Primary health care workers (HCWs) in low-and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and ...particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage.
Les travailleurs en soins de santé primaires (HCW) dans les milieux à revenu faible et intermédiaire (LMIC) opèrent souvent dans des conditions difficiles dans les zones rurales éloignées, à l’écart du reste du système de santé, en particulier des soins spécialisés. Une attention particulière a été accordée à la mise en œuvre d’interventions destinées à soutenir la qualité et l’amélioration de la performance pour les travailleurs évoluant dans ces milieux. Toutefois, on a peu d’informations sur la conception de ces initiatives et sur la prédominance de telle ou telle approche, et encore moins sur celles qui sont les plus efficaces. Notre objectif était une compréhension large de ce qui distingue les différentes programmes destinés à soutenir et améliorer la performance des HCW primaires, et de clarifier les preuves existantes aussi bien que le manque de preuves, ceci dans le but de fournir des informations aux décideurs et aux concepteurs de programmes visant à soutenir et améliorer la performance des travailleurs de la santé dans ces milieux. Nous avons systématiquement cherché dans la littérature les articles abordant ce sujet, et nous avons mené une étude comparative afin de documenter les approches principales visant à l’amélioration de la performance et de la qualité pour les HCW primaires dans ces milieux LMIC. Nous avons identifié 40 articles à retenir sur les interventions, que nous avons classés en cinq approches différentes: (1) supervision et supervision du soutien; (2) mentorat; (3) outils et aides; (4) méthodes d’amélioration de la qualité; et (5) encadrement. La variété des modèles d’étude et des indicateurs qualité/performance n’a pas permis d’obtenir une synthèse formelle des données quantitatives. La documentation la plus fournie concernait la supervision, mais la définition de ce qu’était l’approche la plus efficace pour les activités de supervision elles-mêmes n’était pas claire, sans parler de la conception et de la mise en œuvre des programmes de supervision. La documentation sur le mentorat était limitée et surtout axée sur le renforcement des compétences cliniques, et les stratégies éducatives. Des recherches plus approfondies sont nécessaires, sur la meilleure façon d’intégrer le mentorat dans la formation clinique initiale, tout en maintenant sa fonction dans le système de santé ordinaire. Les preuves ne sont pas suffisantes si l’on veut tirer des conclusions sur l’encadrement dans ce contexte, mais on peut justifier l’examen des publications des entreprise et des écoles de commerce pour identifier les approches transférables. On dispose d’une littérature importante sur les outils, mais une grande disparité entre les approches rend la comparaison difficile. Nous avons trouvé des exemples de projets et de modèles individuels efficaces dans des contextes spécifiques, mais il manque de recherches comparatives sur les outils dans le cadre des approches et des contextes, et il n’exsite aucune analyse systématique au sein des programmes spécifiques pouvant fournir des preuves avec une généralisation claire.
Les recherches futures devraient donner la priorité aux essais d’intervention comparatifs afin d’établir des normes globales claires dans les initiatives d’amélioration de la performance et de la qualité. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage. De telles normes seront essentielles pour créer et maintenir un personnel de santé performant et pour favoriser des initiatives mondiales telles que la couverture de santé universelle.
中低收入国家 （LMIC） 的初级卫生保健工作者 （HCWs） 通 常在偏远农村地区工作, 条件艰苦, 与其他层级的卫生体系, 尤其是专科保健相隔绝。 对于改善此类卫生工作者的质量和 绩效的干预措施, 此前的关注点大多是其实施过程。 鲜有研究 探讨这类干预的设计或是最常用的方法, 更不必说探讨最有效 的方法。 本研究的目的是广泛了解初级HCW支持和绩效改善 的不同方法, 明确现有证据及其空缺, 旨在为决策及艰苦地区 卫生工作者支持和绩效改善干预项目的设计提供信息。 我们 系统检索了探讨这一问题的文献, 进行比较回顾, 记录LMIC改 善HCWs绩效和质量的主要方法。 检索到40篇符合标准的文 献, 将文献中报道的干预分为五类： （1） 监管和支持型监 管； （2） 指导； （3） 工具和援助； （4） 质量改善方法； （5） 辅导。 由于研究设计多样, 质量/绩效指标各不相同, 不 能进行定量数据综合。 多数文献是关于监管型干预, 但并未明 确最有效的监管方法, 监管项目的设计和实施也不明确。 关于 指导的文献有限, 且主要关于临床技能建设和教育策略。 需要 更多研究探讨如何更好地将指导并入服务前的临床培训, 同时 维持常规卫生体系中的指导功能。尚没有关于这类地区辅导 型干预的证据, 但对企业和商业学校文献的回顾足以找到可转 移至卫生体系的方法。 有大量关于工具的文献, 但方法差异非 常大, 难以进行比较。我们发现了特定地区有效的单个项目和 设计, 但缺乏不同方法之间, 或不同地区之间工具的比较研究, 也缺乏特定方法内的系统分析, 因此没有外推性方面的明确证 据。 将来的研究须优先进行干预的比较试验, 以便明确绩效和 质量改善项目的标准。这种标准对于建立和维持完善的卫生 人力, 以及全民卫生覆盖等全球运动都至关重要。
Los trabajadores del cuidado primario de la salud (TCPSs) en entornos de bajos y medios ingresos (PIBM) a menudo trabajan en condiciones difíciles en zonas remotas, rurales, aisladas del resto del sistema de salud y particularmente del cuidado especializado. Se ha prestado mucha atención a la implementación de las intervenciones para apoyar la mejora de la calidad y el desempeño de los trabajadores en tales ubicaciones. Sin embargo, poco se sabe sobre el diseño de tales iniciativas y sobre qué enfoques predominan, y mucho menos las que son más eficaces. Nosotros tuvimos como objetivo una comprensión amplia de lo que distinguen a los diferentes enfoques para el apoyo de los TCPS y mejora de rendimiento y aclarar la evidencia existente, así como los vacíos en la evidencia con el fin de informar sobre la toma de decisiones y el diseño de programas destinados a apoyar y mejorar el desempeño de los trabajadores de la salud en estos entornos. Revisamos sistemáticamente en la literatura artículos sobre este tema y realizamos una revisión comparativa para documentar los principales enfoques del desempeño y la mejora de la calidad de los trabajadores del cuidado primario de la salud en los entornos PIBM. Nosotros identificamos 40 artículos elegibles que informan sobre intervenciones que categorizamos en cinco enfoques diferentes: (1) supervisión y supervisión de apoyo; (2) consejería; (3) herramientas y ayudas; (4) métodos de mejora de la calidad, y (5) entrenamiento. La variedad de diseños de estudio e indicadores de calidad/desempeño impidieron una síntesis formal de datos cuantitativos. La literatura más extensa fue sobre supervisión, pero había poca claridad sobre lo que define el enfoque más efectivo de las actividades de supervisión en sí, y mucho menos sobre el diseño y la implementación de los programas de supervisión. La literatura de consejería era limitada, y se centró principalmente en la construcción de habilidades clínicas y estrategias educativas. Se necesita más investigación sobre cómo mejor incorporar la consejería en el entrenamiento previo al servicio clínico, manteniendo al mismo tiempo su función dentro del sistema de salud de rutina. No hay evidencia suficiente para sacar conclusiones sobre el entrenamiento en este entorno, sin embargo, una revisión de la literatura empresarial y de la escuela de negocios está justificada para identificar enfoques transferibles. Existe una gran literatura sobre herramientas, pero la variación significativa en los enfoques hace que la comparación sea un desafío. Encontramos ejemplos de proyectos y diseños individuales eficaces en contextos específicos, pero faltaba una investigación comparativa sobre las herramientas a través de enfoques o entre contextos y no había un aná
Healthcare transition has been established as a significant topic of interest in pediatric rehabilitation. Healthcare transition research has primarily focused on barriers to self-management and ...achievement of a productive adulthood. Healthcare transition experts have recently called for further attention to social structural factors. Theoretical approaches are, therefore, needed to account for how such factors shape the lives of youth with disabilities, particularly those who experience marginalization and social exclusion.
Taking up this call, the aim of this paper is to examine the potential contributions of two critical theories to healthcare transition research and practice.
Review two theories - intersectionality and critical discourse analysis.
Intersectionality highlights how multiple intersecting social locations and social structures interact with youth's experiences, choices and health care needs. Critical discourse analysis focuses on how discourses and assumptions in healthcare transition research and practice contribute to marginalization and can be resisted and changed by youth, families, researchers, and clinicians.
The uptake of critical theories within health care transition research and practice can account for the complex interplay of social structures, power relations and youth's experiences. Such analysis can contribute to refining assessments and developing interventions that reflect how marginalization and exclusion impact youth's well-being.
IMPLICATIONS FOR REHABILITATION
While critical theories have been applied in health and rehabilitation, there has been limited uptake of these theories in healthcare transition research and practice.
Critical theories can promote awareness of how youth's experiences, choices and actions throughout the healthcare transition process are shaping and shaped by structural factors and assumptions about a productive adulthood.
Applying critical theories in healthcare transition practice involves being responsive to the structural factors that may be shaping youth's experiences, choices and opportunities.
Intersectional and critical discourse analyses can surface how to reduce social exclusion and marginalization for youth transitioning to adulthood through analyses of language, power, dominant discourse and practices amenable to change.
The fastidious nature of the foodborne bacterial pathogen Campylobacter jejuni contrasts with its ability to survive in the food chain. The formation of biofilms, or the integration into existing ...biofilms by C. jejuni, is thought to contribute to food chain survival. As extracellular DNA (eDNA) has previously been proposed to play a role in C. jejuni biofilms, we have investigated the role of extracellular DNases (eDNases) produced by C. jejuni in biofilm formation. A search of 2791 C. jejuni genomes highlighted that almost half of C. jejuni genomes contains at least one eDNase gene, but only a minority of isolates contains two or three of these eDNase genes, such as C. jejuni strain RM1221 which contains the cje0256, cje0566 and cje1441 eDNase genes. Strain RM1221 did not form biofilms, whereas the eDNase-negative strains NCTC 11168 and 81116 did. Incubation of pre-formed biofilms of NCTC 11168 with live C. jejuni RM1221 or with spent medium from a RM1221 culture resulted in removal of the biofilm. Inactivation of the cje1441 eDNase gene in strain RM1221 restored biofilm formation, and made the mutant unable to degrade biofilms of strain NCTC 11168. Finally, C. jejuni strain RM1221 was able to degrade genomic DNA from C. jejuni NCTC 11168, 81116 and RM1221, whereas strain NCTC 11168 and the RM1221 cje1441 mutant were unable to do so. This was mirrored by an absence of eDNA in overnight cultures of C. jejuni RM1221. This suggests that the activity of eDNases in C. jejuni affects biofilm formation and is not conducive to a biofilm lifestyle. These eDNases do however have a potential role in controlling biofilm formation by C. jejuni strains in food chain relevant environments.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Clusters of adolescents differentiated by patterns of physical activity and sedentary behavior (activity-related typologies) are common. Understanding both the characteristics of adolescents and ...modifiable correlates of these typologies, can help to develop interventions for those most at risk. This systematic review aimed to synthesize the socio-demographic characteristics and modifiable correlates of activity-related behavioral typologies among adolescents.
A systematic search of seven electronic databases was conducted to identify quantitative studies using person-oriented statistical approaches to identify activity-related behavioral typologies among 12-18 year-olds. This systematic review was registered in Prospero (registration number: CRD42016046879).
Thirty-six studies met the inclusion criteria and were classified according to three sub-themes based on behaviors included in the typologies (1. physical activity and sedentary behavior only; 2. physical activity, sedentary behavior and risk-related behaviors; 3. physical activity, sedentary behavior and diet). Studies were mostly cross-sectional and relied on self-report measures. Methods were considerably heterogeneous, however results revealed some consistency in typologies within specific groups. For example, typologies characterized by unhealthy behavior patterns (e.g., characterized by physical inactivity, high sedentary behavior and poor diet or high risk-related behaviors) comprised more older adolescents. With the exception of socio-demographics (age, sex, body mass index and socio-economic status), very few correlates have been studied to date (mostly school-related behavioral factors and intrapersonal influences), with evidence largely from typologies comprised of physical activity, sedentary behavior and diet.
More research is needed to assess a range of modifiable correlates associated with activity-related behavior typologies among adolescents. This will allow for more targeted interventions, to achieve long-lasting, positive behavior change in adolescent populations.
This study aimed to assess the extent to which structured approaches to implementation of clinical genomics, proposed or adapted, are informed by evidence.
A systematic approach was used to identify ...peer-reviewed articles and gray literature to report on 4 research questions:
1. What structured approaches have been proposed to support implementation?
2. To what extent are the structured approaches informed by evidence?
3. How have structured approaches been deployed in the genomic setting?
4. What are the intended outcomes of the structured approaches?
A total of 30 unique structured approaches to implementation were reported across 23 peer-reviewed publications and 11 gray literature articles. Most approaches were process models, applied in the preadoption implementation phase, focusing on a “service” outcome. Key findings included a lack of implementation science theory informing the development/implementation of newly designed structured approaches in the genomic setting and a lack of measures to assess implementation effectiveness.
This scoping review identified a significant number of structured approaches developed to inform the implementation of genomic medicine into clinical practice, with limited use of implementation science to support the process. We recommend the use of existing implementation science theory and the expertise of implementation scientists to inform the design of genomic programs being implemented into clinical care.
The specialisation of mammalian cells in time and space requires genes associated with specific pathways and functions to be co-ordinately expressed. Here we have combined a large number of ...publically available microarray datasets derived from human primary cells and analysed large correlation graphs of these data.
Using the network analysis tool BioLayout Express3D we identify robust co-associations of genes expressed in a wide variety of cell lineages. We discuss the biological significance of a number of these associations, in particular the coexpression of key transcription factors with the genes that they are likely to control.
We consider the regulation of genes in human primary cells and specifically in the human mononuclear phagocyte system. Of particular note is the fact that these data do not support the identity of putative markers of antigen-presenting dendritic cells, nor classification of M1 and M2 activation states, a current subject of debate within immunological field. We have provided this data resource on the BioGPS web site (http://biogps.org/dataset/2429/primary-cell-atlas/) and on macrophages.com (http://www.macrophages.com/hu-cell-atlas).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cutibacterium acnes (formally Propionibacterium acnes) is frequently identified within surgical device related infections. It is often co-isolated from infection sites with other opportunistic ...pathogens. Recent studies have demonstrated that C. acnes is able to form biofilms and when co-cultured with Staphylococcus spp. both inhibitory and stimulatory effects have been reported across several studies. Here, we investigated the biofilm-forming ability of 100 clinical C. acnes isolates from various infection sites in human patients, both deep tissue and superficial, followed by an investigation of how the supernatants of C. acnes cultures influenced the attachment and maturation of Staphylococcusaureus NCTC 6571 biofilms. All of the C. acnes isolates were able to form biofilms in vitro, although biofilm biomass varied between isolates. Nineteen isolates were weakly adherent, 33 were moderately adherent and the majority (48) showed strong adherence. The presence of C. acnes sterile supernatants reduced the biomass of S. aureus cultures, with a > 90% reduction observed in the presence of several of the C. acnes isolates. We observed that this decrease was not due to C. acnes affecting S. aureus viability, nor due to the presence of propionic acid. Biofilm maturation was however delayed over a 24-h period as was biofilm surface structure, although initial (up to 8 h) surface attachment was not affected. We hypothesis that this defective biofilm maturation is the cause of the observed biomass decrease. In turn, these altered biofilms showed a greater susceptibility to antibiotic treatments. In contrast the presence of C. acnes supernatant in planktonic (defined as a free moving, non-surface attached population within the liquid column) S. aureus cultures increased antibiotic tolerance, via a currently undefined mechanism. This study suggests that complex interactions between C. acnes and other opportunistic pathogens are likely to exist during colonisation and infection events. Further investigation of these interactions may lead to increased treatment options and a better prognosis for patients.
•Cutibacterium acnes isolates were able to form biofilm in vitro.•Supernatant from C. acnes cultures reduced biofilm biomass of S. aureus biofilms.•This affect was not driven by pH or S. aureus growth rate changes.•S. aureus surface attachment was unaffected, but biofilm maturation was restricted.•C. acnes supernatant altered the susceptibility of S. aureus to antibiotics.
Hospital librarians receive invites to teach thinking and searching in an evidence-based way and critical appraisal of the literature to nurses. With these invitations, the hospital librarians play a ...central role in establishing an evidence-based culture in the hospital and contribute to the nursing staff feeling competent and confident in fulfilling evidence-based competencies. This author just prepared a 17-minute online talk as part of an international nursing webinar on "searching nursing literature in an evidence-based way." Using this experience, remembering other teaching and presentation experiences, and some "help" from AI tools, this experienced hospital librarian suggests decision points for colleagues to create a meaningful, practical information session for nurses and introduce to some AI tools along the way.
Temperature extremes and air pollution both pose significant threats to human health, but it remains uncertain whether pollutants' effects on mortality are modified by temperature levels. In this ...review, we summarized epidemiologic evidence on the modification by temperature of the acute effects of air pollutants on non-accidental and cardiovascular mortality. The EMBASE, PubMed, ProQuest Dissertations and Theses, and Elsevier Science Direct databases were used to identify papers published up to 2nd December 2014. Studies with appropriate design, exposures and outcome indicators, quantitative estimates and high/intermediate quality were included. Twenty-one studies met the inclusion criteria, of which 12 reported the effects of PM10 on mortality modified by temperature, 10 studied O3, and the rest examined NO2, SO2, PM2.5, PM10–2.5, CO and black smoke. We divided temperature into low, medium, and high categories as defined in each study. In high temperature days, a 10μg/m3 increment in PM10 concentration corresponded to pooled estimates of 0.78% (95% CI: 0.44%, 1.11%) and 1.28% (0.66%, 1.91%) increase in non-accidental and cardiovascular mortality, both statistically significantly higher than the estimates in medium temperature stratum. Pooled effects of O3 on non-accidental mortality on low and high temperature days were increases of 0.48% (0.28%, 0.69%) and 0.47% (0.32%, 0.63%) respectively, for 10μg/m3 increase in exposure, both significantly higher than the increase of 0.20% (0.07%, 0.34%) on medium temperature days. The effect of O3 on cardiovascular mortality was strongest on high temperature days with pooled estimate of 1.63% (1.14%, 2.13%). No significant interactions between SO2/NO2 and temperature were detected by meta-analysis. Other pollutants were not analyzed due to the lack of suitable studies. In summary, we observed interactions between high temperature and PM10 and O3 in the effects on non-accidental and cardiovascular mortality. Low temperature modified the effects of air pollutants but not in a consistent fashion: the effect of PM10 oncardiovascular mortality was diminished but the association between O3 and non-accidental mortality was strengthened.
•This is the first review and meta-analysis on the modification of pollutants' effects on mortality by temperature.•We found temperature extremes modify the effects of PM10 and O3 on both non-accidental and cardiovascular mortality.•There may be value in promoting use of early warning systems on extremely hot or cold days that are also heavily polluted.
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