The effectiveness of providing peer benchmarked feedback to hip replacement surgeons based on patient-reported outcome measures—results from the PROFILE (Patient-Reported Outcomes: Feedback Interpretation and Learning Experiment) trial: a cluster randomised controlled study

Objective To test whether providing surgeons with peer benchmarked feedback about patient-reported outcomes is effective in improving patient outcomes.Design Cluster randomised controlled trial.Setting Secondary care—Ireland.Participants Surgeons were recruited through the Irish Institute of Trauma and Orthopaedic Surgery, and patients were recruited in hospitals prior to surgery. We randomly allocated 21 surgeons and 550 patients.Intervention Surgeons in the intervention group received peer benchmarked patient-reported outcome measures (PROMs) feedback and education.Main outcome variable Postoperative Oxford Hip Score (OHS).Results Primary outcome data were available for 11 intervention surgeons with responsibility for 230 patients and 10 control surgeons with responsibility for 228 patients. The mean postoperative OHS for the intervention group was 40.8 (95% CI 39.8 to 41.7) and for the control group was 41.9 (95% CI 41.1 to 42.7). The adjusted effect estimate was −1.1 (95% CI −2.4 to 0.2, p=0.09). Secondary outcomes were the Hip Osteoarthritis Outcome Score (HOOS), EQ-5D and the proportion of patients reporting a problem after surgery. The mean postoperative HOOS for the intervention group was 36.2 and for the control group was 37.1. The adjusted effect estimate was −1.1 (95% CI −2.4 to 0.3, p=0.1). The mean postoperative EQ-5D for the intervention group was 0.85 and for the control group was 0.87. The adjusted effect estimate was −0.02 (95% CI −0.05 to 0.008, p=0.2). 27% of intervention patients and 24% of control patients reported at least one complication after surgery (adjusted OR=1.2, 95% CI 0.6 to 2.3, p=0.6).Conclusions Outcomes for patients operated on by surgeons who had received peer benchmarked PROMs data were not statistically different from the outcomes of patients operated on by surgeons who did not receive feedback. PROMs information alone seems to be insufficient to identify opportunities for quality improvement.Trial registration number ISRCTN 69032522

Patient experience of different regional models of urgent and emergency care: a cross-sectional survey study

Objectives: To compare user experiences of 8 regional urgent and emergency care systems in the Republic of Ireland, and explore potential avenues for improvement. Design: A cross-sectional survey. Setting: Several distinct models of urgent and emergency care operate in Ireland, as system reconfiguration has been implemented in some regions but not others. The Urgent Care System Questionnaire was used to explore service users' experiences with urgent and emergency care. Linear regression and logistic regression were used to detect regional variation in each of the 3 domains and overall ratings of care. Participants: A nationally representative sample (N=8002) of the general population was contacted by telephone, yielding 1205 participants who self-identified as having used urgent and emergency care services in the previous 3?months. Main outcome measures Patient experience was assessed across 3 domains: entry into the system, progress through the system and patient convenience of the system. Participants were also asked to provide an overall rating of the care they received. Results: Service users in Dublin North East gave lower ratings on the entry into the system scale than those in Dublin South (adjusted mean difference=?0.18; 95% CI ?0.35 to ?0.10; p=0.038). For overall ratings of care, service users in the Mid-West were less likely than those in Dublin North East to give an excellent rating (adjusted OR 0.57; 95% CI 0.35 to 0.92; p=0.022). Survey items relating to communication, and consideration of patients' needs were comparatively poorly rated. The use of public emergency departments and out-of-hours general practice care was associated with poorer patient experiences. Conclusions: No consistent relationship was found between the type of urgent and emergency care model in different regions and patient experience. Scale-level data may not offer a useful metric for exploring the impact of system-level service change

The Italian Experience in Protecting Older People During COVID-19: Lessons Learned for Long-Term Care Facilities (LTCF)

Context: Older people living in LTCF were particularly affected by COVID-19. Italy was the first country in Europe to experience high death rates among older people. Analysing the factors which may have determined high mortality rates in LTCF and identifying actions to safeguard older people’s health in long-term care settings may be critical for future public health emergencies. Objectives: Identify the main challenges and failures faced by a small number of Italian professionals working in LTCF and suggest key actions to better protect older people’s health in future emergencies. Methods: Rapid survey conducted among Italian professionals working in the LTC sector in Italy during the pandemic. Findings: Several factors contributed to higher death rates in LTCF for older people in Italy. To better protect LTCF residents in case of future health emergencies, actions need to be implemented in relation to LTCF’s management, governance and capacity building. Furthermore, safety plans and strategies need to be put in place to ensure older residents’ protection and maintain high level of care in LTCF during public health emergencies, such as COVID-19. Limitations: The article reflects the opinions of a limited number of professionals working in the long-term care sector, which may not be representative of all workers operating in the sector. Implications: Policy and system changes are needed to strengthen the capacity of the Italian long- term care sector to respond to the needs of a growing older population in the context of COVID-19 and beyond

Creativity Challenge: The State of Arts Education in California

California has long maintained ambitious goals for arts education. The state Education Code requires schools to offer courses of study in four arts disciplines to all California K–12 students. In 2005/06, with support from the William and Flora Hewlett Foundation, SRI Education researchers conducted a study of arts education in California. Our goal was to assess schools' arts programs relative to state goals, examine the systems of support for these programs, and identify ways in which state and local policymakers might improve conditions for young people to experience arts education in schools. In 2019, the Hewlett Foundation engaged SRI to "refresh" the 2007 study. In most ways, the current study addresses the same research questions and relies on the same research design and data sources as the earlier report—a statewide school survey, case studies, and analysis of extant data provided by the California Department of Education. The context, however, has changed. Perhaps most prominently, in 2013, with the Local Control Funding Formula (LCFF), California radically changed its system for funding schools. Importantly, we examined arts education in California schools in school year 2019/20 and as such the data collected for this study reflect the status of arts education in California prior to the pandemic. In 2021 and 2022, before the release of this report (but after data collection), California enacted a host of new policies that may improve students' opportunities to experience arts education in schools.Overall, we found that, while much remained the same in 2020 as in 2006, some aspects of arts education in California's K–12 schools had improved. These improvements coincide with funding increases associated with LCFF and career and technical education (CTE), coordinated advocacy efforts, changes to the state accountability system, and substantial increases in support from school districts, counties, and partner organizations. Nonetheless, despite improvements, California schools still fall short of state goals for arts education and a persistent pattern of inequity emerges from our current data

Stratum Corneum Lipid Composition and Structure in Cultured Skin Substitutes is Restored to Normal after Grafting onto Athymic Mice

Restoration of an epidermal barrier is a definitive requirement for wound closure. Cultured skin substitutes grafted onto athymic nude mice were used as a model for a long-term study of stratum corneum barrier lipid metabolism and organization. Samples of stratum corneum collected after 12 and 21 d in vitro and 6, 11, and 24 mo postgrafting were examined for their lipid and fatty acid composition, and their lipid organization and structure using electron microscopy and small angle X-ray diffraction, respectively. All of these methods confirm the impaired barrier function of cultured skin substitutes in vitro, as judged from the deviations in lipid composition and from poor organization of the stratum corneum lipids that show no lamellar structure. At 6 mo postgrafting, the total stratum corneum lipid profiles of the epidermal grafts is close to that of the human stratum corneum with the exception of the presence of mouse specific lipids. The increase of ceramides 4–7 in cultured skin substitutes after grafting indicates restored activity of processes involved in the hydroxylation of fatty acids and sphingoid bases. Conversely, the ceramide profile still reveals some abnormalities (elevated content of ceramide 2 and slightly lower content of ceramide 3) and the content of long-chain fatty acids remains below its physiologic level at 6 mo postgrafting, but normalizes by 2 y postgrafting. The ultramicroscopic observations revealed the formation of lamellar extracellular lipid domains by 4 mo postgrafting. Despite these findings, the X-ray diffraction showed differences in the diffraction pattern at 2 y after grafting, suggesting that the organization of stratum corneum lipids in all epidermal grafts differs from that of the native skin. Journal of Investigative Dermatology Symposium Proceedings 3:114–120, 199

EJVES vol 34, issue 2 (August 2007) - Spanish Translated Abstracts

Chronic exposure to arsenic (As) through the consumption of contaminated groundwaters is a major threat to public health in South and Southeast Asia. The source of As-affected groundwaters is important to the fundamental understanding of the controls on As mobilization and subsequent transport throughout shallow aquifers. Using the stable isotopes of hydrogen and oxygen, the source of groundwater and the interactions between various water bodies were investigated in Cambodia’s Kandal Province, an area which is heavily affected by As and typical of many circum-Himalayan shallow aquifers. Two-point mixing models based on δD and δ18O allowed the relative extent of evaporation of groundwater sources to be estimated and allowed various water bodies to be broadly distinguished within the aquifer system. Model limitations are discussed, including the spatial and temporal variation in end member compositions. The conservative tracer Cl/Br is used to further discriminate between groundwater bodies. The stable isotopic signatures of groundwaters containing high As and/or high dissolved organic carbon plot both near the local meteoric water line and near more evaporative lines. The varying degrees of evaporation of high As groundwater sources are indicative of differing recharge contributions (and thus indirectly inferred associated organic matter contributions). The presence of high As groundwaters with recharge derived from both local precipitation and relatively evaporated surface water sources, such as ponds or flooded wetlands, are consistent with (but do not provide direct evidence for) models of a potential dual role of surface-derived and sedimentary organic matter in As mobilization

Dynamic enhancement of drug product labels to support drug safety, efficacy, and effectiveness

Out-of-date or incomplete drug product labeling information may increase the risk of otherwise preventable adverse drug events. In recognition of these concerns, the United States Federal Drug Administration (FDA) requires drug product labels to include specific information. Unfortunately, several studies have found that drug product labeling fails to keep current with the scientific literature. We present a novel approach to addressing this issue. The primary goal of this novel approach is to better meet the information needs of persons who consult the drug product label for information on a drug’s efficacy, effectiveness, and safety. Using FDA product label regulations as a guide, the approach links drug claims present in drug information sources available on the Semantic Web with specific product label sections. Here we report on pilot work that establishes the baseline performance characteristics of a proof-of-concept system implementing the novel approach. Claims from three drug information sources were linked to the Clinical Studies, Drug Interactions, and Clinical Pharmacology sections of the labels for drug products that contain one of 29 psychotropic drugs. The resulting Linked Data set maps 409 efficacy/effectiveness study results, 784 drug-drug interactions, and 112 metabolic pathway assertions derived from three clinically-oriented drug information sources (ClinicalTrials.gov, the National Drug File – Reference Terminology, and the Drug Interaction Knowledge Base) to the sections of 1,102 product labels. Proof-of-concept web pages were created for all 1,102 drug product labels that demonstrate one possible approach to presenting information that dynamically enhances drug product labeling. We found that approximately one in five efficacy/effectiveness claims were relevant to the Clinical Studies section of a psychotropic drug product, with most relevant claims providing new information. We also identified several cases where all of the drug-drug interaction claims linked to the Drug Interactions section for a drug were potentially novel. The baseline performance characteristics of the proof-of-concept will enable further technical and user-centered research on robust methods for scaling the approach to the many thousands of product labels currently on the market

Socioeconomic inequalities in health among Swedish adolescents - adding the subjective perspective

Abstract Background Socioeconomic inequalities in adolescent health predict future inequalities in adult health. Subjective measures of socioeconomic status (SES) may contribute with an increased understanding of these inequalities. The aim of this study was to investigate socioeconomic health inequalities using both a subjective and an objective measure of SES among Swedish adolescents. Method Cross-sectional HBSC-data from 2002 to 2014 was used with a total sample of 23,088 adolescents aged 11–15 years. Three measures of self-rated health (dependent variables) were assessed: multiple health complaints, life satisfaction and health perception. SES was measured objectively by the Family Affluence Scale (FAS) and subjectively by “perceived family wealth” (independent variables). The trend for health inequalities was investigated descriptively with independent t-tests and the relationship between independent and dependent variables was investigated with multiple logistic regression analysis. Gender, age and survey year was considered as possible confounders. Results Subjective SES was more strongly related to health outcomes than the objective measure (FAS). Also, the relation between FAS and health was weakened and even reversed (for multiple health complaints) when subjective SES was tested simultaneously in regression models (FAS OR: 1.03, CI: 1.00;1.06 and subjective SES OR: 0.66, CI: 0.63;0.68). Conclusions The level of socioeconomic inequalities in adolescent health varied depending on which measure that was used to define SES. When focusing on adolescents, the subjective appraisals of SES is important to consider because they seem to provide a stronger tool for identifying inequalities in health for this group. This finding is important for policy makers to consider given the persistence of health inequalities in Sweden and other high-income countries