The Turkish version of the Omaha System: Its use in practice-based family nursing education

The aims of this manuscript are to examine the validity and reliability of the Turkish version of the Omaha System, and to demonstrate its effectiveness as a toot for nursing education. In this methodological and descriptive study, seventy students attending a training program used the Omaha System in clinical practice settings for assessing health problems of 157 clients and for nursing interventions during 378 home visits. After the system's adaptation to the Turkish language, its content validity was reconfirmed through feedback from the students and interrater reliability was tested on six independent students with kappa statistics. The reliabitity scores were at a statistically significant level when coding the records using the Omaha System. Clinical practice was explained with 332 problems and 1783 nursing intervention terms. Study findings indicate several strengths, including high reliability - except in target terms, coding of problems and interventions, improved understanding of the course, as well. as some limitations: the need for new terms and more time required for manual documentation. The findings of the study supported the usefulness of the Omaha System in describing the practice of community health nursing. (c) 2005 Elsevier Ltd. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)