The experiences of people living with peripheral neuropathy in Kuwait - a process map of the patient journey

Peripheral neuropathy is a neurological disease characterised by pain, numbness, tingling, swelling or muscle weakness due to nerve damage, caused by multiple factors such as trauma, infections and metabolic diseases such as diabetes. In Kuwait 54% of the diabetic population, has peripheral neuropathy. In this exploratory, qualitative study conducted in Kuwait, 25 subjects with peripheral neuropathy took part in one-on-one, semi-structured interviews lasting 45−60 min. Interviews were transcribed, translated into English and coded using NVivo 12. Four individual patient journeys were mapped out in detail, then compared and condensed into a single process map. The remaining 21 interviews were then reviewed to ensure the final map represented all patient journeys. Participants reported similar healthcare pathways for their peripheral neuropathy and faced various difficulties including lack of psychological support, administrative issues (long waiting referral periods, loss of medical documents, shortage of specialists and lack of centralized electronic medical records) and inadequate medical care (shortage of new treatments and deficient follow-ups). Mapping the patient journey in Kuwait showed similar pharmacological treatment to UK guidelines, except that some medicines were unavailable. The map also indicated the need for an integrated referral approach, the use of technology for electronic medical recording and report transmission, alongside education on self-management, coping mechanisms and treatment options for people living with peripheral neuropathy

The relationship between in-hospital location and outcomes of care in patients of a large general medical service

Background: The discrepancy between the number of admissions and the allocation of hospital beds means many patients admitted under the care of a general medical service can be placed in other departments’ wards. These patients are called “outliers” and their outcomes are unknown. Aims: To examine the relation between the proportion of time each patient spent in their “home ward” during an index admission and the outcomes of that hospital stay. Methods: Data from Flinders Medical Centre’s (FMC) patient journey database were extracted and analysed. The analysis was carried out on the patient journeys of patients admitted under the General Medicine units. Results: Outlier patients’ length of stay (LOS) was significantly shorter than that of the inlier patients (110.7 hours cf 141.9 hours; p < 0.001).They had a reduced risk of readmission within 28 days of discharge from hospital. Outlier patients’ discharge summaries were less likely to be completed within a week (64.3% cf 78.0%; p < 0.001). Being an outlier patient increased the risk-adjusted risk of in-hospital mortality by over 40%. 50% of deaths in the outlier group occurred within 48 hours of admission. Outlier patients had spent longer in the Emergency Department (ED) waiting for a bed (6.3 hours cf 5.3 hours; p < 0.001) but duration of ED stay was not an independent predictor of mortality risk. Conclusion: Outlier patients had significantly shorter LOS in hospital, but significantly greater in-patient death rates. Surviving outlier patients had lower rates of readmission but lower rates of discharge summary completion

Screening for important unwarranted variation in clinical practice: a triple-test of processes of care, costs and patient outcomes

Objective: Unwarranted variation in clinical practice is a target for quality improvement in health care, but there is no consensus on how to identify such variation or to assess the potential value of initiatives to improve quality in these areas. This study illustrates the use of a triple test, namely the comparative analysis of processes of care, costs and outcomes, to identify and assess the burden of unwarranted variation in clinical practice. Methods: Routinely collected hospital and mortality data were linked for patients presenting with symptoms suggestive of acute coronary syndromes at the emergency departments of four public hospitals in South Australia. Multiple regression models analysed variation in re-admissions and mortality at 30 days and 12 months, patient costs and multiple process indicators. Results: After casemix adjustment, an outlier hospital with statistically significantly poorer outcomes and higher costs was identified. Key process indicators included admission patterns, use of invasive diagnostic procedures and length of stay. Performance varied according to patients’ presenting characteristics and time of presentation. Conclusions: The joint analysis of processes, outcomes and costs as alternative measures of performance inform the importance of reducing variation in clinical practice, as well as identifying specific targets for quality improvement along clinical pathways. Such analyses could be undertaken across a wide range of clinical areas to inform the potential value and prioritisation of quality improvement initiatives.Andrew Partington, Derek P. Chew, David Ben-Tovim, Matthew Horsfall, Paul Hakendorf and Jonathan Karno

Perspectivas psicológicas en el estudio del autoritarismo

Altemeyer (1996), sostiene que han habido tres importantes líneas de investigación en relación al autoritarismo desde una perspectiva psicológica. La primera de estas fue desarrollada por el grupo de Berkeley (Adorno, Frenkel-Brunswik, Levinson & Sanford, 1950), que genero un estudio empírico en torno al constructo del autoritarismo, pensándolo a partir del constructo de personalidad autoritaria. Mientras que la segunda línea, fue realizada por Rokeach (1960), quien propuso el concepto de dogmatismo, para poder evaluar al autoritarismo, sin importar el posicionamiento ideológico. Finalmente la última línea, es la propuesta por Altemeyer (1981), el cual piensa al fenómeno del autoritarismo como un conglomerado actitudinal. Si bien se hallan numerosos estudios sobre autoritarismo en el habla hispana, ninguno de ellos ha realizado una revisión sistemática sobre la historia de este constructo. Es por ello que el objetivo de este trabajo fue realizar una revisión sobre el estudio del autoritarismo desde abordajes psicológicos.Altemeyer (1996), argues that there have been three important lines of research in relation to authoritarianism from a psychological perspective. The first of these was developed by the group of Berkeley (Adorno, Frenkel-Brunswik, Levinson & Sanford, 1950), which generated an empirical study about the construct of authoritarianism, thinking it from the construct of authoritarian personality. While the second line was made by Rokeach (1960), who proposed the concept of dogmatism, to evaluate authoritarianism, regardless of the ideological position. Finally the last line is the one proposed by Altemeyer (1981), which thinks of the phenomenon of authoritarianism as an attitudinal conglomerate. While there are numerous studies on authoritarianism in Spanish speech, none of them has conducted a systematic review of the history of this construct. The aim of this research was to review the authoritarian construct from psychological perspectives.Fil: Jaume, Luis Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Roca, Marcelo Agustin. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Ben Tovim, Jochay. Universidad de Buenos Aires. Facultad de Psicología; Argentin

Modular structures and the delivery of inpatient care in hospitals: a Network Science perspective on healthcare function and dysfunction

Background: Reinforced by the COVID-19 pandemic, the capacity of health systems to cope with increasing healthcare demands has been an abiding concern of both governments and the public. Health systems are made up from non-identical human and physical components interacting in diverse ways in varying locations. It is challeng‑ ing to represent the function and dysfunction of such systems in a scientifc manner. We describe a Network Science approach to that dilemma. General hospitals with large emergency caseloads are the resource intensive components of health systems. We propose that the care-delivery services in such entities are modular, and that their structure and function can be usefully analysed by contemporary Network Science. We explore that possibility in a study of Australian hospitals during 2019 and 2020. Methods: We accessed monthly snapshots of whole of hospital administrative patient level data in two general hospitals during 2019 and 2020. We represented the organisations inpatient services as network graphs and explored their graph structural characteristics using the Louvain algorithm and other methods. We related graph topological features to aspects of observable function and dysfunction in the delivery of care. Results: We constructed a series of whole of institution bipartite hospital graphs with clinical unit and labelled wards as nodes, and patients treated by units in particular wards as edges. Examples of the graphs are provided. Algorithmic identifcation of community structures confrmed the modular structure of the graphs. Their functional implications were readily identifed by domain experts. Topological graph features could be related to functional and dysfunctional issues such as COVID-19 related service changes and levels of hospital congestion. Discussion and conclusions: Contemporary Network Science is one of the fastest growing areas of current scientifc and technical advance. Network Science confrms the modular nature of healthcare service structures. It holds con‑ siderable promise for understanding function and dysfunction in healthcare systems, and for reconceptualising issues such as hospital capacity in new and interesting ways.David I. Ben, Tovim, Mariusz Bajger, Viet Duong Bui, Shaowen Qin, and Campbell H. Thompso

Implicit body representations and the conscious body image

Recent studies have revealed that somatosensory processing relies on a class of implicit body representations showing large distortions of size and shape. The relation between these representations and the conscious body image remains unclear. Dissociations have been reported in the clinical literature on eating disorders between different body image measures, with larger and more consistent distortions found with depictive measures, in which participants compare their body to a visual depiction of a body, than metric measures, in which participants compare their body to some non-body standard. Here, we compared implicit body representations underlying position sense to the body image measured with both depictive and metric methods. The body image was measured using both a depictive method (template matching) in which participants judged whether their hand was wider or more slender than a shown hand picture, and a metric method (line length) in which participants judged whether different parts of the their hand were shorter or longer than a presented line. Consistent with previous findings, characteristic distortions were found for the implicit body representation underlying position sense. These distortions were also found in attenuated form for metric – but not depictive – body image measures. While replicating the basic dissociation between implicit body representations and the conscious body image, these results demonstrate that this dissociation is not absolute and specific tasks may utilise both to varying degrees depending on task demands. Metric measures may not be pure measures of body image, but some combination of visual and somatosensory body representations

Improving the Estimation of Risk-Adjusted Grouped Hospital Standardized Mortality Ratios Using Cross-Jurisdictional Linked Administrative Data: A Retrospective Cohort Study.

Background: Hospitals and death registries in Australia are operated under individual state government jurisdictions. Some state borders are located in heavily populated areas or are located near to major capital cities. Mortality indicators for hospital located near state borders may not be estimated accurately if patients are lost as they cross state borders. The aim of this study was to evaluate how cross-jurisdictional linkage of state hospital and death records across state borders may improve estimation of the hospital standardized mortality ratio (HSMR), a tool used in Australia as a hospital performance indicator. Method: Retrospective cohort study of 7.7 million hospital patients from July 2004 to June 2009. Inhospital deaths and deaths within 30 days of hospital discharge from four state jurisdictions were used to estimate the standardized mortality ratio of hospital groups defined by geography and type of hospital (grouped HSMR) under three record linkage scenarios, as follows: (1) cross-jurisdictional person-level linkage, (2) within-jurisdictional (state-based) person-level linkage, and (3) unlinked records. All public and private hospitals in New South Wales, Queensland, Western Australia, and public hospitals in South Australia were included in this study. Death registrations from all four states were obtained from state-based registries of births, deaths, and marriages. Results: Cross-jurisdictional linkage identified 11,116 cross-border hospital transfers of which 170 resulted in a cross-border inhospital death. An additional 496 cross-border deaths occurred within 30 days of hospital discharge. The inclusion of cross-jurisdictional person-level links to unlinked hospital records reduced the coefficient of variation among the grouped HSMRs from 0.19 to 0.15; the inclusion of 30-day deaths reduced the coefficient of variation further to 0.11. There were minor changes in grouped HSMRs between cross-jurisdictional and within-jurisdictional linkages, although the impact of cross-jurisdictional linkage increased when restricted to regions with high cross-border hospital use. Conclusion: Cross-jurisdictional linkage modified estimates of grouped HSMRs in hospital groups likely to receive a high proportion of cross-border users. Hospital identifiers will be required to confirm whether individual hospital performance indicators change

Hospital Event Simulation Model: Arrivals to Discharge

MODSIM2015 was held jointly with the 23rd National Conference of the Australian Society for Operations Research and the DSTO led Defence Operations Research Symposium (DORS 2015).Many Australian public hospitals operate under strict resource constraints. Arguably, this is manifested in higher incidence of ambulance ramping and patient flow congestion episodes, which has led to an increase in public complaints and, possibly, sub-optimal health outcomes for patients. Consequently, there is a well accepted need to make best use of all available information and domain knowledge to ensure that hospital resources and expertise are utilised more efficiently, for the benefit of patients. The latter is not a simple task since hospital operations involve complex interactions among many groups of health professionals utilising limited physical facilities and equipment. This is further complicated by the inherent variability of patient responses to treatments. Indeed, the stochastic nature of the demand process, as well as uncertainty in durations of medical treatments and patient recovery, lead to probabilistically distributed bed availability. Fortunately, in Australia, hospitals are ”data rich” in the sense that reliable records of patient journeys have been kept for many years. While older data may reflect procedures and priorities that are no longer in place, data from recent years may be regarded as quite robust, especially in cities that have not experienced major demographic changes. Thus there is an opportunity to apply modern tools of mathematical, statistical and simulation modelling to enhance our understanding of key processes that influence a hospital’s operations. The understanding so obtained can then be used to assist hospital staff in devising operational procedures that are likely to minimise disruption without adversely impacting the public service provided to the patient population. In this paper we outline the Hospital Event Simulation Model: Arrivals to Discharge (HESMAD) to describe the patterns of patient flows within the Flinders Medical Centre, an urban teaching hospital. The logical design of HESMAD was developed through extensive consultation with colleagues from the hospital. In particular, patients within HESMAD are not modelled as identical entities, rather, they are assigned different attribute values such as mode of arrival, triage category and division to reflect the typical profile of all patients. Patients go through a set of physical units and process modules that model various physical areas, processes, interactions and behaviours within the hospital to replicate a wide spectrum of patient journeys. Hospital and patient data from 2012 to 2013 were used to fit various probability distributions, for instance the waiting times for treatment or discharges. The model allows for a realistic representation of patient flows, at a level of resolution that was deemed appropriate by the hospitals data management experts. The model has been validated against historical data and through consultation with health care and hospital experts. Within space limitation we provide an outline and a brief discussion of HESMAD’s structure, features, capabilities, design decisions and development. In addition, we provide a brief case study demonstrating the potential applicability of HESMAD for ’what if’ analyses of hospital interventions. While all discussions are specific to the Flinders Medical Centre, the methodology used within HESMAD is generic enough to apply to other public hospitals in Australia.D. Ben-Tovim, J. Filar, P. Hakendorf, S. Qin, C. Thompson and D. War

BASES PSICOLÓGICAS DE LA JUSTIFICACIÓN DEL SISTEMA ECONOMICO: UN ANÁLISIS DE CLASES LATENTES

The theory of the system justification (ESJ) indicates that individuals possess a motivation to justify the social systems to which they belong. The approach to this phenomenon enables to investigate personality characteristics associated with the ESJ. Individual differences such as social dominance orientation (SDO) and right wing authoritarianism (RWA) can constitute the basis of justification. Although there have been numerous advances in the study of the ESJ, research on this type of relationship is unprecedented in the Argentinian context. The objective was to analyze whether SDO and RWA relates to ESJ. The study has a sample of 843 participants (51.8% female; 48.2% male), with an age range of 18 to 88 years (M = 46.03; SD = 15.88). Results indicate that RWA and SDO are positively associated with ESJ through Latent Class Analysis. Therefore, RWA and SDO may be presented as the psychological basis on which ESJ is sustained.La teoría de la justificación del sistema (ESJ) indica que los individuos poseen una motivación para justificar los sistemas sociales a los que pertenecen. La aproximación a este fenómeno permite investigar características de personalidad asociadas a la ESJ. Diferencias individuales como la orientación a la dominación social (SDO) y el autoritarismo de derechas (RWA) pueden constituir la base de la justificación. Aunque se han producido numerosos avances en el estudio del ESJ, la investigación sobre este tipo de relación no tiene precedentes en el contexto Argentino. El objetivo fue analizar si el SDO y el RWA se relacionan con el ESJ. El estudio contó con una muestra de 843 participantes (51,8 % mujeres; 48,2 % hombres), con un rango de edad de 18 a 88 años (M = 46,03; DE = 15,88). Los resultados indican que RWA y SDO se asocian positivamente con ESJ a través del Análisis de Clases Latentes. Por lo tanto, el RWA y el SDO pueden presentarse como la base psicológica sobre la que se sustenta el ESJ

Body size adaptation alters perception of test stimuli, not internal body image

Recent studies have reported that adaptation to extreme body types produces aftereffects on judgments of body normality and attractiveness, and also judgments of the size and shape of the viewer’s own body. This latter effect suggests that adaptation could constitute an experimental model of media influences on body image. Alternatively, adaptation could affect perception of test stimuli, which should produce the same aftereffects for judgments about participant’s own body or someone else’s body. Here, we investigated whether adaptation similarly affects judgments about one’s body and other bodies. We were interested in participants’ own body image judgements, i.e. we wanted to measure the mental representations to which the test stimuli were compared to and not the perception of test stimuli per se. Participants were adapted to pictures of thin or fat bodies and then rated whether bodies were fatter or thinner than either: their own body, an average body (Experiment 1) or the body of another person (Experiments 2-3). By keeping the visual stimuli constant but changing the task/type of judgement, i.e. the internal criterion participants are asked to judge the bodies against, we investigated how adaptation affects different stored representations of bodies, specifically. own body image vs representations of others. After adaptation, a classic aftereffect was found, with judgments biased away from the adapting stimulus. Critically, aftereffects were nearly identical for judgments of one’s own body and for other people’s bodies. These results suggest that adaptation affects body representations in a generic way and may not be specific to the own body image