Effectiveness of Platform-Based Robot-Assisted Rehabilitation for Musculoskeletal or Neurologic Injuries: A Systematic Review

During the last ten years the use of robotic-assisted rehabilitation has increased significantly. Compared with traditional care, robotic rehabilitation has several potential advantages. Platform-based robotic rehabilitation can help patients recover from musculoskeletal and neurological conditions. Evidence on how platform-based robotic technologies can positively impact on disability recovery is still lacking, and it is unclear which intervention is most effective in individual cases. This systematic review aims to evaluate the effectiveness of platform-based robotic rehabilitation for individuals with musculoskeletal or neurological injuries. Thirty-eight studies met the inclusion criteria and evaluated the efficacy of platform-based rehabilitation robots. Our findings showed that rehabilitation with platform-based robots produced some encouraging results. Among the platform-based robots studied, the VR-based Rutgers Ankle and the Hunova were found to be the most effective robots for the rehabilitation of patients with neurological conditions (stroke, spinal cord injury, Parkinson’s disease) and various musculoskeletal ankle injuries. Our results were drawn mainly from studies with low-level evidence, and we think that our conclusions should be taken with caution to some extent and that further studies are needed to better evaluate the effectiveness of platform-based robotic rehabilitation devices

Recommended content of referral letters from general practitioners to specialised mental health care: a qualitative multi-perspective study

Background: In most Western countries, the referral letter forms the basis for establishing the priority of patients for specialised health care and for the coordination of care between the services. To be able to define the quality of referral letters, the potential impact of the quality on the organisation of care, and to improve the quality of the letters, we need a multidimensional definition of the ideal content. The study’s aim was to explore what information is seen as most important and should be included in referral letters from primary care to specialised mental health care to facilitate prioritisation and planning of treatment and follow-up of the patients. Methods: Based on purposive sampling, four mixed discussion groups, which included general practitioners, mental health nurses from primary health care, psychiatrists and psychologists from specialised mental health care, managers and patient representatives, were formed; they were asked to identify the information they considered important in a mental health referral letter. In line with the Delphi technique, the importance of the themes was later individually rated by the participants. The study was conducted within The Western Norway Regional Health Authority.Results: The four groups identified 174 information themes. After excluding themes that were assessed as duplicates, replaceable or less important, 40 themes were suggested, organised in seven units. A set of check-off points of essential information is recommended as an introduction in the referral letter. Conclusion: Compared with general guidelines and guidelines for somatic care, the results of this study suggest that the referral letter to specialised mental health care should have a larger emphasis on the overall treatment plan, on the specific role of specialised health care in the continuum of care, and on patient involvement. Further research should evaluate the validity of these findings for other patient groups in need of integrated care and investigate how the quality of referral letters affects patient-related and organisational outcomes

Approximation of fixed points of nonexpansive mappings and quasinonexpansive mappings in a Hilbert space

In this paper, we give a simple proof and some generalizations of results in Falset, Llorens-Fuster, Marino, and Rugiano (2016).Comment: 8 page

Psychological impact and recovery after involvement in a patient safety incident: A repeated measures analysis

OBJECTIVE: To examine individual, situational and organisational aspects that influence psychological impact and recovery of a patient safety incident on physicians, nurses and midwives. DESIGN: Cross-sectional, retrospective surveys of physicians, midwives and nurses. SETTING: 33 Belgian hospitals. PARTICIPANTS: 913 clinicians (186 physicians, 682 nurses, 45 midwives) involved in a patient safety incident. MAIN OUTCOME MEASURES: The Impact of Event Scale was used to retrospectively measure psychological impact of the safety incident at the time of the event and compare it with psychological impact at the time of the survey. RESULTS: Individual, situational as well as organisational aspects influenced psychological impact and recovery of a patient safety incident. Psychological impact is higher when the degree of harm for the patient is more severe, when healthcare professionals feel responsible for the incident and among female healthcare professionals. Impact of degree of harm differed across clinicians. Psychological impact is lower among more optimistic professionals. Overall, impact decreased significantly over time. This effect was more pronounced for women and for those who feel responsible for the incident. The longer ago the incident took place, the stronger impact had decreased. Also, higher psychological impact is related with the use of a more active coping and planning coping strategy, and is unrelated to support seeking coping strategies. Rendered support and a support culture reduce psychological impact, whereas a blame culture increases psychological impact. No associations were found with job experience and resilience of the health professional, the presence of a second victim support team or guideline and working in a learning culture. CONCLUSIONS: Healthcare organisations should anticipate on providing their staff appropriate and timely support structures that are tailored to the healthcare professional involved in the incident and to the specific situation of the incident

Adherence to guidelines for the management of donors after brain death

Purpose: Guideline adherence for the management of a donor after brain death (DBD) is largely unknown. This study aimed to perform an importance-performance analysis of prioritized key interventions (KIs) by linking guideline adherence rates to expert consensus ratings for the management of a DBD. Materials and methods: This observational, cross-sectional multicenter study was performed in 21 Belgian ICUs. A retrospective review of patient records of adult utilized DBDs between 2013 and 2016 used 67 KIs to describe adherence to guidelines. Results: A total of 296 patients were included. Thirty-five of 67 KIs had a high level of adherence congruent to a high expert panel rating of importance. Nineteen of 67 KIs had a low level of adherence in spite of a high level of importance according to expert consensus. However, inadequate documentation proved an important issue, hampering true guideline adherence assessment. Adherence ranged between 3 and 100% for single KI items and on average, patients received 72% of the integrated expert panel recommended care set. Conclusions: Guideline adherence to an expert panel predefined care set in DBD donor management proved moderate leaving substantial room for improvement. An importance-performance analysis can be used to improve implementation and documentation of guidelines

Duration of second victim symptoms in the aftermath of a patient safety incident and association with the level of patient harm: A cross-sectional study in the Netherlands

OBJECTIVES: To describe healthcare providers' symptoms evoked by patient safety incidents (PSIs), the duration of these symptoms and the association with the degree of patient harm caused by the incident. DESIGN: Cross-sectional survey. SETTING: 32 Dutch hospitals that participate in the 'Peer Support Collaborative'. PARTICIPANTS: 4369 healthcare providers (1619 doctors and 2750 nurses) involved in a PSI at any time during their career. INTERVENTIONS: All doctors and nurses working in direct patient care in the 32 participating hospitals were invited via email to participate in an online survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of symptoms, symptom duration and its relationship with the degree of patient harm. RESULTS: In total 4369 respondents were involved in a PSI and completely filled in the questionnaire. Of these, 462 reported having been involved in a PSI with permanent harm or death during the last 6 months. This had a personal, professional impact as well as impact on effective teamwork requirements. The impact of a PSI increased when the degree of patient harm was more severe. The most common symptom was hypervigilance (53.0%). The three most common symptoms related to teamwork were having doubts about knowledge and skill (27.0%), feeling unable to provide quality care (15.6%) and feeling uncomfortable within the team (15.5%). PSI with permanent harm or death was related to eightfold higher likelihood of provider-related symptoms lasting for more than 1\u2009month and ninefold lasting longer than 6\u2009months compared with symptoms reported when the PSI caused no harm. CONCLUSION: The impact of PSI remains an underestimated problem. The higher the degree of harm, the longer the symptoms last. Future studies should evaluate how these data can be integrated in evidence-based support systems

Similarities and differences in the associations between patient safety culture dimensions and self-reported outcomes in two different cultural settings: a national cross-sectional study in Palestinian and Belgian hospitals

Objectives To investigate the relationships between patient safety culture (PSC) dimensions and PSC selfreported outcomes across different cultures and to gain insights in cultural differences regarding PSC. Design Observational, cross-sectional study. Setting Ninety Belgian hospitals and 13 Palestinian hospitals. Participants A total of 2836 healthcare professionals matched for profession, tenure and working hours. Primary and secondary outcome measures The validated versions of the Belgian and Palestinian Hospital Survey on Patient Safety Culture were used. An exploratory factor analysis was conducted. Reliability was tested using Cronbach’s alpha (α). In this study, we examined the specific predictive value of the PSC dimensions and its self-reported outcome measures across different cultures and countries. Hierarchical regression and bivariate analyses were performed. Results Eight PSC dimensions and four PSC selfreported outcomes were distinguished in both countries. Cronbach’s α was α≥0.60. Significant correlations were found between PSC dimensions and its self-reported outcome (p value range <0.05 to <0.001). Hierarchical regression analyses showed overall perception of safety was highly predicted by hospital management support in Palestine (β=0.16, p<0.001) and staffing in Belgium (β=0.24, p<0.001). The frequency of events was largely predicted by feedback and communication in both countries (Palestine: β=0.24, p<0.001; Belgium: β=0.35, p<0.001). Overall grade for patient safety was predicted by organisational learning in Palestine (β=0.19, p<0.001) and staffing in Belgium (β=0.19, p<0.001). Number of events reported was predicted by staffing in Palestine (β=−0.20, p<0.001) and feedback and communication in Belgium (β=0.11, p<0.01). Conclusion To promote patient safety in Palestine and Belgium, staffing and communication regarding errors should be improved in both countries. Initiatives to improve hospital management support and establish constructive learning systems would be especially beneficial for patient safety in Palestine. Future research should address the association between safety culture and hard patient safety measures such as patient outcomes.We particularly acknowledge all participating hospitals and their staff who devoted time to completing the surveys. We extend our gratitude to the Palestinian and Belgian governments for their cooperation and supporting this research

Participation and healthcare: a survey investigating current and desired levels of collaboration between patient organizations and hospitals

Participation and healthcare: a survey investigating current and desired levels of collaboration between patient organizations and hospitalsBackground: Patient participation is widely seen as a way of improving the quality of healthcare. It is encouraged by public health policies, but the systematic development and implementation of these policies in practice is still lacking.Objective: To facilitate a structural approach to the involvement of patient organizations at the meso level, we conducted an explorative survey to gain an understanding of the current state of collaboration between patient associations and hospitals, and to gain an insight into the needs and wishes of these patient organizations.Design: 111 patient organizations participated in our cross-sectional web-based survey. The results were analysed using a quantitative and qualitative approach.Results: The majority of the patient organizations in the survey aspired to “advise” healthcare professionals regarding service development and evaluations. They wish to participate in hospital processes, produce brochures to inform their peers and provide support for peers. The aim of their collaboration with hospitals is fourfold: to offer complementary services to patients of the hospital, increase patient satisfaction, facilitate patient empowerment and increase the quality of care. In general, the organizations reported a need for increased support.Discussion and conclusion: The ultimate ambition of patient organizations is to collaborate more closely with professionals and become an acknowledged partner in patient care networks. After all, successful collaboration can produce synergies and establish a complementary type of care and information for both patients and caregivers. Participatie en gezondheidszorg: een surveyonderzoek naar de huidige en gewenste samenwerking tussen patiëntenorganisaties en ziekenhuizen Patiëntenparticipatie is één van de manieren om de kwaliteit van de gezondheidszorg te verbeteren. Het wordt dan ook gepromoot door verschillende beleidsinstanties, maar een systematische ontwikkeling en implementatie in de praktijk ontbreken voorlopig nog. Om een structurele aanpak van patiëntenparticipatie op mesoniveau uit te werken werd een exploratieve studie uitgevoerd om de huidige stand van zaken en de wenselijkheden op het vlak van samenwerking tussen patiëntenverenigingen en ziekenhuizen in kaart te brengen. In totaal namen 111 patiëntenorganisaties deel aan onze “cross-sectionele online enquête”. De resultaten werden geanalyseerd door middel van een kwantitatieve en kwalitatieve analyse. Uit de resultaten bleek dat de meerderheid van de patiëntenorganisaties ernaar streeft om ziekenhuizen en hun medewerkers te “adviseren”. Daarnaast willen patiëntenorganisaties samenwerken om brochures te ontwikkelen en hun lotgenoten te informeren en ondersteunen. Het doel van hun samenwerking is viervoudig: het aanbieden van aanvullende diensten aan patiënten in het ziekenhuis, het vergroten van de tevredenheid, het bevorderen van empowerment bij patiënten en het verbeteren van de zorgkwaliteit. In het algemeen signaleren de patiëntenorganisaties een behoefte aan meer ondersteuning tijdens participatieactiviteiten. De conclusie is dat de patiëntenorganisaties nauwer willen samenwerken met professionals om zo een erkende partner te worden in het zorgnetwerk van de patiënt. Succesvolle samenwerking tussen beide partijen kan immers leiden tot synergiën en een complementair type van zorg en informatie voor zowel patiënten als professionals