An exploratory qualitative study to identify factors that influence the use of electronic patient journey boards in Queensland health

Technology in the healthcare and use of Information and Communication technologies (ICT) in healthcare is on the rise among the developing economies. In spite of some limitations and limited use of ICT in the healthcare domain, ICT is expected to grow in the Australian Healthcare system. This research paper provides preliminary findings on views expressed by users regarding the use of Electronic Patient Journey Boards (EPJBs) in Queensland Health. Initial data was collected through a qualitative approach in order to understand the views of health professionals regarding EPJBs. This was achieved through interviews, brainstorming sessions and focus groups held with healthcare professionals who have used the EPJB and those who will be using EPJBs in the future. This qualitative data was analysed through the lens of three key critical variables, namely people, processes and technology. The preliminary findings show that these three variables are critical for the success of the use and implementation of EPJBs in the healthcare domain. Furthermore, this research paper was also able to identify factors that will have a significant influence on the implementation of a technology in a healthcare setting. This study is limited to Queensland Health and needs further research to test the findings of the study in order to apply the findings more generally

The impact of maintaining serum potassium ≥3.6 mEq/L vs ≥4.5 mEq/L on the incidence of new-onset atrial fibrillation in the first 120 hours after isolated elective coronary artery bypass grafting - study protocol for a randomised feasibility trial for the proposed Tight K randomized non-inferiority trial.

BACKGROUND: Atrial fibrillation (AF) occurs in approximately one in three patients after cardiac surgery, and is associated with increased short-term and long-term mortality, intensive care unit (ICU) and hospital stay, and increased cost of care. In an attempt to reduce AF incidence in these patients, serum potassium (K+) levels are commonly maintained at the high end of normal (4.5-5.5 mEq/L). However, such potassium supplementation is without proven benefit, and is not without negative consequences. It carries clinical risk, negatively impacts patient experience and is both time-consuming and costly. This protocol describes a randomised controlled pilot trial to assess the feasibility of a proposed randomised non-inferiority trial to investigate the impact of maintaining serum potassium ≥ 3.6 mEq/L vs ≥ 4.5 mEq/L on the incidence of new-onset atrial fibrillation in the first 120 hours after isolated elective coronary artery bypass grafting. METHODS: Design: this is a randomized feasibility trial as a pilot for a randomized non-inferiority trial. PARTICIPANTS: are 160 patients undergoing isolated coronary artery bypass grafting at two centres. Allocation: patients will be randomized (1:1) to protocols aiming to maintain serum potassium at either ≥ 3.6 mEq/L ("relaxed control") or ≥ 4.5 mEq/L ("tight control"). Primary analytic aim: was to assess the feasibility and acceptability of planning and delivering the intervention and trial methods to inform a full-scale non-inferiority trial. OUTCOME: the primary indicative efficacy outcome measures being field-tested are feasibility of participant recruitment and randomization, maintaining a protocol violation rate < 10%, and retaining 90% patient follow up 28 days after surgery. The primary clinical outcome measure of the future full "Tight K Study" will be incidence of AF after cardiac surgery. DISCUSSION: The Tight K Pilot will assess the feasibility of conducting the full trial, which is intended to confirm or refute the efficacy of current potassium management in preventing AF after cardiac surgery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03195647 . Registered on 23 May 2017. Last updated 19June 2017

Reducing youth suicide : systems modelling and simulation to guide targeted investments across the determinants

Background: Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources. Methods: Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period. Results: A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3–30.8%) and suicide deaths by 29.3% (95% interval 27.1–31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that ‘more is not necessarily better.’ Conclusion: Results indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources

Impact of maintaining serum potassium concentration ≥ 3.6mEq/L versus ≥ 4.5mEq/L for 120 hours after isolated coronary artery bypass graft surgery on incidence of new onset atrial fibrillation: Protocol for a randomized non-inferiority trial.

BACKGROUND: Atrial Fibrillation After Cardiac Surgery (AFACS) occurs in about one in three patients following Coronary Artery Bypass Grafting (CABG). It is associated with increased short- and long-term morbidity, mortality and costs. To reduce AFACS incidence, efforts are often made to maintain serum potassium in the high-normal range (≥ 4.5mEq/L). However, there is no evidence that this strategy is efficacious. Furthermore, the approach is costly, often unpleasant for patients, and risks causing harm. We describe the protocol of a planned randomized non-inferiority trial to investigate the impact of intervening to maintain serum potassium ≥ 3.6 mEq/L vs ≥ 4.5 mEq/L on incidence of new-onset AFACS after isolated elective CABG. METHODS: Patients undergoing isolated CABG at sites in the UK and Germany will be recruited, randomized 1:1 and stratified by site to protocols maintaining serum potassium at either ≥ 3.6 mEq/L or ≥ 4.5 mEq/L. Participants will not be blind to treatment allocation. The primary endpoint is AFACS, defined as an episode of atrial fibrillation, flutter or tachycardia lasting ≥ 30 seconds until hour 120 after surgery, which is both clinically detected and electrocardiographically confirmed. Assuming a 35% incidence of AFACS in the 'tight control group', and allowing for a 10% loss to follow-up, 1684 participants are required to provide 90% certainty that the upper limit of a one-sided 97.5% confidence interval (CI) will exclude a > 10% difference in favour of tight potassium control. Secondary endpoints include mortality, use of hospital resources and incidence of dysrhythmias not meeting the primary endpoint (detected using continuous heart rhythm monitoring). DISCUSSION: The Tight K Trial will assess whether a protocol to maintain serum potassium ≥ 3.6 mEq/L is non inferior to maintaining serum potassium ≥ 4.5 mEq/L in preventing new-onset AFACS after isolated CABG. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04053816. Registered on 13 August 2019. Last update 7 January 2021

Maintenance of Serum Potassium Levels ≥3.6 mEq/L Versus ≥4.5 mEq/L After Isolated Elective Coronary Artery Bypass Grafting and the Incidence of New-Onset Atrial Fibrillation: Pilot and Feasibility Study Results.

OBJECTIVE: Serum potassium levels frequently are maintained at high levels (≥4.5 mEq/L) to prevent atrial fibrillation after cardiac surgery (AFACS), with limited evidence. Before undertaking a noninferiority randomized controlled trial to investigate the noninferiority of maintaining levels ≥3.6 mEq/L compared with this strategy, the authors wanted to assess the feasibility, acceptability, and safety of recruiting for such a trial. DESIGN: Pilot and feasibility study of full trial protocol. SETTING: Two university tertiary-care hospitals. PARTICIPANTS: A total of 160 individuals undergoing first-time elective isolated coronary artery bypass grafting. INTERVENTIONS: Randomization (1:1) to protocols aiming to maintain serum potassium at either ≥3.6 mEq/L or ≥4.5 mEq/L after arrival in the postoperative care facility and for 120 hours or until discharge from the hospital or AFACS occurred, whichever happened first. MEASUREMENTS AND MAIN RESULTS: Primary outcomes: (1) whether it was possible to recruit and randomize 160 patients for six months (estimated 20% of those eligible); (2) maintaining supplementation protocol violation rate ≤10% (defined as potassium supplementation being inappropriately administered or withheld according to treatment allocation after a serum potassium measurement); and (3) retaining 28-day follow-up rates ≥90% after surgery. Between August 2017 and April 2018, 723 patients were screened and 160 (22%) were recruited. Potassium protocol violation rate = 9.8%. Follow-up rate at 28 days = 94.3%. Data on planned outcomes for the full trial also were collected. CONCLUSIONS: It is feasible to recruit and randomize patients to a study assessing the impact of maintaining serum potassium concentrations at either ≥3.6 mEq/L or ≥4.5 mEq/L on the incidence of AFACS

International overview of adoption Policy and practice

Includes bibliographical referencesSIGLEAvailable from British Library Document Supply Centre- DSC:m03/25301 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Evaluating open and distance education at Central Queensland University: three sites of evidence-based practice and reflection

This seminar articulates with the recent publication of Evaluation in Open and Distance Education: Retrospects and Prospects (Nouwens, Erdinc & Danaher, 2004a), a special theme issue of the Turkish Online Journal of Distance Education, five of whose eight articles were co-written by twelve CQU staff members from three Faculties and one Division. http://tojde.anadolu.edu.tr/tojde15/index.htm The seminar takes up three of the sites of evidence-based practice and reflection around evaluating open and distance education at Central Queensland University canvassed in the theme issue: • an online discussion list as promoting students’ attitudinal change (Bradshaw & Hinton, 2004); • a philosophically informed framework for identifying multiple interests of evaluating open and distance education (Nouwens, Ross, Harreveld, Thomson & Danaher, 2004); • the selection of CQU’s designated online learning management system (Sturgess & Nouwens, 2004). Each site is examined for what it highlighted about the nature, purposes and effects of evaluating open and distance education and also for its potential utility in contributing to ongoing discussions about understanding and enhancing the effectiveness of teaching and learning at CQU

An exploratory study to identify factors that influence the use of electronic patient boards in Queensland Health

This research paper provides preliminary findings on views expressed by users regarding the use of Electronic Patient Journey Boards (EPJBs) in Queensland Health. Initial data were collected through a qualitative approach in order to understand the views of health professionals regarding EPJBs. This was achieved through interviews, brainstorming sessions and focus groups held with healthcare professionals who have used the EPJB and those who will be using EPJBs in the future. These qualitative data were analysed through the lens of three key critical variables, namely people, processes and technology. The preliminary findings show that these three variables are critical for the success of the use and implementation of EPJBs in the healthcare domain. Furthermore, this research paper was also able to identify factors that will have a significant influence on the implementation of a technology in a healthcare setting. This study is limited to Queensland Health and needs further research to test the findings of the study, in order to apply the findings more generally. The analysis of data provides an initial blueprint for the implementation of EPJBs more widely

The impact of technology-enabled care coordination in a complex mental health system : a local system dynamics model

Background: Prior to the COVID-19 pandemic major shortcomings in the way mental health care systems are organised was impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and resulting social dislocation will depend on the extent to which care systems will become overwhelmed and the strategic investments made across the system to effectively respond. Objective: This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. Methods: A system dynamics model for the regional population catchment of North Coast New South Wales was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care and suicidal behaviour (SB). The model reproduced historic timeseries data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (self-harm hospitalisations), suicide deaths, mental health-related ED presentations and psychological distress over the period of 2021 to 2030. These scenarios include: (1) business as usual; (2) increase in service capacity growth rate by 20% (3) standard telehealth; and (4) technology-enabled care coordination. Each scenario was tested using both pre- and post-COVID-19 social and economic conditions. Results: Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalisations and suicide deaths by 6·71% (95% interval, 5·63-7·8%), mental health-related ED presentations by 10·33% (95% interval, 8·58-12·1%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval, 1·35-2·32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had a substantially lower impact. This pattern of results was replicated under post-COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which effectively reduces the negative impact of the pandemic on mental health and suicide. Conclusions: The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of increasing service capacity growth rate by 20% or standard telehealth reiterates that strengthening how the whole mental health system functions together will have a greater impact on outcomes than simply improving the capacity of individual components of the system. Investments into more of the same type of programs and services alone won’t be enough to improve outcomes, instead new models of care and the digital infrastructure to support them are needed. Clinical Trial: N