Preoperative Prevention of Surgical-Site Infection in Spine Surgery.

Surgical-site infections (SSI) contribute to increased hospital length of stay, readmission rates, cost, and morbidity and mortality rates. The spine service line at a suburban Level II trauma center encountered 2 SSIs among the spine fusion population within a 6-month period. This did not meet the organization's internal benchmark of zero. A pilot quasi-experimental design was used to determine whether preoperative cleansing with 2% chlorhexidine gluconate (CHG)-impregnated cloths versus current practice of bathing with 4% CHG solution would reduce SSIs. Infection rates were measured using simple percentages. Level of significance was p < .05. Outcome data showed a reduction in SSIs from 3.9% to 1.9% with use of 2% CHG-impregnated cloths. There was no significant difference found between the use of 2% CHG-impregnated cloths and 4% CHG solution (p = .524). This quality improvement change, combined with a strengthened preoperative bundle approach, has permanently been adopted within the spine service line. From October 2017 to March 2021, the spine service line has had zero SSIs within the spine fusion population.

Using expert knowledge to support Endangered Species Act decision-making for data-deficient species.

Many questions relevant to conservation decision-making are characterized by extreme uncertainty due to lack of empirical data and complexity of the underlying ecologic processes, leading to a rapid increase in the use of structured protocols to elicit expert knowledge. Published ecologic applications often employ a modified Delphi method, where experts provide judgments anonymously and mathematical aggregation techniques are used to combine judgments. The Sheffield elicitation framework (SHELF) differs in its behavioral approach to synthesizing individual judgments into a fully specified probability distribution for an unknown quantity. We used the SHELF protocol remotely to assess extinction risk of three subterranean aquatic species that are being considered for listing under the U.S. Endangered Species Act. We provided experts an empirical threat assessment for each known locality over a video conference and recorded judgments on the probability of population persistence over four generations with online submission forms and R-shiny apps available through the SHELF package. Despite large uncertainty for all populations, there were key differences between species' risk of extirpation based on spatial variation in dominant threats, local land use and management practices, and species' microhabitat. The resulting probability distributions provided decision makers with a full picture of uncertainty that was consistent with the probabilistic nature of risk assessments. Discussion among experts during SHELF's behavioral aggregation stage clearly documented dominant threats (e.g., development, timber harvest, animal agriculture, and cave visitation) and their interactions with local cave geology and species' habitat. Our virtual implementation of the SHELF protocol demonstrated the flexibility of the approach for conservation applications operating on budgets and time lines that can limit in-person meetings of geographically dispersed experts.

Uso del Conocimiento Experto para Respaldar la Toma de Decisiones del Acta de Especies en Peligro para Especies con Información Deficiente Resumen Muchas preguntas relevantes para la toma de decisiones de conservación se caracterizan por una incertidumbre extrema causada por la falta de información empírica y por la complejidad de los procesos ecológicos subyacentes. Esto lleva a un rápido incremento en el uso de protocolos estructurados para obtener conocimiento de los expertos en el tema. Las aplicaciones ecológicas publicadas con frecuencia emplean un método Delphi modificado, en el cual los expertos proporcionan dictámenes anónimamente y luego se usan técnicas de agregación matemática para combinar estos dictámenes. El marco de trabajo de obtención Sheffield (SHELF) difiere en su enfoque conductual para sintetizar los dictámenes individuales en una distribución de probabilidad completamente especificada para una cantidad desconocida. Usamos el protocolo SHELF remotamente para evaluar el riesgo de extinción de tres especies acuáticas subterráneas que están siendo consideradas para ser incluidas en el Acta de Especies en Peligro de los E.U.A. Les proporcionamos a los expertos una evaluación empírica de la amenaza para cada localidad conocida durante una videoconferencia y registramos los dictámenes sobre la probabilidad de la persistencia poblacional durante cuatro generaciones por medio de formularios enviados en línea y las apps R-shiny disponibles a través del paquete SHELF. A pesar de la gran incertidumbre para todas las poblaciones, hubo diferencias importantes entre el riesgo de extirpación de las especies con base en la variación espacial en las amenazas dominantes, el uso del suelo local y las prácticas de manejo, y el microhábitat de las especies. Las distribuciones resultantes de la probabilidad proporcionaron al órgano decisorio un cuadro completo de la incertidumbre que fue consistente con la naturaleza probabilística de las evaluaciones de riesgo. Las discusiones entre los expertos durante la fase de agregación conductual de SHELF documentaron claramente las amenazas dominantes (p. ej.: desarrollo, extracción de madera, agricultura animal y visitas a las cuevas) y sus interacciones con la geología de las cuevas locales y el hábitat de la especie. Nuestra implementación virtual del protocolo SHELF demostró la flexibilidad del enfoque para las aplicaciones de la conservación que operan con presupuestos y líneas de tiempo que pueden limitar las reuniones en persona de expertos dispersados geográficamente.

"What? That's for Old People, that." Home Adaptations, Ageing and Stigmatisation: A Qualitative Inquiry.

Older people, even those living with long-term conditions or poor mobility, can be supported to live well at home, through adapting their home to meet changing need. Installing home adaptations, from grab rails to walk in shower rooms, is cost effective, may prevent falls, reduce social isolation and improve self confidence. Despite austerity cuts to public spending, the UK government increased home adaptations' funding. However, not much is known about older people's experiences and understanding of acquiring and living with home adaptations and uptake of home adaptations could be improved. Using wearable camera and face to face interview data, this qualitative study explored a diverse group of older people's retrospective experiences (n = 30). Focus group discussions were also carried out with a wide range of professionals involved in the provision of home adaptations (n = 39). Findings suggest people may delay having adaptations, because of perceived stigmatising associations with decline and vulnerability. As delaying the installation of home adaptations until crisis point is known to reduce their effectiveness, such associations need to be challenged.

Disease-Specific Care: Spine Surgery Program Development.

Minimal literature exists describing the process for development of a Joint Commission comprehensive spine surgery program within a community hospital health system. Components of a comprehensive program include structured communication across care settings, preoperative education, quality outcomes tracking, and patient follow-up. Organizations obtaining disease-specific certification must have clear knowledge of the planning, time, and overall commitment, essential to developing a successful program. Health systems benefit from disease-specific certification because of their commitment to a higher standard of service. Certification standards establish a framework for organizational structure and management and provide institutions a competitive edge in the marketplace. A framework for the development of a spine surgery program is described to help guide organizations seeking disease-specific certification. In developing a comprehensive program, it is critical to define the program's mission and vision, identify key stakeholders, implement clinical practice guidelines, and evaluate program outcomes.

A bundle strategy including patient hand hygiene to decrease clostridium difficile infections.

Prevention strategies for Clostridium difficile infection traditionally have addressed barrier precautions, environmental disinfection, and health care worker hand hygiene. When applied as a bundle, this approach has been used widely as an evidence-based strategy to prevent hospital-acquired C. difficile infection. Expanding the bundle to include patient hand hygiene is a nurse-driven approach to prevent C. difficile transmission.

Eating disorder counsellors with eating disorder histories: a story of being "normal".

Debate exists in the eating disorders field about the fitness to practise of counsellors with eating disorder histories (Johnston, Smethurst & Gowers, 2005). Yet despite widespread acknowledgement of the demanding nature of eating disorder counselling in general (Zerbe, 2008), almost no research exists about the actual experiences of recovered eating disorder counsellors in particular. Using semi-structured interviews this study aimed to address the research gap by investigating the experiences of 7 counsellors with eating disorder histories. Particular emphasis was given to their beliefs about the impact of their work on their own body image, weight and relationship with food. Results derived from an Interpretative Phenomenological Analysis suggested that the counsellors' experienced their eating disorder history as a double-edged sword that led them to engage in a number of self-presentational activities. Implications of these findings for the eating disorders field are discussed.

Going home from hospital -- an appreciative inquiry study.

This paper reports on a project that involved a number of agencies and groups, including older people, working together to examine and develop practice in an area of shared concern -- going home from hospital. The project was stimulated by a 'whole-system event', and was based on appreciative inquiry (AI) methodology, which has roots in both action research and organisational development. In AI, the research is directed towards appreciating what it is about the social world that is positive, and exploring this. The study was planned around three workshops to streamline data collection and analysis. Group members were also required to carry out some activities between workshops. Invitations were sent out to groups and individuals previously identified as involved or interested in the discharge process across one health district (n = 71). Workshop one discussed the planned research schedule, and introduced the basic concepts of AI. This workshop also took participants through the interview process. Each participant was asked to undertake two interviews. Thirty-five individual interviews and one focus group were completed. At workshop two, interview data were analysed by the group using the nominal group technique. Subsequent group discussion produced 'provocative propositions'. At the third workshop, provocative propositions were developed into action plans. This paper gives an overview of the study, and explores some of the issues involved when working with service users and providers as co-researchers.