Feedback of patient-reported outcomes to healthcare professionals for comparing health service performance: a scoping review

Objective: Patient-reported outcomes (PROs) provide self-reported patient assessments of their quality of life, daily functioning, and symptom severity after experiencing an illness and having contact with the health system. Feeding back summarised PROs data, aggregated at the health-service level, to healthcare professionals may inform clinical practice and quality improvement efforts. However, little is known about the best methods for providing these summarised data in a way that is meaningful for this audience. Therefore, the aim of this scoping review was to summarise the emerging approaches to PROs data for &lsquo;service-level&rsquo; feedback to healthcare professionals. Setting: Healthcare professionals receiving PROs data feedback at the health-service level. Data sources: Databases selected for the search were Embase, Ovid Medline, Scopus, Web of Science and targeted web searching. The main search terms included: &lsquo;patient-reported outcome measures&rsquo;, &lsquo;patient-reported outcomes&rsquo;, &lsquo;patient-centred care&rsquo;, &lsquo;value-based care&rsquo;, &lsquo;quality improvement&rsquo; and &lsquo;feedback&rsquo;. Studies included were those that were published in English between January 2009 and June 2019. Primary and secondary outcome measures: Data were extracted on the feedback methods of PROs to patients or healthcare providers. A standardised template was used to extract information from included documents and academic publications. Risk of bias was assessed using Joanna Briggs Institute Levels of Evidence for Effectiveness. Results: Overall, 3480 articles were identified after de-duplication. Of these, 19 academic publications and 22 documents from the grey literature were included in the final review. Guiding principles for data display methods and graphical formats were identified. Seven major factors that may influence PRO data interpretation and use by healthcare professionals were also identified. Conclusion: While a single best format or approach to feedback PROs data to healthcare professionals was not identified, numerous guiding principles emerged to inform the field.</jats:sec

A five-membered PdSbn coordination series

Five complexes of the general formula PdCl2(SbMe2Cl)n (n = 1-5) have been synthesised by combining [PdCl2(MeCN)2] and SbMe2Cl in different molar ratios in toluene. Their solid-state structures have been determined by X-ray crystallography. The complexes display considerable structural diversity: [Pd4Cl8(SbMe2Cl)4] (1, n = 1) is a chloride bridged tetramer, [Pd2Cl4(SbMe2Cl)4] (2, n = 2) is a dimer, [PdCl(SbMe2Cl)2(SbMe2Cl2)] (3, n = 3) is a supramolecular polymer, [Pd2(SbMe2Cl)8]Cl4¬ (4, n = 4) is a loosely associated dimer and [Pd(SbMe2Cl)5]Cl2 (5, n = 5) is a monomer with square pyramidal PdSb5 coordination geometry. Each structure contains secondary interactions between coordinated Sb centres and chloride ligands or anions, resulting in five-coordinate Sb in all cases with a range of Sb∙∙∙Cl bond lengths. The electronic structures of these complexes have been investigated using DFT methods including NBO and Pipek-Mezey localised orbital methods in order to interrogate both the Sb-Pd and secondary Sb∙∙∙Cl bonding

Utilizing electronic health records to predict acute kidney injury risk and outcomes: Workgroup statements from the 15^th ADQI Consensus Conference

The data contained within the electronic health record (EHR) is "big" from the standpoint of volume, velocity, and variety. These circumstances and the pervasive trend towards EHR adoption have sparked interest in applying big data predictive analytic techniques to EHR data. Acute kidney injury (AKI) is a condition well suited to prediction and risk forecasting; not only does the consensus definition for AKI allow temporal anchoring of events, but no treatments exist once AKI develops, underscoring the importance of early identification and prevention. The Acute Dialysis Quality Initiative (ADQI) convened a group of key opinion leaders and stakeholders to consider how best to approach AKI research and care in the "Big Data" era. This manuscript addresses the core elements of AKI risk prediction and outlines potential pathways and processes. We describe AKI prediction targets, feature selection, model development, and data display

Modelling ground vibrations induced by harmonic loads

A finite-element model combining the frequency domain thin-layer method with paraxial boundary conditions to simulate the semi-infinite extent of a soil medium is presented in this paper. The combined numerical model is used to deal with harmonic vibrations of surface rigid foundations on non-horizontal soil profiles. The model can deal with soil media over rigid bedrock or significant depths of half-space. Structured finite elements are used to mesh simple geometry soil domains, whereas unstructured triangular mesh grids are employed to deal with complex geometry problems. Dynamic responses of homogeneous as well as layered soil profiles are simulated and validated against analytical and approximate solutions. Finally, the model is used to deal with surface ground vibration reduction, in which it is first validated against published results and then followed by an example involving a bridge

Combinatorial Roles of Heparan Sulfate Proteoglycans and Heparan Sulfates in Caenorhabditis elegans Neural Development

Heparan sulfate proteoglycans (HSPGs) play critical roles in the development and adult physiology of all metazoan organisms. Most of the known molecular interactions of HSPGs are attributed to the structurally highly complex heparan sulfate (HS) glycans. However, whether a specific HSPG (such as syndecan) contains HS modifications that differ from another HSPG (such as glypican) has remained largely unresolved. Here, a neural model in C. elegans is used to demonstrate for the first time the relationship between specific HSPGs and HS modifications in a defined biological process in vivo. HSPGs are critical for the migration of hermaphrodite specific neurons (HSNs) as genetic elimination of multiple HSPGs leads to 80% defect of HSN migration. The effects of genetic elimination of HSPGs are additive, suggesting that multiple HSPGs, present in the migrating neuron and in the matrix, act in parallel to support neuron migration. Genetic analyses suggest that syndecan/sdn-1 and HS 6-O-sulfotransferase, hst-6, function in a linear signaling pathway and glypican/lon-2 and HS 2-O-sulfotransferase, hst-2, function together in a pathway that is parallel to sdn-1 and hst-6. These results suggest core protein specific HS modifications that are critical for HSN migration. In C. elegans, the core protein specificity of distinct HS modifications may be in part regulated at the level of tissue specific expression of genes encoding for HSPGs and HS modifying enzymes. Genetic analysis reveals that there is a delicate balance of HS modifications and eliminating one HS modifying enzyme in a compromised genetic background leads to significant changes in the overall phenotype. These findings are of importance with the view of HS as a critical regulator of cell signaling in normal development and disease

Vibrating barrier:a novel device for the passive control of structures under ground motion

A novel device, called vibrating barrier (ViBa), that aims to reduce the vibrations of adjacent structures subjected to ground motion waves is proposed. The ViBa is a structure buried in the soil and detached from surrounding buildings that is able to absorb a significant portion of the dynamic energy arising from the ground motion. The working principle exploits the dynamic interaction among vibrating structures due to the propagation of waves through the soil, namely the structure–soil–structure interaction. The underlying theoretical aspects of the novel control strategy are scrutinized along with its numerical modelling. Closed-form solutions are also derived to design the ViBa in the case of harmonic excitation. Numerical and experimental analyses are performed in order to investigate the efficiency of the device in mitigating the effects of ground motion waves on the structural response. A significant reduction in the maximum structural acceleration of 87% has been achieved experimentally

Loading protocols for European regions of low to moderate seismicity

Existing loading protocols for quasi-static cyclic testing of structures are based on recordings from regions of high seismicity. For regions of low to moderate seismicity they overestimate imposed cumulative damage demands. Since structural capacities are a function of demand, existing loading protocols applied to specimens representative of structures in low to moderate seismicity regions might underestimate structural strength and deformation capacity. To overcome this problem, this paper deals with the development of cyclic loading protocols for European regions of low to moderate seismicity. Cumulative damage demands imposed by a set of 60 ground motion records are evaluated for a wide variety of SDOF systems that reflect the fundamental properties of a large portion of the existing building stock. The ground motions are representative of the seismic hazard level corresponding to a 2% probability of exceedance in 50 years in a European moderate seismicity region. To meet the calculated cumulative damage demands, loading protocols for different structural types and vibration periods are developed. For comparison, cumulative seismic demands are also calculated for existing protocols and a set of records that was used in a previous study on loading protocols for regions of high seismicity. The median cumulative demands for regions of low to moderate seismicity are significantly less than those of existing protocols and records of high seismicity regions. For regions of low to moderate seismicity the new protocols might therefore result in larger strength and deformation capacities and hence in more cost-effective structural configurations or less expensive retrofit measures