DESIGN/METHODOLOGY/APPROACH: The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman's test.
FINDINGS: The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman's test, showed a statistically significant increase in the PSI, χ2 = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases ( Z=3.317, p=0.003) between the baseline and continuous improvement phases ( Z=6.633, p<0.001), and between the action and continuous improvement phases ( Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.
RESEARCH LIMITATIONS/IMPLICATIONS: The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.
PRACTICAL IMPLICATIONS: The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.
ORIGINALITY/VALUE: The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.
METHODS: An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).
RESULTS: A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.
DISCUSSION: Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.
Methods: A cross-sectional study using a validated 20-item questionnaire was conducted among physicians (n=78) and clinical pharmacists (n=45) working in the medical wards of two tertiary hospitals in Malaysia. Knowledge was assessed by six clinical vignettes which were developed based on Beers criteria and the STOPP/START criteria. Other domains of the study were investigated using a four-point or five-point Likert scale.
Results: Of the 82 participants who completed the questionnaire, 65% were physicians, 90.2% had never received training in geriatric medicine, and 70.8% estimated that 25% or more of their patients were elderly. Only six participants (7.3%) had ever used STOPP/START or Beers criteria when prescribing for elderly patients, and 60% of the respondents had never heard of either one of those criteria. The mean score (SD) for the knowledge part was 3.65 (1.46) points, and only 27 participants (22.9%) scored more than four out of a possible six points. Overall, 34% of the participants rated themselves as confident in prescribing for elderly patients, and this was significantly associated with their knowledge score (P=0.02). The mean number (SD) of barriers cited per participant was 6.88 (2.84), with polypharmacy being the most cited barrier.
Conclusions: The majority of the participants had inadequate knowledge and low confidence regarding recommending medications for elderly patients. Continuing education on geriatric pharmacotherapy may be of value for the hospital physicians and pharmacists.
DESIGN/METHODOLOGY/APPROACH: Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture.
FINDINGS: Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 - 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 - 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 - 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 - 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 - 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 - 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 - 1.818; p<0.001).
PRACTICAL IMPLICATIONS: With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations.
ORIGINALITY/VALUE: Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.
CASE REPORT: A 58-year-old female presented with a 3-cm painless right axillary mass. Extensive radiological investigations that include mammography, ultrasonography of the breasts and positron emission tomography (PET) scan failed to conclude the primary site of the tumour. Histological examination of the lymph node revealed loosely cohesive sheets of poorly differentiated malignant cells, without discernible glandular or squamous differentiation. Immunohistochemically, the malignant cells exhibited diffuse immunoreactivity toward pan-cytokeratin and CK7, while leukocyte common antigen, S100 and CK20 were negative. A second panel of immunomarkers was carried out. The malignant cells expressed breast-specific markers (GATA-3, GCDFP-15 and mammaglobin), and were negative for ER, PR and TTF-1 immunohistochemistry. A diagnosis of OBC was rendered.
DISCUSSION: Breast primary must always be considered in the differential diagnosis in patients with sole presentation of axillary lymphadenopathy. The breast-specific immunomarkers play a pivotal role in the diagnosis of ER, PR-negative occult breast cancer.
OBJECTIVE: This study aimed to evaluate the research output of the top 100 publications and further identify a research theme of breast cancer and machine-learning studies.
METHODS: Databases of Scopus and Web of Science were used to extract the top 100 publications. These publications were filtered based on the total citation of each paper. Additionally, a bibliometric analysis was applied to the top 100 publications.
RESULTS: The top 100 publications were published between 1993 and 2019. The most productive author was Giger ML, and the top two institutions were the University of Chicago and the National University of Singapore. The most active countries were the USA, Germany and China. Ten clusters were identified as both basic and specialised themes of breast cancer and machine learning.
CONCLUSION: Various countries demonstrated comparable interest in breast cancer and machine-learning research. A few Asian countries, such as China, India and Singapore, were listed in the top 10 countries based on the total citation. Additionally, the use of deep learning and breast imaging data was trending in the past 10 years in the field of breast cancer and machine-learning research.