Implementation outcome instruments for use in physical healthcare settings: a systematic review

BACKGROUND: Implementation research aims to facilitate the timely and routine implementation and sustainment of evidence-based interventions and services. A glaring gap in this endeavour is the capability of researchers, healthcare practitioners and managers to quantitatively evaluate implementation efforts using psychometrically sound instruments. To encourage and support the use of precise and accurate implementation outcome measures, this systematic review aimed to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings. METHOD: The following data sources were searched from inception to March 2019, with no language restrictions: MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL and the Cochrane library. Studies that evaluated the measurement properties of implementation outcome instruments in physical healthcare settings were eligible for inclusion. Proctor et al.'s taxonomy of implementation outcomes was used to guide the inclusion of implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration, implementation cost and sustainability. Methodological quality of the included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Psychometric quality of the included instruments was assessed using the Contemporary Psychometrics checklist (ConPsy). Usability was determined by number of items per instrument. RESULTS: Fifty-eight publications reporting on the measurement properties of 55 implementation outcome instruments (65 scales) were identified. The majority of instruments assessed acceptability (n = 33), followed by appropriateness (n = 7), adoption (n = 4), feasibility (n = 4), penetration (n = 4) and sustainability (n = 3) of evidence-based practice. The methodological quality of individual scales was low, with few studies rated as 'excellent' for reliability (6/62) and validity (7/63), and both studies that assessed responsiveness rated as 'poor' (2/2). The psychometric quality of the scales was also low, with 12/65 scales scoring 7 or more out of 22, indicating greater psychometric strength. Six scales (6/65) rated as 'excellent' for usability. CONCLUSION: Investigators assessing implementation outcomes quantitatively should select instruments based on their methodological and psychometric quality to promote consistent and comparable implementation evaluations. Rather than developing ad hoc instruments, we encourage further psychometric testing of instruments with promising methodological and psychometric evidence. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2017 CRD42017065348

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

The flora and vegetation of rocky outcrops in three municipalities in the northern region of Ceará, Brazil: phytosociological characterization

Veja material suplementar em <https://doi.org/10.6084/m9.figshare.5915233.v2O presente estudo teve como objetivo identificar a flora e a vegetação dos afloramentos rochosos isolados e de baixa altitude (lajedos), na vegetação de Caatinga Arbustiva Aberta, que se encontram nos municípios de Sobral, Groaíras e Santa Quitéria, no estado do Ceará, Brasil e propor uma classificação fitossociológica para estas comunidades xerófilas. Foram definidas cinco áreas de coleta de dados com elevada proporção de rochas expostas (> 80%) onde as excursões de campo decorreram em março de 2014 e 2015 (3º56’S e 40º23’W, 4º01’S e 40º05’W, 4º07’S e 40º08’W, 4º09’S e 40º09’W e 4º03’S e 40º00’W). No estudo da vegetação aplicou-se os métodos TWINSPAN (two-way indicator species analysis) e o clássico sigmatista de Braun-Blanquet. As áreas mínimas dos inventários fitossociológicos variaram de 8 a 16 m2. Foram coletadas as espécies vegetais que crescem em fissuras, fendas e ilhas de vegetação que se encontram em afloramentos rochosos. Foram registradas 88 espécies, distribuídas em 59 gêneros e 30 famílias botânicas. Fabaceae foi a família que se destacou em riqueza específica (20 spp.), seguida por Poaceae (dez spp.), Euphorbiaceae (sete spp.) e Convolvulaceae (seis spp.). Quanto ao endemismo foram registradas, em vegetação rupestre, 19 espécies endêmicas para o Brasil. Na análise fitossociológica da vegetação propôs-se estudar a comunidade de Pilosocereus gounellei (FA.C.Weber) Byles & Rowley e Encholirium spectabile Mart. ex Schult. & Schult.f. e a de Crateva tapia L. e Combretum leprosum Martinfo:eu-repo/semantics/publishedVersio

Study of the rare decays of B_{s}^{0} and B^{0} mesons into muon pairs using data collected during 2015 and 2016 with the ATLAS detector

A study of the decays B_{s}^{0} → μ⁺μ⁻ and B_{0} → μ⁺μ⁻ has been performed using 26.3 fb⁻¹ of 13 TeV LHC proton-proton collision data collected with the ATLAS detector in 2015 and 2016. Since the detector resolution in μ⁺μ⁻ invariant mass is comparable to the B_{s}^{0} - B^{0} mass difference, a single fit determines the signal yields for both decay modes. This results in a measurement of the branching fraction Β (B^{0} → μ⁺μ⁻) < 4.3 x 10⁻¹⁰ at 95% confidence level. The result is combined with the Run 1 ATLAS result, yielding Β (B_{s}^{0} → μ⁺μ⁻) = (2.8_{-0.7}^{+0.8}) x 10⁻⁹ and Β (B^{0} → μ⁺μ⁻) < 2.1 x 10⁻¹⁰ at 95% confidence level. The combined result is consistent with the Standard Model prediction within 2.4 standard deviations in the B (B^{0} → μ⁺μ⁻) - Β (B_{s}^{0} → μ⁺μ⁻) plane

Search for new phenomena in high-mass final states with a photon and a jet from pp collisions at root s=13 TeV with the ATLAS detector

A search is performed for new phenomena in events having a photon with high transverse momentum and a jet collected in 36.7 fb−1 of proton–proton collisions at a centre-of-mass energy of s√ = 13 TeV recorded with the ATLAS detector at the Large Hadron Collider. The invariant mass distribution of the leading photon and jet is examined to look for the resonant production of new particles or the presence of new high-mass states beyond the Standard Model. No significant deviation from the background-only hypothesis is observed and cross-section limits for generic Gaussian-shaped resonances are extracted. Excited quarks hypothesized in quark compositeness models and high-mass states predicted in quantum black hole models with extra dimensions are also examined in the analysis. The observed data exclude, at 95% confidence level, the mass range below 5.3 TeV for excited quarks and 7.1 TeV (4.4 TeV) for quantum black holes in the Arkani-Hamed–Dimopoulos–Dvali (Randall–Sundrum) model with six (one) extra dimensions

Measurement of the transverse momentum and ϕ∗ηϕη∗ distributions of Drell–Yan lepton pairs in proton–proton collisions at s√=8s=8 TeV with the ATLAS detector

Distributions of transverse momentum p T and the related angular variable φ∗ η of Drell–Yan lepton pairs are measured in 20.3 fb−1 of proton–proton collisions at √s = 8 TeV with the ATLAS detector at the LHC. Measurements in electron-pair and muon-pair final states are corrected for detector effects and combined. Compared to previous measurements in proton–proton collisions at √s = 7 TeV, these new measurements benefit from a larger data sample and improved control of systematic uncertainties. Measurements are performed in bins of lepton-pair mass above, around and below the Z-boson mass peak. The data are compared to predictions from perturbative and resummed QCD calculations. For values of φ∗ η < 1 the predictions from the Monte Carlo generator ResBos are generally consistent with the data within the theoretical uncertainties. However, at larger values of φ∗ η this is not the case. Monte Carlo generators based on the parton-shower approach are unable to describe the data over the full range of p T while the fixed-order prediction of Dynnlo falls below the data at high values of p T . ResBos and the parton-shower Monte Carlo generators provide a much better description of the evolution of the φ∗ η and p T distributions as a function of lepton-pair mass and rapidity than the basic shape of the data. Conte

Adesão de mulheres mastectomizadas ao início precoce de um programa de reabilitação Adhesión de mujeres mastectomizadas al inicio de un programa de rehabilitación temprana Adherence to an early rehabilitation program among women who underwent mastectomy

OBJETIVOS: Verificar a adesão de mulheres mastectomizadas ao início precoce de um programa de reabilitação da amplitude de movimento do ombro homolateral à cirurgia e identificar as dificuldades na realização dos exercícios e das atividades de vida diária. MÉTODOS: Estudo prospectivo desenvolvido no Ambulatório de Oncomastologia do Hospital São Paulo/Universidade Federal de São Paulo, no período de 2003 a 2004. A amostra constitui-se de 28 mulheres mastectomizadas que aceitaram participar do programa de reabilitação, desde a alta hospitalar até o primeiro retorno ambulatorial. RESULTADOS: Aderiram ao programa 64,2% das pacientes e 82,1% referiram dificuldade para execução dos exercícios, principalmente devido à dor. A maioria realizou as atividades de vida diária sem dificuldades. CONCLUSÃO: Faz-se necessário um melhor controle da dor pós-operatória e reforço das orientações para incrementar a adesão das pacientes ao programa de reabilitação.<br>OBJETIVOS: Verificar la adhesión de mujeres mastectomizadas al inicio de un programa de rehabilitación temprana de la amplitud de movimiento del hombro homolateral a la cirugía, e identificar las dificultades en la realización de los ejercicios y de las actividades de vida diaria. MÉTODOS: Estudio prospectivo desarrollado en consulta externa de Oncomastología del Hospital São Paulo/Universidade Federal de São Paulo, en el período 2003 al 2004. La muestra se constituyó de 28 mujeres mastectomizadas que aceptaron participar del programa de rehabilitación, desde el alta hospitalario hasta el primer retorno ambulatorio. RESULTADOS: La adhesion al programa fue del 64,2% de las pacientes y el 82,1% refirieron dificultad para la ejecución de los ejercicios, principalmente debido al dolor. La mayoría realizó las actividades de vida diaria sin dificultades. CONCLUSIÓN: Se hace necesario un mejor control del dolor post operatorio y refuerzo de las orientaciones para incrementar la adhesión de las pacientes al programa de rehabilitación.<br>OBJECTIVES: The main objective was to measure adherence to an early rehabilitation program among women who underwent mastectomy. Other specific objectives included the identification of women's difficulties to comply with the exercise prescription and to perform daily life activities, and whether women's adherence to the rehabilitation program was effective in regaining their shoulder's full range of motion on the side of the surgery. METHODS: A prospective study design was used. A sample of 28 women who underwent mastectomy and agreed to participate in an early rehabilitation program from discharge to the first outpatient clinic follow-up participated in the study. Data were collected from 2003 to 2004 in the oncomastology outpatient clinic of the Hospital São Paulo of the University Federal of São Paulo. RESULTS: The majority of women (63.2%) adhered to the early rehabilitation program. The majority of women (82.1%) also reported having difficulties to perform the prescribed exercise program due to pain but not with daily life activities. CONCLUSION: Pain management and patient education must be addressed to improve adherence to the early rehabilitation program

Accomplishing the genotype-specific serodiagnosis of single and dual <i>Trypanosoma cruzi</i> infections by flow cytometry Chagas-Flow ATE-IgG2a

<div><p>The methods currently available for genotype-specific diagnosis of <i>T</i>. <i>cruzi</i> infection still present relevant limitations, especially to identify mixed infection. In the present investigation, we have evaluated the performance of Chagas-Flow ATE-IgG2a test for early and late differential diagnosis of single and dual genotype-specific <i>T</i>. <i>cruzi</i> infections. Serum samples from Swiss mice at early and late stages of <i>T</i>. <i>cruzi</i> infection were assayed in parallel batches for genotype-specific diagnosis of single (TcI, TcVI or TcII) and dual (TcI+TcVI, TcVI+TcII or TcII+TcI) infections. The intrinsic reactivity to TcI, TcVI and TcII target antigens, including amastigote (AI/AVI/AII), trypomastigote-(TI/TVI/TII) and epimastigote (EI/EVI/EII), at specific reverse of serum dilutions (500 to 64,000), was employed to provide reliable decision-trees for “early” <i>vs</i> “late”, “single <i>vs</i> “dual” and “genotype-specific” serology. The results demonstrated that selective set of attributes “EII 500/EI 2,000/AII 500” were able to provide high-quality accuracy (81%) to segregate early and late stages of <i>T</i>. <i>cruzi</i> infection. The sets “TI 2,000/AI 1,000/EII 1,000” and “TI 8,000/AII 32,000” presented expressive scores to discriminate single from dual <i>T</i>. <i>cruzi</i> infections at early (85%) and late stages (84%), respectively. Moreover, the attributes “TI 4,000/TVI 500/TII 1,000”, “TI 16,000/EI 2,000/EII 2,000/AI 500/TVI 500” showed good performance for genotype-specific diagnosis at early stage of single (72%) and dual (80%) <i>T</i>. <i>cruzi</i> infections, respectively. In addition, the attributes “TI 4,000/AII 1,000/EVI 1,000”, “TI 64,000/AVI 500/AI 2,000/AII 1,000/EII 4,000” showed moderate performance for genotype-specific diagnosis at late stage of single (69%) and dual (76%) <i>T</i>. <i>cruzi</i> infections, respectively. The sets of decision-trees were assembled to construct a sequential algorithm with expressive accuracy (81%) for serological diagnosis of <i>T</i>. <i>cruzi</i> infection. These findings engender new perspectives for the application of Chagas-Flow ATE-IgG2a method for genotype-specific diagnosis in humans, with relevant contributions for epidemiological surveys as well as clinical and post-therapeutic monitoring of Chagas disease.</p></div