A novel computerized approach to scoping reviews using Synthesis software: the first 15 years of The American College of Surgeons National Surgical Quality Improvement Program.

Scoping reviews of innovations in health care characterized by large numbers and types of publications present a unique challenge. A novel software application, Synthesis, can efficiently scan the literature to map the evidence and inform practice. We applied Synthesis to the National Surgical Quality Improvement Program (NSQIP), a high-quality database designed to measure risk-adjusted 30-day surgical outcomes for national and international benchmarking. The scoping review describes the breadth of studies in the NSQIP literature. We performed a comprehensive electronic literature search using PubMed, MEDLINE, Web of Knowledge and Scopus to capture all NSQIP articles published between Jan. 1, 2000, and Dec. 31, 2020. Two reviewers independently reviewed articles to determine their relevance using predefined inclusion criteria. We imported references into Synthesis to semiautomate data management. Extracted data included surgical specialty, study type and year of publication. Of the 4661 NSQIP articles included, 3631 (77.9%) were published within the last 5 years. Among NSQIP-related articles, the most common study types were based on outcomes (46.7%) and association (41.7%), and the most common surgical specialties were general surgery and orthopedic surgery, representing 35.7% and 24.0% of the articles, respectively. Synthesis enabled a rapid review of thousands of NSQIP publications. The scoping review provided an overview of the articles in the NSQIP literature and suggested that the NSQIP is increasingly being described in publications of quality and safety in surgery.

Automated Identification of National Health Survey Research Topics in the Academic Literature.

National health surveys are routinely conducted to provide value data about a country's health status and the health services being consumed by the population. This information is used for surveillance, research, and the planning of healthcare services at local and national levels. Although these national health surveys are viewed as important resources for public and population health, there is limited information as to the type of research being conducted with these surveys. This study investigates, through the use of automated text data mining, an approach to identify and collate the type of academic literature being published using national health surveys.

Assessing the association between occupancy and outcome in critically Ill hospitalized patients with sepsis.

BACKGROUND: Sepsis has a high prevalence, mortality-rate and cost. Sepsis patients usually enter the hospital through the Emergency Department (ED). Process or structural issues related to care may affect outcome. METHODS: Multi-centered retrospective observational cohort study using administrative databases to identify adult patients (> = 18 years) with sepsis and severe sepsis admitted to Alberta Health Services Calgary zone adult multisystem intensive care units (ICU) through the ED between January 1, 2006 and September 30, 2009. We examined the association between ICU occupancy and hospital outcome. We explored other associations of hospital outcome including the effect of ED wait time, admission from ED during weekdays versus weekends and ED admission during the day versus at night. RESULTS: One thousand and seven hundred seventy patients were admitted to hospital via ED, 1036 (58.5 %) with sepsis and 734 (41.5 %) with severe sepsis. In patients with sepsis, ICU occupancy > 90 % was associated with an increase in hospital mortality even after adjusting for age, sex, triage level, Charlson index, time of first ED physician assessment and ICU admission. No differences in hospital mortality were found for patients who waited more than 7 h, were admitted during the day versus night or weekdays versus weekends. CONCLUSIONS: In patients with sepsis admitted via the ED, increased ICU occupancy was associated with higher in-hospital mortality.

Validity of administrative data in recording sepsis: a systematic review.

INTRODUCTION: Administrative health data have been used to study sepsis in large population-based studies. The validity of these study findings depends largely on the quality of the administrative data source and the validity of the case definition used. We systematically reviewed the literature to assess the validity of case definitions of sepsis used with administrative data. METHODS: Embase and MEDLINE were searched for published articles with International Classification of Diseases (ICD) coded data used to define sepsis. Abstracts and full-text articles were reviewed in duplicate. Data were abstracted from all eligible full-text articles, including ICD-9- and/or ICD-10-based case definitions, sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). RESULTS: Of 2,317 individual studies identified, 12 full-text articles met all eligibility criteria. A total of 38 sepsis case definitions were tested, which included over 130 different ICD codes. The most common ICD-9 codes were 038.x, 790.7 and 995.92, and the most common ICD-10 codes were A40.x and A41.x. The PPV was reported in ten studies and ranged from 5.6% to 100%, with a median of 50%. Other tests of diagnostic accuracy were reported only in some studies. Sn ranged from 5.9% to 82.3%; Sp ranged from 78.3% to 100%; and NPV ranged from 62.1% to 99.7%. CONCLUSIONS: The validity of administrative data in recording sepsis varied substantially across individual studies and ICD definitions. Our work may serve as a reference point for consensus towards an improved and harmonized ICD-coded definition of sepsis.

An overview of the statistical methods reported by studies using the Canadian community health survey.

BACKGROUND: The Canadian Community Health Survey (CCHS) is a cross-sectional survey that has collected information on health determinants, health status and the utilization of the health system in Canada since 2001. Several hundred articles have been written utilizing the CCHS dataset. Previous analyses of statistical methods utilized in the literature have focused on a particular journal or set of journals to understand the statistical literacy required for understanding the published research. In this study, we describe the statistical methods referenced in the published literature utilizing the CCHS dataset(s). METHODS: A descriptive study was undertaken of references published in Medline, Embase, Web of Knowledge and Scopus associated with the CCHS. These references were imported into a Java application utilizing the searchable Apache Lucene text database and screened based upon pre-defined inclusion and exclusion criteria. Full-text PDF articles that met the inclusion criteria were then used for the identification of descriptive, elementary and regression statistical methods referenced in these articles. The identification of statistical methods occurred through an automated search of key words on the full-text articles utilizing the Java application. RESULTS: We identified 4811 references from the 4 bibliographical databases for possible inclusion. After exclusions, 663 references were used for the analysis. Descriptive statistics such as means or proportions were presented in a majority of the articles (97.7%). Elementary-level statistics such as t-tests were less frequently referenced (29.7%) than descriptive statistics. Regression methods were frequently referenced in the articles: 79.8% of articles contained reference to regression in general with logistic regression appearing most frequently in 67.1% of the articles. CONCLUSIONS: Our study shows a diverse set of analysis methods being referenced in the CCHS literature, however, the literature heavily relies on only a subset of all possible statistical tools. This information can be used in identifying gaps in statistical methods that could be applied to future analysis of public health surveys, insight into training and educational programs, and also identifies the level of statistical literacy needed to understand the published literature.

An environmental scan of medical assessment units in Canada.

Many initiatives have been proposed to improve emergency department (ED) overcrowding. One such strategy has been to implement medical assessment units (MAUs). This study reports on an environmental scan of MAU distribution and characteristics across Canada. A telephone survey was administered to administrative and clinical leaders at acute-care hospitals in Canada. The survey was designed in two sections: (1) description of hospital and ED characteristics; and (2) description of any existing MAU-like units associated with the hospital's ED structure and processes. Our survey reveals that MAU-like initiatives exist in several Canadian hospitals but are heterogeneous in structure and functionality.

Emerging Therapeutic Enhancement Enabling Health Technologies and Their Discourses: What Is Discussed within the Health Domain?

So far, the very meaning of health and therefore, treatment and rehabilitation is benchmarked to the normal or species-typical body. We expect certain abilities in members of a species; we expect humans to walk but not to fly, but a bird we expect to fly. However, increasingly therapeutic interventions have the potential to give recipients beyond species-typical body related abilities (therapeutic enhancements, TE). We believe that the perfect storm of TE, the shift in ability expectations toward beyond species-typical body abilities, and the increasing desire of health consumers to shape the health system will increasingly influence various aspects of health care practice, policy, and scholarship. We employed qualitative and quantitative methods to investigate among others how human enhancement, neuro/cognitive enhancement, brain machine interfaces, and social robot discourses cover (a) healthcare, healthcare policy, and healthcare ethics, (b) disability and (c) health consumers and how visible various assessment fields are within Neuro/Cogno/ Human enhancement and within the BMI and social robotics discourse. We found that health care, as such, is little discussed, as are health care policy and ethics; that the term consumers (but not health consumers) is used; that technology, impact and needs assessment is absent; and that the imagery of disabled people is primarily a medical one. We submit that now, at this early stage, is the time to gain a good understanding of what drives the push for the enhancement agenda and enhancement-enabling devices, and the dynamics around acceptance and diffusion of therapeutic enhancements.

Multidimensional evaluation of a radio frequency identification wi-fi location tracking system in an acute-care hospital setting.

Real-time locating systems (RTLS) have the potential to enhance healthcare systems through the live tracking of assets, patients and staff. This study evaluated a commercially available RTLS system deployed in a clinical setting, with three objectives: (1) assessment of the location accuracy of the technology in a clinical setting; (2) assessment of the value of asset tracking to staff; and (3) assessment of threshold monitoring applications developed for patient tracking and inventory control. Simulated daily activities were monitored by RTLS and compared with direct research team observations. Staff surveys and interviews concerning the system's effectiveness and accuracy were also conducted and analyzed. The study showed only modest location accuracy, and mixed reactions in staff interviews. These findings reveal that the technology needs to be refined further for better specific location accuracy before full-scale implementation can be recommended.

Outcomes of elderly survivors of intensive care: a review of the literature.

An increasing proportion of critically ill patients are elderly (ie, >or= 65 years of age). This poses complex challenges and choices for the management of elderly patients. Outcome following admission to the ICU has been traditionally concerned with mortality. Beyond mortality, outcomes such as functional status and health-related quality of life (HRQOL) have assumed greater importance. This article reviews the literature, published in English from 1990 to December 2003, pertaining to HRQOL and functional status outcomes of elderly patients. Functional status and HRQOL of elderly survivors of ICUs has been underinvestigated. There is no agreement as to the optimal instrument choice, and differences between studies preclude meaningful comparison or pooling of results.