Systematic review of patients’ views on the quality of primary health care in sub-Saharan Africa

This is the first systematic review of patient views on the quality of primary health care services in sub-Saharan Africa using studies identified from MEDLINE, CINAHL Plus, EMBASE and PsycINFO. In total, 20 studies (3 qualitative, 3 mixed method and 14 quantitative) were included. Meta-analysis was done using quantitative findings from facility- and community-based studies of patient evaluation of primary health care. There was low use of validated measures, and the most common scales assessed were humanness (70%) and access (70%). While 66% (standard deviation = 21%) of respondents gave favourable feedback, there were discrepancies between surveys in community and facility contexts. Findings suggest that patient views could vary with subject recruitment site. We recommend improvement in the methods used to examine patient views on quality of primary health care

Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review

Objective The aim of this systematic review was to develop a ‘contributory factors framework’ from a synthesis of empirical work which summarises factors contributing to patient safety incidents in hospital settings. Design A mixed-methods systematic review of the literature was conducted. Data sources Electronic databases (Medline, PsycInfo, ISI Web of knowledge, CINAHL and EMBASE), article reference lists, patient safety websites, registered study databases and author contacts. Eligibility criteria Studies were included that reported data from primary research in secondary care aiming to identify the contributory factors to error or threats to patient safety. Results 1502 potential articles were identified. 95 papers (representing 83 studies) which met the inclusion criteria were included, and 1676 contributory factors extracted. Initial coding of contributory factors by two independent reviewers resulted in 20 domains (eg, team factors, supervision and leadership). Each contributory factor was then coded by two reviewers to one of these 20 domains. The majority of studies identified active failures (errors and violations) as factors contributing to patient safety incidents. Individual factors, communication, and equipment and supplies were the other most frequently reported factors within the existing evidence base. Conclusions This review has culminated in an empirically based framework of the factors contributing to patient safety incidents. This framework has the potential to be applied across hospital settings to improve the identification and prevention of factors that cause harm to patients

Nature and type of patient-reported safety incidents in primary care: Cross-sectional survey of patients from Australia and England

Background Patient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement. Objective The aim of this study was to characterise the nature of patient-reported safety incidents in primary care. Design Secondary analysis of two cross sectional studies. Participants Adult patients from Australian and English primary care settings. Measures Patients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented. Results A total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent. Conclusions The nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement

Development and validation of the DIabetes Severity SCOre (DISSCO) in 139 626 individuals with type 2 diabetes: a retrospective cohort study

OBJECTIVE: Clinically applicable diabetes severity measures are lacking, with no previous studies comparing their predictive value with glycated hemoglobin (HbA1c). We developed and validated a type 2 diabetes severity score (the DIabetes Severity SCOre, DISSCO) and evaluated its association with risks of hospitalization and mortality, assessing its additional risk information to sociodemographic factors and HbA1c. RESEARCH DESIGN AND METHODS: We used UK primary and secondary care data for 139 626 individuals with type 2 diabetes between 2007 and 2017, aged ≥35 years, and registered in general practices in England. The study cohort was randomly divided into a training cohort (n=111 748, 80%) to develop the severity tool and a validation cohort (n=27 878). We developed baseline and longitudinal severity scores using 34 diabetes-related domains. Cox regression models (adjusted for age, gender, ethnicity, deprivation, and HbA1c) were used for primary (all-cause mortality) and secondary (hospitalization due to any cause, diabetes, hypoglycemia, or cardiovascular disease or procedures) outcomes. Likelihood ratio (LR) tests were fitted to assess the significance of adding DISSCO to the sociodemographics and HbA1c models. RESULTS: A total of 139 626 patients registered in 400 general practices, aged 63±12 years were included, 45% of whom were women, 83% were White, and 18% were from deprived areas. The mean baseline severity score was 1.3±2.0. Overall, 27 362 (20%) people died and 99 951 (72%) had ≥1 hospitalization. In the training cohort, a one-unit increase in baseline DISSCO was associated with higher hazard of mortality (HR: 1.14, 95% CI 1.13 to 1.15, area under the receiver operating characteristics curve (AUROC)=0.76) and cardiovascular hospitalization (HR: 1.45, 95% CI 1.43 to 1.46, AUROC=0.73). The LR tests showed that adding DISSCO to sociodemographic variables significantly improved the predictive value of survival models, outperforming the added value of HbA1c for all outcomes. Findings were consistent in the validation cohort. CONCLUSIONS: Higher levels of DISSCO are associated with higher risks for hospital admissions and mortality. The new severity score had higher predictive value than the proxy used in clinical practice, HbA1c. This reproducible algorithm can help practitioners stratify clinical care of patients with type 2 diabetes

Meteorological training for the digital age: A Blueprint for a new curriculum

Almost all professional meteorologists take part in meteorological training during their undergraduate or graduate study or professional job training in the public or private sector. Increased benefits can be accrued by employers and employees, if this training is based on the same underpinning skills and attributes, aimed to equip people entering meteorology for the wide range of future roles they might undertake. While there is a great deal of excellent, innovative practice in our community, the time is now right to look again at the nature of the meteorological curriculum. Meteorology faces significant challenges in the 21st century to deal with the twin challenges of increases in the number and severity of extreme weather events and the increased complexity of forecasts demanded by end-users. Here, a blueprint which describes a number of key principles which should be used to design, evaluate and enhance curricula for students entering our field in the next 10 years is proposed. The blueprint does not discuss in detail the core mathematical and physical principles which underlie any high quality training in meteorology but rather focuses on the key skills and attributes needed to make the next-generation of meteorologists innovative and effective which include: • Meteorological competencies, • Personal and inter-personal attributes, • Core skills as a scientist and • Ethical and professional interaction with broader society. The blueprint is intended to encourage debate about how we equip new meteorologists for the digital age. We plan to use these principles to review and enhance our own curricula in the near future

Beyond the control of the care home: A meta‐ethnography of qualitative studies of Infection Prevention and Control in residential and nursing homes for older people

OBJECTIVE: This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. DESIGN: This study had a meta‐ethnography design. DATA SOURCES: Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. REVIEW METHODS: A meta‐ethnography was performed. RESULTS: Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. CONCLUSIONS: Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. PATIENT OR PUBLIC CONTRIBUTION: A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings

The impact of neglecting ice phase on cloud optical depth retrievals from AERONET cloud mode observations

Clouds present many challenges to climate modelling. To develop and verify the parameterisations needed to allow climate models to represent cloud structure and processes, there is a need for high-quality observations of cloud optical depth from locations around the world. Retrievals of cloud optical depth are obtainable from radiances measured by Aerosol Robotic Network (AERONET) radiometers in “cloud mode” using a two-wavelength retrieval method. However, the method is unable to detect cloud phase, and hence assumes that all of the cloud in a profile is liquid. This assumption has the potential to introduce errors into long-term statistics of retrieved optical depth for clouds that also contain ice. Using a set of idealised cloud profiles we find that, for optical depths above 20, the fractional error in retrieved optical depth is a linear function of the fraction of the optical depth that is due to the presence of ice cloud (“ice fraction”). Clouds that are entirely ice have positive errors with magnitudes of the order of 55 % to 70 %. We derive a simple linear equation that can be used as a correction at AERONET sites where ice fraction can be independently estimated. Using this linear equation, we estimate the magnitude of the error for a set of cloud profiles from five sites of the Atmospheric Radiation Measurement programme. The dataset contains separate retrievals of ice and liquid retrievals; hence ice fraction can be estimated. The magnitude of the error at each location was related to the relative frequencies of occurrence in thick frontal cloud at the mid-latitude sites and of deep convection at the tropical sites – that is, of deep cloud containing both ice and liquid particles. The long-term mean optical depth error at the five locations spans the range 2–4, which we show to be small enough to allow calculation of top-of-atmosphere flux to within 10 % and surface flux to about 15 %