Implementation of a Patient Satisfaction Survey: A Pilot Project

Background: Patients who report higher satisfaction scores have better healthcare outcomes and lower financial burden in comparison to those who report lower satisfaction scores. Those less satisfied with their medical care tend to have poorer physical and mental health, which can impact daily life. For students in particular, health status impacts academic performance. Patient satisfaction surveys are a standard tool used to determine areas needing improvement within a healthcare delivery system. Objective: The purpose of this project was to implement a patient satisfaction survey at a student health center on a university campus. Design: The project was a two-month pilot study with aims to: 1) analyze response data and response rate, 2) assess survey feasibility, and 3) evaluate staff perception of patient satisfaction surveys. The patient satisfaction survey was used to achieve the first two aims. To achieve the third aim, a staff survey was distributed before and after patient survey implementation to assess changes in perception of patient satisfaction surveys. Setting: The project was implemented at a student health center at a small private university’s student health center. The clinic employs five nurse practitioners, two medical assistants and three office staff members. On average, the clinic services about 1700 students per year. Participants: All students seen at least once by a clinic provider between September 20, 2021 and March 26, 2022 were recruited for the patient satisfaction survey. All staff members were recruited for the staff surveys. Interventions: The patient satisfaction survey was based on the CG-CAHPS survey which measures satisfaction in five core areas: access to care, provider communication, care coordination, provider rating, and office staff. Patients were recruited via email, and data were collected through Qualtrics. Results: The patient survey response rate was 4.9%. The composite satisfaction scores for each measure were as follows: access to care (50%), provider communication (80%), care coordination (75%), provider rating (8.8/10), medical assistants (82.5%), front desk staff (54%). The staff survey response rate was 67%. Though a t-test and p value of each question implies no significant change in staff perception, the raw scores of most questions increased by 0.7 points, indicating a slightly more positive view of patient satisfaction surveys post-implementation. Conclusions: Establishing a patient satisfaction survey for a student health center is feasible and staff perception is generally positive

Internal Culture, External Impact: How a Change-Making Culture Positions Foundations to Achieve Transformational Change

This article argues that a foundation’s internal culture is critical to achieving large-scale social change, but that efforts to build a change-making culture too often are left out of strategy conversations. While there is no one culture that suits every foundation, a particular set of characteristics must be present in those that seek large-scale social change: a focus on outcomes, transparency, authenticity, collaboration, racial equity and inclusion, continuous learning, and openness to risk. This article offers insights into why culture can be challenging for foundations to address and maintain, examines cases of successful culture change at foundations, and offers advice for foundations that aspire to it

Re-Placing Research in the Literature Classroom

Putting research at the conceptual center of the literature classroom renews literature students’ place in the university. Students develop independent projects that make original contributions to scholarship, reinvigorate literary study, and make them competitive candidates for research fellowships. The leaders of this workshop will share their experience working on an experimental course that both redrew the relationship between the classroom and the library and offered students a new approach to research and literary study. They will discuss how the collaboration led to innovations in literary pedagogy and facilitated undergraduates’ use of contemporary digital research methods. Drawing on this experience, they will invite participants to imagine other models and offer approaches that are adaptable to various institutional and pedagogical circumstances

Tranexamic acid for post-partum haemorrhage: What, who and when.

Tranexamic acid reduces bleeding by inhibiting the breakdown of blood clots. It is cost-effective and heat-stable with a long shelf life. In the WOMAN trial, tranexamic acid reduced deaths due to bleeding with no increase in thromboembolic events. The effect was greatest when women received tranexamic acid within 3 h of childbirth (RR = 0.69, 95% CI 0.52-0.91). The WHO recommends that women with post-partum haemorrhage receive 1 g tranexamic acid intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 min or restarts within 24 h since the first dose. Urgent treatment is critical because women with post-partum haemorrhage bleed to death quickly, and tranexamic acid is most effective when given early. Evidence suggests there is no benefit when the drug is given more than 3 h after bleeding onset. Alternative routes of administration and use of tranexamic acid in the prevention of post-partum haemorrhage are research priorities

WOMAN-2 Pilot Study Data

Data and supporting material produced as part of a pilot study to test outcome questions for the WOMAN-2 trial of tranexamic acid for the prevention of postpartum haemorrhage. This pilot study was conducted in one hospital which will also be conducting the WOMAN-2 Trial in Pakistan. The pilot study population included participants similar to those to be included in the WOMAN-2 Trial: women who are anaemic, and having given birth. Participants took part in an interview which included answering questions from the draft participant reported outcomes questionnaire. A small subset of participants enrolled in this pilot study also took part in a cognitive interview directly following the questionnaire to learn how they understood the questions. Each row of the dataset table represents data for an individual participant

What Counts as Evidence in Rural Schools.pdf

This policy breif examines the importance of practice-based evidence for rural education

Tranexamic acid to reduce head injury death in people with traumatic brain injury: the CRASH-3 international RCT

Background: Tranexamic acid safely reduces mortality in traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury and can cause brain herniation and death. We assessed the effects of tranexamic acid in traumatic brain injury patients.Objective: To assess the effects of tranexamic acid on death, disability and vascular occlusive events in traumatic brain injury patients. We also assessed cost-effectiveness.Design: Randomised trial and economic evaluation. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers and those assessing outcomes were masked to allocation. All analyses were by intention to treat. We assessed the cost-effectiveness of tranexamic acid versus no treatment from a UK NHS perspective using the trial results and a Markov model.Setting: 175 hospitals in 29 countries.Participants: Adults with traumatic brain injury within 3 hours of injury with a Glasgow Coma Scale score of ≤ 12 or any intracranial bleeding on computerised tomography scan, and no major extracranial bleeding, were eligible.Intervention: Tranexamic acid (loading dose 1 g over 10 minutes then infusion of 1 g over 8 hours) or matching placebo.Main outcome measures: Head injury death in hospital within 28 days of injury in patients treated within 3 hours of injury. Secondary outcomes were early head injury deaths, all-cause and cause-specific mortality, disability, vascular occlusive events, seizures, complications and adverse events.Results: Among patients treated within 3 hours of injury (n = 9127), the risk of head injury death was 18.5% in the tranexamic acid group versus 19.8% in the placebo group (855/4613 vs. 892/4514; risk ratio 0.94, 95% confidence interval 0.86 to 1.02). In a prespecified analysis excluding patients with a Glasgow Coma Scale score of 3 or bilateral unreactive pupils at baseline, the results were 12.5% in the tranexamic acid group versus 14.0% in the placebo group (485/3880 vs. 525/3757; risk ratio 0.89, 95% confidence interval 0.80 to 1.00). There was a reduction in the risk of head injury death with tranexamic acid in those with mild to moderate head injury (166/2846 vs. 207/2769; risk ratio 0.78, 95% confidence interval 0.64 to 0.95), but in those with severe head injury (689/1739 vs. 685/1710; risk ratio 0.99, 95% confidence interval 0.91 to 1.07) there was no apparent reduction (p-value for heterogeneity = 0.030). Early treatment was more effective in mild and moderate head injury (p = 0.005), but there was no obvious impact of time to treatment in cases of severe head injury (p = 0.73). The risk of disability, vascular occlusive events and seizures was similar in both groups. Tranexamic acid is highly cost-effective for mild and moderate traumatic brain injury (base case of £4288 per quality-adjusted life-year gained).Conclusion: Early tranexamic acid treatment reduces head injury deaths. Treatment is cost-effective for patients with mild or moderate traumatic brain injury, or those with both pupils reactive.Future work: Further trials should examine early tranexamic acid treatment in mild head injury. Research on alternative routes of administration is needed.Limitations: Time to treatment may have been underestimated.Trial registration: Current Controlled Trials ISRCTN15088122, ClinicalTrials.gov NCT01402882, EudraCT 2011-003669-14, Pan African Clinical Trial Registry PACTR20121000441277.Funding: The project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 26. See the NIHR Journals Library website for further project information. In addition, funding was provided by JP Moulton Charitable Trust, Joint Global Health Trials (Medical Research Council, Department for International Development and the Wellcome Trust). This project was funded by the NIHR Global Health Trials programme

Tranexamic Acid Treatment for Trauma Victims.

Worldwide, traumatic injury is responsible for over 5 million deaths per year, the majority due to exsanguination and head injury. The antifibrinolytic drug tranexamic acid is the only drug proven to reduce deaths after traumatic injury. Several large randomized controlled trials have provided high-quality evidence of its effectiveness and safety in trauma patients. Early tranexamic acid reduces deaths on the day of the injury in polytrauma patients and patients with isolated traumatic brain injury by around 20%. Treatment is time critical; for patients to benefit, tranexamic acid must be given as soon as possible after injury. Intramuscular administration is well tolerated and rapidly absorbed, with the potential to reduce time to treatment. Because the proportional reduction in bleeding death with tranexamic acid does not vary by baseline risk, a wide range of trauma patients stands to benefit. There are far more low-risk trauma patients than high-risk patients, with a substantial proportion of bleeding deaths in the low-risk group. As such, treatment should not be limited to patients with severe traumatic hemorrhage. We must give paramedics and physicians the confidence to treat a far wider range of trauma patients while emphasizing the importance of early treatment

Use of tranexamic acid in major trauma: a sex-disaggregated analysis of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2 and CRASH-3) trials and UK trauma registry (Trauma and Audit Research Network) data

Background Women are less likely than men to receive some emergency treatments. This study examines whether the effect of tranexamic acid (TXA) on mortality in trauma patients varies by sex and whether the receipt of TXA by trauma patients varies by sex. Methods First, we conducted a sex-disaggregated analysis of data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH)-2 and CRASH-3 trials. We used interaction tests to determine whether the treatment effect varied by sex. Second, we examined data from the Trauma and Audit Research Network (TARN) to explore sex differences in the receipt of TXA. We used logistic regression models to estimate the odds ratio for receipt of TXA in females compared with males. Results are reported as n (%), risk ratios (RR), and odds ratios (OR) with 95% confidence intervals. Results Overall, 20 211 polytrauma patients (CRASH-2) and 12 737 patients with traumatic brain injuries (CRASH-3) were included in our analysis. TXA reduced the risk of death in females (RR=0.69 [0.52–0.91]) and in males (RR=0.80 [0.71–0.90]) with no significant heterogeneity by sex (P=0.34). We examined TARN data for 216 364 patients aged ≥16 yr with an Injury Severity Score ≥9 with 98 879 (46%) females and 117 485 (54%) males. TXA was received by 7198 (7.3% [7.1–7.4%]) of the females and 19 697 (16.8% [16.6–17.0%]) of the males (OR=0.39 [0.38–0.40]). The sex difference in the receipt of TXA increased with increasing age. Conclusions Administration of TXA to patients with bleeding trauma reduces mortality to a similar extent in women and men, but women are substantially less likely to be treated with TXA

Primary CNS lymphoma commonly expresses immune response biomarkers.

Background: Primary central nervous system lymphoma (PCNSL) is rare and there is limited genomic and immunological information available. Incidental clinical and radiographic responses have been reported in PCNSL patients treated with immune checkpoint inhibitors. Materials and Methods: To genetically characterize and ascertain if the majority of PCNSL patients may potentially benefit from immune checkpoint inhibitors, we profiled 48 subjects with PCNSL from 2013 to 2018 with (1) next-generation sequencing to detect mutations, gene amplifications, and microsatellite instability (MSI); (2) RNA sequencing to detect gene fusions; and (3) immunohistochemistry to ascertain PD-1 and PD-L1 expression. Tumor mutational burden (TMB) was calculated using somatic nonsynonymous missense mutations. Results: High PD-L1 expression (\u3e5% staining) was seen in 18 patients (37.5%), and intermediate expression (1-5% staining) was noted in 14 patients (29.2%). Sixteen patients (33.3%) lacked PD-L1 expression. PD-1 expression (\u3e1 cell/high-power field) was seen in 12/14 tumors (85.7%), uncorrelated with PD-L1 expression. TMB of greater than or equal to 5 mutations per megabase (mt/Mb) occurred in 41/42 tumors, with 19% ( Conclusions: Based on TMB biomarker expression, over 90% of PCNSL patients may benefit from the use of immune checkpoint inhibitors