The development and application of a new tool to assess the adequacy of the content and timing of antenatal care

Abstract Background: Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care. Methods: The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from ‘Inadequate’ (both tools) to ‘Adequate plus’ (APNCU) or ‘Appropriate’ (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools. Results: According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as ‘Adequate’ or ‘Adequate plus’ by the APNCU were deemed ‘Inadequate’ by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care. Conclusions: The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as ‘Inappropriate’. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure

The emergence of shared leadership in newly-formed teams with an initial structure of vertical leadership: A longitudinal analysis

The importance of high-quality leadership for team effectiveness is widely recognized, with recent viewpoints arguing shared leadership to be a more powerful predictor than vertical leadership. To identify changes in leadership structures over time, we longitudinally tracked the leadership structure of 27 newly-formed teams (N = 195), all having an initial structure of vertical leadership. Our findings demonstrated that the average team leadership strengthened over the course of the 24-week project and leadership tended to become more distributed among team members. Regarding the antecedents of these changes, we found evidence that the more team members are perceived as warm or competent, the higher their perceived influence. Finally, examining the consequences of these changes, the leadership structure was found to be related with team performance in that teams with higher average leadership perceptions performed better. These findings underpin the importance of shared leadership, thereby suggesting leaders to empower their team members.status: publishe

The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering

Context.—Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospital stays. Objective.—To evaluate the effect of computerized clinical decision support systems on appropriateness of laboratory test ordering. Data Sources.—We used MEDLINE, Embase, CINAHL, MEDLINE In-Process and Other Non-Indexed Citations, Clinicaltrials.gov, Cochrane Library, and Inspec through December 2015. Investigators independently screened articles to identify randomized trials that assessed a computerized clinical decision support system aimed at improving laboratory test ordering by providing patientspecific information, delivered in the form of an on-screen management option, reminder, or suggestion through a computerized physician order entry using a rule-based or algorithm-based system relying on an evidence-based knowledge resource. Investigators extracted data from 30 papers about study design, various study characteristics, study setting, various intervention characteristics, involvement of the software developers in the evaluation of the computerized clinical decision support system, outcome types, and various outcome characteristics. Conclusions.—Because of heterogeneity of systems and settings, pooled estimates of effect could not be made. Data showed that computerized clinical decision support systems had little or no effect on clinical outcomes but some effect on compliance. Computerized clinical decision support systems targeted at laboratory test ordering for multiple conditions appear to be more effective than those targeted at a single condition.status: publishe

Bone mass and lifetime physical activity in Flemish males: a 27- year follow-up study

Etnografisch geïnspireerde onderzoekers observeren in de regel gemeenschappen, oftewel groepen van individuen die ‘iets’ met elkaar hebben: dorpelingen, soldaten, gangs, noem maar op. In de online wereld zijn allerlei virtuele groepen ontstaan die weliswaar als gemeenschap bestaan, maar niet geconcentreerd zijn op een bepaalde fysieke plek. Er is daarmee geen natuurlijke afbakening (zoals bijvoorbeeld in een traditionele dorpssamenleving) en daardoor is de vraag naar de grenzen van de gemeenschap een belangrijke. In het geval van virtuele, online gemeenschappen zou je zeggen: overal en nergens waar de pc maar verbinding met het internet biedt. Deze gemeenschappen lijken zich zo te onttrekken aan de eis van fysieke nabijheid, die vaak als kenmerkend wordt gezien voor gemeenschapsvorming. Om de etnografische taak scherper te krijgen moet dus allereerst de vraag worden beantwoord hoe een gemeenschap zich eigenlijk kan vormen zonder dat de leden ervan elkaar kunnen zien, horen en ruiken. Vervolgens moet worden vastgesteld wat er dan precies aan geobserveerd kan worden