The Timely Open Communication for Patient Safety Project

Background: Concern is growing over increased numbers of adverse events experienced by patients when admitted to acute care hospitals in Canada due to breakdowns in communication. The purpose of the Timely Open Communication for Patient Safety (TOC) project was to create a culture of patient safety through enhanced interprofessional communication by developing resources for caregivers and patients. Methods and Findings: The research was framed by a mixed methods design that included pre- and post-surveys and focus groups, online educational modules, face-to-face activities, and the development of patient orientation materials. Three clinical sites participated in the study. The findings indicate that supporting healthcare teams to identify strengths, challenges, and future directions of communicating, clarifying roles, functioning, and collaborating, coupled with educational interventions that raise awareness of patient safety,may enhance patient safety. The study was limited by the absence of data regarding the incidence of adverse events during the research period. Conclusion: The data showed improvement in team members' perceptions of interprofessional collaborative practice within the participating Collaborative Learning Units (CLUs). If the CLU model of care is adopted within the healthcare system, the safety of patients/clients may improve

Living with an acquired brain injury. Barriers and facilitators to developing community supports as a basis for independent living: the experiences and perceptions of people with acquired brain injury

This study found that natural community supports were comprised of two distinct groupings; firstly immediate families, friends and peer support groups; secondly neighbours and local community groups such as sporting and activity- based organisations and groups. The findings of this study indicate that living with acquired brain injury involves a process where the person moves from acute high intensity health services onto rehabilitative services and then onto re-establishing independent lives. It is evident that smooth transitions and interconnectivity of services are essential in facilitating this recovery process. Instrumental to the recovery is the support of immediate family and close friends, who form people’s immediate natural support network and go a long way towards facilitating individuals in rebuilding their lives. A key finding of this study is that broader natural community supports do not appear to play as central a role in supporting individuals to live independent lives when compared to the role of family and friends. The lack of involvement of broader community groups, in many ways, prompted individuals to contact formal support services. For the majority of participants, independence is facilitated through the combination of immediate natural community supports and formal services. The role of formal support services is key to developing broader community support networks. This study found a blurred division between formal services and broader community support networks. The authors recommended that the role of formal supports services in acting as a bridge between the needs of the individual and the development of meaningful community networks, be formally recognised and further developed. Additionally, they argued that the importance of the role of broader natural community, supports such as those provided by community and sporting groups must be enhanced. Greater awareness of the issues faced by people living with acquired brain injury and its often invisible nature is necessary in this endeavour. The authors stated it is important to recognise that there are multiple issues impacting on independent living and these issues intersect, for instance with age, gender, employment, qualifications and so on. A lack of public awareness of acquired brain injury was found to be a key barrier to independent living, along with issues relating to socialising, access to employment and finances. The findings of this study reflect the complexities of living with acquired brain injury and the need for holistic support that is cognisant of the factors which impact on integration. It is vital that flexible, personalised services are developed which are fit for purpose and meet the needs of not only people with acquired brain injury but also their immediate natural community support network. Recognition of the intersection between immediate/ broader natural community supports and formal services is also key to developing the comprehensive and practical supports required to achieve an independent life. This was a qualitative study and all participants were sourced through Headway, a community based service provider for people with ABI. Data collection was divided into two stages: firstly focus groups, followed by individual interviews. Four focus groups were convened in Cork (2), Dublin (1) and Limerick (1). Each focus group was facilitated by at least two members of the research team and a total of twenty-six individuals participated in the focus groups. Thematic analysis of the data was undertaken to guide and inform the second stage of the study; the individual interviews. Ten interviews were undertaken with individuals who presented with ABI in the Cork and Limerick regions

Preparing Students in Professional Programs for Rural Practice: A Case Study

Understanding the supports and constraints available in rural communities is integral to the education of professionals who choose to practise in rural settings. Previous research has indicated that many professionals do not have an accurate understanding of rural contexts and how rural settings impact personal life and professional practice. To address this gap, an interprofessional course centring on professional practice in rural and remote communities was developed. This course was designed to be reflective of rural practice, not only in content but also in the way the course was delivered. Findings from this case study indicated that students’ understanding of the complexity of rural settings was enhanced on multiple levels. The interactive and experiential nature of the course allowed students to develop working relationships that increased both their understanding of the value of interprofessional collaboration as well as the professional opportunities that are available in rural areas.  Comprendre les soutiens accessibles dans les communautés rurales et leurs contraintes fait partie intégrante de la formation des professionnels qui choisissent de pratiquer en milieu rural. Des recherches antérieures ont indiqué que de nombreux professionnels n’ont pas une compréhension adéquate des contextes ruraux ni des répercussions de ces paramètres sur la vie personnelle et la pratique professionnelle. Pour combler cette lacune, un cours interprofessionnel centré sur la pratique professionnelle dans les collectivités rurales et éloignées a été créé. Ce cours se veut le reflet de la pratique rurale, non seulement dans son contenu mais aussi dans sa façon d’être enseigné. Les résultats de cette étude de cas ont indiqué que la compréhension qu’ont les élèves de la complexité du milieu rural a été renforcée à plusieurs niveaux. La nature interactive et expérientielle du cours a permis aux étudiants de parfaire leurs relations de travail, ce qui a augmenté à la fois leur compréhension de la valeur de la collaboration interprofessionnelle ainsi que celle des occasions professionnelles disponibles dans les zones rurales

South Eastern Interprofessional Collaborative Learning Environment (SEIPCLE): Nurturing Collaborative Practice

AbstractBackground: There has been tremendous pressure on Canada’s healthcare system to respond to the increasingly complex health needs of the population despite worsening constraints in financial and human resources. Interprofessional collaborative practice has been seen as an enabler for improving patient care and meeting the current demands on the healthcare system.Methods: The South Eastern Interprofessional Collaborative Learning Environment (SEIPCLE) project, funded by HealthForceOntario, focused on the development and evaluation of the collaborative practice care model in three clinical settings in Southeastern Ontario, Canada. The project was exploratory in nature and used a quasi-experimental design with pre- and post-tests matched with non-equivalent control groups. Several different measures were used, including the Collaborative Practice Assessment Tool (CPAT), an Interprofessional Clinical Education Survey, and a Patient Participation Survey. Quantitative outcome measures were derived from these instruments using factor analysis, and analyzed using regression modelling with co-variates. Focus groups, interviews, and questionnaires provided qualitative data that was coded conceptually and used to complement the results of analyses using quantitative measures. Intervention teams participated in educational components that addressed identified weaknesses in their collaborative practice. Educational components included online modules, workshops, and real-time activities.Findings: Implementation of educational components in the clinical setting posed a number of challenges to reducing the exposure time for some of the intervention teams. Barriers to and enablers of the development of collaborative practice in the healthcare system were identified.Conclusion: Overall, all three intervention teams demonstrated an increase in perceived levels of collaborative practice. Although the results were not statistically significant, the effect, size, and magnitude of change were considered substantial

Extending the Grazing Period for Bulls, Prior to Finishing on a Concentrate Ration: Composition, Collagen Structure and Organoleptic Characteristics of Beef.

peer-reviewedThe biochemical and organoleptic characteristics of the longissimus thoracis muscle from suckler bulls (n = 56) finished on a concentrate-based system (C) or raised in a pasture-based system (P) incorporating 99 (P99), 162 (P162) or 231 days (P231) of grazing prior to indoor finishing on the concentrate-based diet were investigated. Age at slaughter increased with increasing period at pasture. Intramuscular fat concentration was lower (p < 0.001) for P99 than for C, P162 and P231 bulls, which did not differ. Soluble collagen proportion was lower (p < 0.01) for P162 and P231 than for P99 and C bulls. Collagen cross-link content was higher (p < 0.05) for P231 than for P99 and C bulls and for P162 than for C bulls. The proportion of type I muscle fibres was higher (p < 0.01) for P231 and P162 than for P99 and C bulls. Sensory tenderness was higher (p < 0.001) for C and P162 than for P99 and P231 bulls and overall liking was higher (p < 0.01) for C than for P99 and P231 bulls but similar to P162 bulls. Extending the grazing period to 162 days did not negatively influence the sensory qualities of beef compared to the intensive concentrate-based system

Beef production from feedstuffs conserved using new technologies to reduce negative environmental impacts

End of project reportMost (ca. 86%) Irish farms make some silage. Besides directly providing feed for livestock, the provision of grass silage within integrated grassland systems makes an important positive contribution to effective grazing management and improved forage utilisation by grazing animals, and to effective feed budgeting by farmers. It can also contribute to maintaining the content of desirable species in pastures, and to livestock not succumbing to parasites at sensitive times of the year. Furthermore, the optimal recycling of nutrients collected from housed livestock can often be best achieved by spreading the manures on the land used for producing the conserved feed. On most Irish farms, grass silage will remain the main conserved forage for feeding to livestock during winter for the foreseeable future. However, on some farms high yields of whole-crop (i.e. grain + straw) cereals such as wheat, barley and triticale, and of forage maize, will be an alternative option provided that losses during harvesting, storage and feedout are minimised and that input costs are restrained. These alternative forages have the potential to reliably support high levels of animal performance while avoiding the production of effluent. Their production and use however will need to advantageously integrate into ruminant production systems. A range of technologies can be employed for crop production and conservation, and for beef production, and the optimal options need to be identified. Beef cattle being finished indoors are offered concentrate feedstuffs at rates that range from modest inputs through to ad libitum access. Such concentrates frequently contain high levels of cereals such as barley or wheat. These cereals are generally between 14% to 18% moisture content and tend to be rolled shortly before being included in coarse rations or are more finely processed prior to pelleting. Farmers thinking of using ‘high-moisture grain’ techniques for preserving and processing cereal grains destined for feeding to beef cattle need to know how the yield, conservation efficiency and feeding value of such grains compares with grains conserved using more conventional techniques. European Union policy strongly encourages a sustainable and multifunctional agriculture. Therefore, in addition to providing European consumers with quality food produced within approved systems, agriculture must also contribute positively to the conservation of natural resources and the upkeep of the rural landscape. Plastics are widely used in agriculture and their post-use fate on farms must not harm the environment - they must be managed to support the enduring sustainability of farming systems. There is an absence of information on the efficacy of some new options for covering and sealing silage with plastic sheeting and tyres, and an absence of an inventory of the use, re-use and post-use fate of plastic film on farms. Irish cattle farmers operate a large number of beef production systems, half of which use dairy bred calves. In the current, continuously changing production and market conditions, new beef systems must be considered. A computer package is required that will allow the rapid, repeatable simulation and assessment of alternate beef production systems using appropriate, standardised procedures. There is thus a need to construct, evaluate and utilise computer models of components of beef production systems and to develop mathematical relationships to link system components into a network that would support their integration into an optimal system model. This will provide a framework to integrate physical and financial on-farm conditions with models for estimating feed supply and animal growth patterns. Cash flow and profit/loss results will be developed. This will help identify optimal systems, indicate the cause of failure of imperfect systems and identify areas where applied research data are currently lacking, or more basic research is required

FUSE-ML: development and external validation of a clinical prediction model for mid-term outcomes after lumbar spinal fusion for degenerative disease

Background: Indications and outcomes in lumbar spinal fusion for degenerative disease are notoriously heterogenous. Selected subsets of patients show remarkable benefit. However, their objective identification is often difficult. Decision-making may be improved with reliable prediction of long-term outcomes for each individual patient, improving patient selection and avoiding ineffective procedures. Methods: Clinical prediction models for long-term functional impairment [Oswestry Disability Index (ODI) or Core Outcome Measures Index (COMI)], back pain, and leg pain after lumbar fusion for degenerative disease were developed. Achievement of the minimum clinically important difference at 12 months postoperatively was defined as a reduction from baseline of at least 15 points for ODI, 2.2 points for COMI, or 2 points for pain severity. Results: Models were developed and integrated into a web-app ( https://neurosurgery.shinyapps.io/fuseml/ ) based on a multinational cohort [N = 817; 42.7% male; mean (SD) age: 61.19 (12.36) years]. At external validation [N = 298; 35.6% male; mean (SD) age: 59.73 (12.64) years], areas under the curves for functional impairment [0.67, 95% confidence interval (CI): 0.59-0.74], back pain (0.72, 95%CI: 0.64-0.79), and leg pain (0.64, 95%CI: 0.54-0.73) demonstrated moderate ability to identify patients who are likely to benefit from surgery. Models demonstrated fair calibration of the predicted probabilities. Conclusions: Outcomes after lumbar spinal fusion for degenerative disease remain difficult to predict. Although assistive clinical prediction models can help in quantifying potential benefits of surgery and the externally validated FUSE-ML tool may aid in individualized risk-benefit estimation, truly impacting clinical practice in the era of "personalized medicine" necessitates more robust tools in this patient population. Keywords: Clinical prediction model; Machine learning; Neurosurgery; Outcome prediction; Predictive analytics; Spinal fusion