for age, sex, and residency. Overall, age-, gender-, and group-specific mortality rates were calculated. Results: A total of 942 (267 male and 675 female) patients with a fragility hip fracture were identified. In the hip fracture patients, overall mortality rate after 1 year was 21.3% (males 30.7% and females 19.1%, P &lt; 0.005) and, after 5 years, 59.0% (males 70.0% and females 54.6%, P &lt; 0.005). The corresponding figures for matched controls were 5.6% (males 5.9%, females 5.4%, P = 0.6) and 24.9% (males 25.9%, females 24.5%, P = 0.4), respectively. A statistically significant difference was seen in the log-rank statistical analysis between hip fracture patients and controls, both in males (P &lt; 0.0005) and females (P &lt; 0.0005), and for age groups 50&ndash;80 years (P &lt; 0.0005) and 80 years and older (P &lt; 0.0005). Conclusion: Mortality in males and females with hip fractures is high not only in the first year after fracture, but remains higher than in the background population during 5 years of follow-up. The high mortality in hip fracture patients remains a challenge both in middle-aged and elderly individuals. Optimization of post-fracture treatment and care could reduce mortality of hip fracture in middle-aged and elderly individuals. Keywords: hip fracture, mortality, survival, population-based stud

The use of ultrasound to assess giant cell arteritis: Review of the current evidence and practical guide for the rheumatologist

Colour duplex sonography (CDS) of temporal arteries and large vessels is an emerging diagnostic tool for GCA. CDS can detect wall oedema, known as a halo, throughout the length of the vessel and shows higher sensitivity compared with biopsy. Specificity reaches 100% in case of bilateral halos. A positive compression sign has been demonstrated to be a robust marker with excellent inter-observer agreement. The assessment of other large vessels, particularly the axillary arteries, is recognized to further increase the sensitivity and to reliably represent extra-cranial involvement in other areas. Nevertheless, CDS use is still not widespread in routine clinical practice and requires skilled sonographers. Moreover, its role in the follow-up of patients still needs to be defined. The aim of this review is to provide the current evidence and technical parameters to support the rheumatologist in the CDS evaluation of patients with suspected GCA

THU0296 The role of ultrasound in the management of giant cell arteritis (GCA) in routine clinical practice

Objective To develop and explore a protocol for using colour duplex sonography (CDS) in the routine care of GCA. Methods We tested CDS of temporal arteries and axillary arteries (AXs) on consecutive patients with suspected or established GCA, between July 2014 and September 2016. Results We assessed 293 patients [age 72 (10), female/male 196/97], of whom 118 had clinically confirmed GCA. Seventy-three percent of patients had already received high-dose glucocorticoids (GCs) for 17 (33) days. Among new referrals with Conclusion CDS provides high positive predictive value for diagnosing GCA and allows for a significant reduction in temporal artery biopsies. We explored the role of CDS in detecting flares and demonstrated a relationship to the extent of the distribution of halos, but not to their size.</p