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Introduction:While the efficacy and guidelines for implementation of rapid response systems are well established, limited information exists about rapid response paradigms for paediatric cardiac patients despite their unique pathophysiology.Methods:With endorsement from the Paediatric Cardiac Intensive Care Society, we designed and implemented a web-based survey of paediatric cardiac and multidisciplinary ICU medical directors in the United States of America and Canada to better understand paediatric cardiac rapid response practices.Results:Sixty-five (52%) of 125 centres responded. Seventy-one per cent of centres had ∼300 non-ICU beds and 71% had dedicated cardiac ICUs. To respond to cardiac patients, dedicated cardiac rapid response teams were utilised in 29% of all centres (39% and 5% in centres with and without dedicated cardiac ICUs, respectively) [p = 0.006]. Early warning scores were utilised in 62% of centres. Only 31% reported that rapid response teams received specialised training. Transfers to ICU were higher for cardiac (73%) compared to generalised rapid response events (54%). The monitoring and reassessment of patients not transferred to ICU after the rapid response was variable. Cardiac and respiratory arrests outside the ICU were infrequent. Only 29% of centres formally appraise critical deterioration events (need for ventilation and/or inotropes post-rapid response) and 34% perform post-event debriefs.Conclusion:Paediatric cardiac rapid response practices are variable and dedicated paediatric cardiac rapid response systems are infrequent in the United States of America and Canada. Opportunity exists to delineate best practices for paediatric cardiac rapid response and standardise practices for activation, training, patient monitoring post-rapid response events, and outcomes evaluation.

Background Facial nerve injury after facelift is rare; hence, its treatment is poorly established. Botulinum toxin type A (BTXA) can be employed to resolve the asymmetry. To our knowledge, there is no protocol in the literature about the best timing for this treatment, injection sites, or recommended dose. Objectives The authors sought to propose a protocol to guide the management of asymmetries post-facelift. Methods Fifteen patients with post-rhytidectomy facial palsies were treated in the non-paralyzed side with BTXA. After analysis of the smile deviation vectors, it is possible to identify the muscles that should be treated. The dose varied from 1 to 2 volume-unit per point. Patients were examined after 15 days for outcomes evaluation and touch-up if needed. Patients were re-treated after 5 to 6 months in case of asymmetry recurrence. Results Symmetry was achieved in all cases. Six patients had definitive nerve lesions and required treatment every 6 months after the first session. Five patients had lesions affecting the upper third of the face; 4 of them were definitive nerve lesions. Two of the 4 patients who were treated less than 2 weeks after surgery recovered early from the post-facelift paralysis and developed reversed asymmetry due to the BTXA. In 7 patients, the post-facelift asymmetry was due to neuropraxis: the recovery from the nerve injury and BTXA treatment occurred symmetrically on both sides of the face in the following months after 1 single session. Conclusions Asymmetries post-facelift were successfully managed with the proposed protocol. The best time for injection was 2 to 4 weeks after surgery. Level of Evidence: 4

OBJECTIVE: The purpose of this review is to highlight critical advances and innovative approaches to the most challenging clinical situations in congenital heart surgery, to establish a new perspective from which to evaluate current clinical practice patterns and contemporary United States program ranking systems. BACKGROUND: The past decades have witnessed substantial advances in the treatment of congenital heart defects. New strategies are deeply rooted in calculated risk-taking innovations. Pioneer surgeons developed, improved and refined critical operative skills and techniques to optimize cardiovascular physiology, decrease operative mortality and improve clinical outcomes. METHODS: Unfortunately, in the modern surgical era, supportive environments to allow surgeons to make similar gains and innovative contributions remain scarce. In the current practice, overall procedure volume is prioritized to safeguard quality metrics, including hospital survival and length of stay, surgical complications, and neurocognitive outcomes. As a result, exceptional surgical results have become translated and defined by public ranking systems such as the US News and World Report Best Children’s Hospital National Ranking (USNWR) and the Congenital Heart Surgery Database of the Society for Thoracic Surgeons (CHSD-STS), primary based upon early post-operative mortality. This reality places surgeons in a vulnerable position where pressure to achieve a high clinical ranking contrasts with a surgeon definition of “acceptable” surgical risk. Currently, the most frequently used risk stratification tools do not factor in important differences in strategies, such as staged palliation versus complete repair, or bi-ventricular versus uni-ventricular physiology. This favors hospitals pursuing multistage surgical approaches, even if the result is worse long-term morbidity, mortality and increased resource utilization. This economy of ranking-based decision-making causes surgeons either avoid operating altogether or accept less advantageous multi-staged treatment strategies for patients with elevated expected mortality. Such an environment also might present much farther-reaching negative impacts on the growth and development of junior surgeons and trainees, as well as on the pursuit of new surgical innovations to aid future generations of patients. CONCLUSIONS: Risk aversive surgical behavior is creating an environment not favorable for the children born with truly complex congenital heart defects. KEYWORDS: Biventricular conversion; congenital heart surgery; multidisciplinary approach; risk-stratification; surgical outcomes

Background: Identifying those at risk for suboptimal breastfeeding outcomes remains critical for improving maternal and child health. Prenatal breastfeeding motivation may be a key predictor useful for identifying those who would benefit from additional breastfeeding support. Research Aims: To (1) validate a breastfeeding-specific adaptation of the Treatment Self-Regulation Questionnaire (TSRQ-BF); and (2) determine if breastfeeding motivation predicts prenatal breastfeeding intentions and early breastfeeding outcomes. Methods: Participants in their third trimester of pregnancy ( N = 150) completed several instruments, including the TSRQ-BF and infant feeding intention, and could opt to participate in an assessment of early breastfeeding outcomes (by medical record review). TSRQ-BF subscales were derived from factor analysis, and multivariable regression was used to evaluate the association between TSRQ-BF subscale scores and breastfeeding intention and outcomes during the birth hospitalization. Results: Autonomous (related to personal values/beliefs regarding self) and Autonomous-Baby (values/benefits for the infant) subscale scores were positively associated with intended exclusivity (aOR [95% CI]: 2.22 [1.57, 3.30], 4.94 [2.49, 11.07], respectively) while higher scores on these subscales predicted longer time to planned cessation (aHR [95% CI]: 0.72 [0.61, 0.84],0.52 [0.34, 0.81]). Higher Amotivation (lack of motivation) scores were negatively associated with intended exclusivity (0.45 [0.26, 0.74]). Higher scores on Autonomous, Autonomous-Baby, and Controlled (avoidance of negative feelings/punishment or gaining reward) subscales were associated with greater odds of hospital exclusivity (aOR [95% CI]: 3.39 [1.75, 8.00], 3.44 [1.66, 9.04] and 6.05 [1.88, 29.04]) and lower odds of 2-day formula supplementation (aOR [95% CI]: 0.31 [0.14, 0.59],0.28 [0.11, 0.59], 0.19 [0.04, 0.62]). Conclusions: The TSRQ-BF predicted breastfeeding intent and outcomes, and may be helpful for identifying patients at risk for suboptimal breastfeeding outcomes before delivery.

When the focus of the accreditation process for social work programs in the United States shifted to competency-based student achievement in 2008 the overall student experience in a program seemed ...

BackgroundPercutaneous cervical cordotomy (PCC) offers pain relief to patients with unilateral treatment-refractory cancer-related pain. There is insufficient evidence about any effects of this intervention on patients’ quality of life.MethodComprehensive multimodal assessment to determine how PCC affects pain, analgesic intake and quality of life of patients with medically refractory, unilateral cancer-related pain.This study was set in a multidisciplinary, tertiary cancer pain service. Patient outcomes immediately following PCC were prospectively recorded. Patients were also followed up at 4 weeks.ResultsOutcome variables collected included: background and breakthrough pain numerical rating scores before PCC, at discharge and 4 weeks postprocedure; oral morphine equivalent opioid dose changes, Patient’s Global Impression of Change, Eastern Cooperative oncology group performance status and health related quality of life score, that is, EuroQol-5 dimension-5 level (EQ-5D).ConclusionsDespite significant improvement in pain and other standard outcomes sustained at 4 weeks, there was little evidence of improvement in EQ-5D scores. In patients with terminal cancer, improved pain levels following cordotomy for cancer-related pain does not appear to translate into improvements in overall quality of life as assessed with the generic EQ-5D measure.

Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics, with most of the literature now relying on these scoring tools to measure change in patient health status. This patient-reported information is increasingly collected routinely by orthopaedic providers but use of the data is typically restricted to academic research. Developments in electronic data capture and the outcome tools themselves now allow use of this data as part of the clinical consultation. This review evaluates the role of patient reported outcomes data as a tool to enhance daily orthopaedic clinical practice, and documents how develop-ments in electronic outcome measures, computer-adaptive questionnaire design and instant graphical display of questionnaire can facilitate enhanced patient-clinician shared decision making.

Warping is the most important problem of costal cartilage grafts used in secondary rhinoplasties. The aim of this study is to show that costal cartilage grafts prepared with oblique sliced method (OSM), can solve the warping problem and provides successful results in both functional and aesthetic appearance. There are 42 patients who had previous nose surgery and dissatisfied with their facial appearance included in the study to perform secondary rhinoplasty with costal cartilage graft OSM technique. The outcomes of the operations were performed objectively using facial measurements and subjectively using rhinoplasty outcomes evaluation (ROE) scale, before and 12 months after the operation. The mean of total ROE score was 8.171 ± 3.285 on the pre-operative period and it was increased to 19.11 ± 3.652 where the P value was found to be

The Expert Consensus reviews current literatures and provides clinical practice guidelines for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The main contents include the following: (1) clinical evaluation of GGN; (2) procedures, indications, contraindications, outcomes evaluation, and related complications of thermal ablation for GGN; and (3) future development directions.

Introduction & Objective: In observational studies, it is recommended to use propensity score (PS) methods or covariate adjustment for confounding effect adjustment. However, few guidelines are available regarding the choice of PS approaches or covariate adjustment for the best performance in a particular data. In this study, we compared different PS methods and conventional covariate adjustment to investigate the treatment effect for the overall population on time-to-event outcomes. Methods: In the Monte Carlo simulations, we compared the hazard ratio (HR) and precision estimated using covariate adjustment and eight different PS approaches, including matching, stratification, and inverse probability of treatment weighting (IPTW). In the Oral Squamous-Cell Carcinoma Cancer case study, we applied the aforementioned PS approaches to compare the effect of receiving post-operative radiation therapy (PORT) and having engraftable tumors on different time-to-event clinical outcomes. Results: In the simulations, both IPTW and covariate adjustment produced unbiased HR estimates with small uncertainty. In the case study, covariate adjustment showed that patients with engraftable tumors were twice as likely to have local/regional recurrence (HR 1.98 [1.23, 3.18], p-value

BACKGROUND: Although Clostridioides difficile surveillance often identifies emerging strains, clinical outcome evaluations are rarely performed. Ribotype (RT) 106 is a commonly isolated C. difficile strain worldwide; however, studies investigating RT 106 clinical outcomes are limited. The purpose of this study was to investigate clinical outcomes of RT 106 infections compared with two other endemic strains of varying virulence. METHODS: This multicenter study evaluated adults hospitalized with C. difficile infection (CDI). C. difficile samples underwent PCR ribotyping and patients infected with RT 106 were compared to patients infected with a known hypervirulent strain (RT 027) and a strain associated with less virulence (RT 014-020). Electronic medical records were reviewed by blinded investigators to assess the primary outcome of poor clinical outcome (composite of initial clinical failure, discharge to a higher level of care, 90-day CDI recurrence, and CDI-contributable mortality). RESULTS: A total of 396 patients with CDI were identified (RT 106, 32.3%; RT 027, 29.3%; RT 014-020, 38.3%). Patients infected with RT 014-020 less often experienced a poor clinical outcome (40%) compared with RT 106 (56%) and RT 027 (65%) infection (P

Background Several patient-reported outcome measures are available to monitor headache impact, but are those reliable in real-life clinical practice? Methods Two identical patient-reported outcome measures (HALT-90 and MIDAS) were applied simultaneously in each clinical visit to a series of patients treated with monoclonal antibodies for migraine and intra-individual agreement was evaluated using the intraclass correlation coefficients. Results Our sample included 92 patients, 92.4% females, 45 years old on average. Moderate (0.50 to 0.75) and even poor (Discussion We observed intra-personal variation in reliability when answering patient-reported outcome measures, persisting in repeated applications, and a decrease in the motivation to respond, which should alert clinicians for these additional challenges in real-life clinical practice.

Highlights • Three case of radial head fracture treated with radial head arthroplasty. • Evaluation of the functional outcomes after operative treatment of radial head arthroplasty. • Functional outcomes assessment with active and passive range of motion. • Satisfying result on pain and a fair result on functional outcome on patient follow-up. • Good follow up is important to minimize the complications of radial head arthroplasty., Introduction Radial head arthroplasty (RHA) has become one of the mainstay surgical treatment for radial head fracture in certain conditions. Many previous studies compared the superiority of either open reduction and internal fixation (ORIF) and RHA with inconclusive result. Our case series aim to evaluate the functional outcome of the patients treated with RHA in our institution. Presentation of case We evaluated three patients who had RHA in 2018 and 2019. The function of flexion, extension, supination and pronation of the elbow was evaluated. The range of motion (ROM) was assessed in both active and passive way. Discussion An abundant of literatures stated that RHA result is superior than radial head resection and ORIF. Our case series present a satisfying result on pain and a fair result on functional outcome from the range of motion (ROM) evaluation on patient follow-up. Conclusion A good follow up for post-operative care plays an important role in management of RHA to minimize the rate of complications. In this case series, the functional outcomes after RHA is good, but a larger number of patient and longer follow up duration is needed for a better analysis.

According to the DSM-V, gambling can be defined as a “persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress”, not better defined by a manic episode. ORTHOS is a three-week intensive residential intervention program with three follow-up meetings during the year following intensive residential interventions. ORTHOS’ philosophy envisages a non-moralistic and prejudicial approach to gambling (Zerbetto, 2002). The findings of the present study confirm the efficacy of ORTHOS treatment compared to the reduction of gambling symptoms, with over 85% of the sample in which the symptoms manifested no longer clinical relevance (scores below 5 in SOGS).

Background: An assessment of rhinoplasty from the patient’s perspective, in terms of satisfaction and quality of life, is quite important because these are the predominant factors indicating the success of rhinoplasty. Aims: To translate the Rhinoplasty Outcomes Evaluation into Turkish and then validate the new version for use in Turkish patients. Study Design: Validation study. Methods: We enrolled 30 participants who were able to read and write Turkish and underwent primary rhinoplasty. The control group consisted of 58 healthy volunteers with no need for aesthetic or functional nasal surgery. The reliability of the Rhinoplasty Outcomes Evaluation-T was analyzed according to its internal consistency and test-retest reproducibility. Discriminant validity was calculated by comparing the Rhinoplasty Outcomes Evaluation-T scores between the patient and control groups. Responsiveness and sensitivity to changes in rhinoplasty outcomes were analyzed by comparing the patients’ pre- and postoperative Rhinoplasty Outcomes Evaluation-T scores. Results: The scores for questions 1-6 of the Rhinoplasty Outcomes Evaluation-T, as well as the total scores, were significantly lower in the patient group than in the control group (all p0.05). The internal consistency of the Rhinoplasty Outcomes Evaluation-T was high, as evidenced by Cronbach’s α values of 0.887 preoperatively and 0.798 postoperatively. Conclusion: The Rhinoplasty Outcomes Evaluation-T constitutes a validated instrument with which to measure rhinoplasty outcomes among Turkish patients.

Correction of crooked nose with long-term functional and aesthetic success remains a great challenge for rhinoplasty surgeons. The aim of this study was to present the aesthetic and functional results of the cross-spreader graft technique applied for the correction of I-shaped crooked nose. A retrospective examination was made of 25 patients applied with open technique rhinoplasty using cross-spreader graft for the correction of I-shaped crooked nose between March 2016 and June 2019. The functional results of the patients were evaluated using the Nasal Obstruction Symptoms Evaluation scale. The Rhinoplasty Outcomes Evaluation was used to evaluate the subjective aesthetic results, and the external nose deviation angle was measured from the frontal aspect to evaluate the objective aesthetic results. Evaluation was made of 25 patients comprising 11 males and 14 females with a mean age of 26.64±7.08 years. The post-operative mean NOSE and ROE scores were significantly improved compared to the preoperative values (p

Purpose We aimed to evaluate the current situation of electronic health records (EHRs) and patient registries in the oncology departments of hospitals in Spain. Methods This was a cross-sectional study conducted from December 2018 to September 2019. The survey was designed ad hoc by the Outcomes Evaluation and Clinical Practice Section of the Spanish Society of Medical Oncology (SEOM) and was distributed to all head of medical oncology department members of SEOM. Results We invited 148 heads of oncology departments, and 81 (54.7%) questionnaires were completed, with representation from all 17 Spanish autonomous communities. Seventy-seven (95%) of the respondents had EHRs implemented at their hospitals; of them, over 80% considered EHRs to have a positive impact on work organization and clinical practice, and 73% considered that EHRs improve the quality of patient care. In contrast, 27 (35.1%) of these respondents felt that EHRs worsened the physician–patient relationship and conveyed an additional workload (n = 29; 37.6%). Several drawbacks in the implementation of EHRs were identified, including the limited inclusion of information on both outpatients and inpatients, information recorded in free text data fields, and the availability of specific informed consent. Forty-six (56.7%) respondents had patient registries where they recorded information from all patients seen in the department. Conclusion Our study indicates that EHRs are almost universally implemented in the hospitals surveyed and are considered to have a positive impact on work organization and clinical practice. However, EHRs currently have several drawbacks that limit their use for investigational purposes. Clinical trial registration Not applicable

Objective: To determine the Rhinoplasty as a powerful tool to boost patient’s self-confidence. Study Design: Prospective study. Settings: Islamabad cosmetic surgery and department of plastic surgery PIMS Islamabad Pakistan. Duration: From October 2019 March 2020. Methodology: All the patients underwent rhinoplasty having age 18 to 50 years and wither of gender were included. Rhinoplasty outcomes Evaluation (ROE) questioner containing (6 questions, was used to assess improvement of patient’s self-confidence. All the data was recorded by study proforma. Data was analyzed by using SPSS version 20. Results: Total 51 patients were assessed; their mean age was 28.54+6.65 years. Male were 27(52.9%) and females were 24(47.1%). After 3 months postoperatively patients were assessed, according to (ROE) questioner. Almost all the patients were completely agree with the appearance their nose, they can completely breath and feeling very much and completely their friends and loved ones like their nose. All the patients were confident regarding their nasal appearance as it is the best that it can be and refused, when they were asked regarding that they want to alter appearance or function of their nose surgically. Conclusion: Rhinoplasty is the best tool to boost patient’s self-confidence having nose common deformities. Almost all the participants were satisfied, good feeling and confident after surgery.

The goals of this analysis are (i) to offer elements of reflection to the actors who design and implement public policies; (ii) to keep the debate on outcomes evaluation alight; (iii) to contribute toward integrating the debate on evaluation to the complexity of actions in the public sector. This theoretical essay researched works published on the subject from 1979 to 2019. The investigation of the approaches offered by the selected authors allowed identifying variables that are relevant to the analysis of public policies. The variables are expressed in the influences of institutional trajectories, actors, and organizational context. The analysis brings the following concluions: (i) the link between institutionality and the capacity to conduct results evaluations in public policies deserves attention in future studies; (ii) the debate on the topic can be strengthened by analyses that consider not only the decisions adopted, but also the rules, norms and strategies that define the political-institutional scene in which public policies are implemented. Resumen Los objetivos de este análisis fueron: (i) ofrecer elementos de reflexión a los actores que diseñan e implementan políticas públicas; (ii) mantener vigente el debate sobre la evaluación de resultados; (iii) contribuir a integrar el debate sobre la evaluación y la complejidad de las acciones en el sector público. El ensayo teórico investigó trabajos relacionados desde 1979 hasta 2019. La exploración de los enfoques ofrecidos por los autores seleccionados permitió la identificación de variables que son relevantes para el análisis de políticas públicas y que se expresan en las influencias ejercidas por las trayectorias institucionales, los actores y el contexto organizacional. Se concluye que: (i) el vínculo entre la institucionalidad y la capacidad para llevar a cabo evaluaciones de resultados en políticas públicas merece atención en estudios futuros; (ii) el debate sobre el tema puede fortalecerse mediante análisis que consideren no solo las decisiones adoptadas, sino también las reglas, normas y estrategias que definen el escenario político-institucional en el que se implementan las políticas públicas. Resumo A análise teve os objetivos de oferecer elementos de reflexão aos atores que desenham e implementam políticas públicas e de manter aceso o debate sobre a avaliação de resultados, concorrendo para integrá-lo à complexidade da ação no setor público. O estudo foi motivado a partir do levantamento de trabalhos sobre o tema, publicados no período de 1979 a 2019. A exploração das abordagens oferecidas pelos autores selecionados permitiu a identificação de variáveis que possuem relevância para a análise de políticas públicas e que se expressam nas influências exercidas pelas trajetórias institucionais, pelos atores e pelo contexto organizacional. Conclui-se que: (i) a vinculação entre a institucionalidade e a capacidade de condução de avaliações de resultados em políticas públicas merece ser objeto de atenção em estudos futuros; (ii) o debate sobre o tema poderá ser fortalecido por análises que considerem não apenas as decisões adotadas, mas também as regras, normas e estratégias, que definem a cena político-institucional na qual são implementadas as políticas públicas.

BackgroundThe Functional Assessment of Cancer Therapy Scale Brain Cancer-Specific Module (FACT-Br) was developed by a standard measurement theory and used to assess the symptoms, functions, and quality of life among brain cancer patients in English spoken countries. However, this instrument has not been translated into Chinese.ObjectiveThis study aimed to develop the Chinese version of the Functional Assessment of Cancer Therapy Scale Brain Cancer-Specific Module (C-FACT-Br).MethodsC-FACT-Br was translated following the standard Functional Assessment of Chronic Illness Therapy Translation (FACIT) methodology. Then, the cognitive briefing interviews were done to ensure the conceptual equivalence by probing 10 native Chinese-speaking brain cancer patients.ResultsThe translation was finished by bilingual teams with the help of the FACIT organization. All items in C-FACT-Br were understandable to patients, and they also gave some comments in adjusting items in scale.ConclusionsC-FACIT-Br items had the equivalence meaning, same structure, and harmonization with the English version. Brain cancer patients over 18 years old can understand the scale and express their symptoms, function, and quality of life by these measures.

Purpose: In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture.Methods: Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes.Results: The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels.Conclusion: Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.

Purpose To select outcomes from the Nursing Outcomes Classification (NOC) to evaluate impaired tissue integrity in patients undergoing orthopedic surgeries, and develop conceptual and operational definitions for their indicators. Methods A consensus study involving 10 nurses from clinical practice. A 100% consensus was established in the outcomes selection. Findings Wound Healing: Primary intention (1102) with two indicators: (110214) Scar formation, and (110201) Skin approximation were selected. Four indicators were grouped to evaluate inflammatory signs together with foul wound odor and six for drainage. Conclusions These indicators direct the outcomes evaluation for wound healing. Implications for nursing practice Support to the definition the priority interventions in nursing process documentation.

This article considers the findings of a survey of evaluators practising in Australian health and welfare organisations to learn about strategy in outcomes evaluation design. Outcomes evaluation is identified as an opportunity for health and welfare programs to learn if and how different practice interventions are contributing to the achievement of desired outcomes, for the purpose of building an evidence base for advancing the wellbeing of people. Results indicate that current strategy to determine client outcomes in these sectors is typified by reliance on program logic models and funding specifications, with limited translation of best practice evidence or client wellbeing preferences. We suggest that clarity of purpose is an important consideration for non-profit programs embarking on evaluation design, bringing attention to the need for skill development and better resourcing of non-profit organisations to support the production of evaluations capable of contributing to best practice evidence.

Objective To evaluate patient satisfaction and quality of life following secondary cleft rhinoplasty. Design Prospective consecutive patient, single unit, single surgeon study. Setting Spires Cleft Centre, Salisbury, Wilshire, United Kingdom, and private practice. Patients, Participants 56 (27 secondary cleft rhinoplasty) patients completed evaluation forms preoperatively and 3 to 6 months postoperatively. Interventions Subjective assessment was performed using a validated Rhinoplasty Outcomes Evaluation (ROE) questionnaire. This instrument comprises six questions that capture three quality-of-life domains: physical, mental/emotional, and social. Main Outcome Rhinoplasty outcomes evaluation scores were calculated (range = 0 to 100) to indication satisfaction with rhinoplasty outcomes. Results Average age was 28 years (range = 18 to 59 years). There was a significant subjective improvement in the total ROE evaluation scores from 28 ± 10 to 80 ± 11 ( P < .01) in secondary cleft rhinoplasty. Similar results were achieved in noncleft rhinoplasty 34 ± 9 to 84 ± 9 ( P < .01). Specific scores for nasal aesthetic appearance improved from 0.3 ± 0.2 to 3.2 ± 0.3 ( P < .01) in secondary cleft rhinoplasty. No significant change was seen in breathing capacity in secondary cleft rhinoplasty (from 2.7 ± 0.3 to 3.2 ± 0.2; P = .29). All patients said they would undergo the procedure again. Conclusion Our results demonstrate high patient satisfaction after cleft rhinoplasty with particular regard to cosmetic appearance. These results are similar to those for noncleft rhinoplasty. We would recommend the use of this simple and quick validated outcome tool with all rhinoplasty patients.

BackgroundSevere sepsis and septic shock are among the leading causes of death in the USA. While early prediction of severe sepsis can reduce adverse patient outcomes, sepsis remains one of the most expensive conditions to diagnose and treat.ObjectiveThe purpose of this study was to evaluate the effect of a machine learning algorithm for severe sepsis prediction on in-hospital mortality, hospital length of stay and 30-day readmission.DesignProspective clinical outcomes evaluation.SettingEvaluation was performed on a multiyear, multicentre clinical data set of real-world data containing 75 147 patient encounters from nine hospitals across the continental USA, ranging from community hospitals to large academic medical centres.ParticipantsAnalyses were performed for 17 758 adult patients who met two or more systemic inflammatory response syndrome criteria at any point during their stay (‘sepsis-related’ patients).InterventionsMachine learning algorithm for severe sepsis prediction.Outcome measuresIn-hospital mortality, length of stay and 30-day readmission rates.ResultsHospitals saw an average 39.5% reduction of in-hospital mortality, a 32.3% reduction in hospital length of stay and a 22.7% reduction in 30-day readmission rate for sepsis-related patient stays when using the machine learning algorithm in clinical outcomes analysis.ConclusionsReductions of in-hospital mortality, hospital length of stay and 30-day readmissions were observed in real-world clinical use of the machine learning-based algorithm. The predictive algorithm may be successfully used to improve sepsis-related outcomes in live clinical settings.Trial registration numberNCT03960203

Background Single-stage unifocalisation for pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCA) requires a high degree of three-dimensional (3D) anatomical imagination. A previous study has reported the application of a 3D-printed heart model with virtual reality (VR) or mixed reality (MR). However, few studies have evaluated the surgical outcomes of the 3D model with VR or MR in PA/VSD patients. Methods Three-dimensional (3D) heart models of five selected PA/VSD patients were derived from traditional imageology of their hearts. Using VR glasses, the 3D models were also visualised in the operating room. Both the 3D-printed heart models and preoperative evaluation by VR were used in the five selected patients for surgical simulation and better anatomical understanding. Mixed reality holograms were used as perioperative assistive tools. Surgical outcomes were assessed, including in-hospital and early follow-up clinical data. Results The use of these three new technologies had favourable feedback from the surgeons on intraoperative judgment. There were no in-hospital or early deaths. No reintervention was required until the last follow-up. Three (3) patients developed postoperative complications: one had right bundle branch block and ST-segment change, one had chest drainage >7 days (>40 mL/day) and one had pneumonia. Conclusion The preoperative application of a 3D-printed heart model with VR or MR helped in aligning the surgical field. These technologies improved the understanding of complicated cardiac anatomy and achieved acceptable surgical outcomes as guiding surgical planning.

INTRODUCTION Pedicled perforator flaps are widely used for soft tissue reconstruction, but evidence in literature about risk factors associated with complications is still controvert. The aim of this study is to evaluate risk factors and outcomes associated with pedicled perforator-based flaps harvested at different anatomical sites. PATIENTS AND METHODS Seventy-one propeller and 59 V-Y advancement flaps were performed to reconstruct defects of the face (24 cases), trunk (47 cases), and extremities (59 cases). Mean defect and flap area were 32.43 and 43.2 cm2 , respectively. The average age recorded was 66 years. We statistically analyzed whether patient and flap-related variables had an impact on flap vascular complications rate. Patients were asked to rate on a 5-point Likert scale the aesthetic and functional outcomes of the surgery. RESULTS Overall flap complications rate was 23.07%. Coronary heart disease was an independent risk factor for flap complications (p = .010), while hypertension was associated with a lower complication rate (p = .010). The increasing degree of pedicle rotation had a significant impact on the development of flap vascular complications (p = .008). Mean patients' aesthetic and functional ratings were 4.23 of 5 and 4.37 of 5, respectively. CONCLUSIONS We found a positive correlation between both coronary heart disease and increasing degree of pedicle rotation and complications. Other factors tested were not significantly associated with complications. Patients were overall satisfied with both the aesthetic and functional outcomes of the procedure. The decisional algorithm hereby suggested yields a 93.1% overall success rate and we believe it could be of help to plastic surgeons approaching soft tissue defects.

e18826 Background: New cancer treatments have the potential to cause economic stress at the personal and societal level. Little is known on the evaluation of financial outcomes in clinical trials. We hypothesized that randomized controlled trials (RCTs) are unlikely to have pre-planned analyses to look at economic outcomes that address financial toxicity to patients and cost-effectiveness to society. Methods: Interventional therapeutic-intent phase 3 cancer-specific RCTs were identified through ClinicalTrials.gov. Pre-planned economic outcomes addressing financial toxicity or cost-effectiveness were identified. Results: We identified 1,069 interventional phase 3 oncology RCTs. Overall, 101 (9.4%) had pre-planned to evaluate quality of life using the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Questionnaire (EORTC QLQ-C30) instrument, of which a single question (Q28) relates to financial toxicity. However, only ten (0.94%) trials included pre-planned financial/economic endpoints; all were secondary endpoints. Among those planning to evaluate economic outcomes, 6/10 planned to collect data and report on financial distress using Q28 on EORTC QLQ-C30 and 3/10 pre-planned performing cost-effectiveness analyses. One study planned to perform an economic evaluation, including health utilities, as measured by the EuroQol-Five Dimension (EQ-5D) Questionnaire. All ten trials were industry–sponsored, and two were co-sponsored by a National Cancer Institute (NCI) cooperative group. The majority (8/10) were superiority-designed trials, and 6/10 included progression-free survival as the primary endpoint. The majority (6/10) assessed targeted therapy as the primary intervention. Multinational enrollment was predominant (8/10). Of the 10 trials, nine had a published manuscript. One was closed because of accrual issues. Among the six trials that had pre-specified reporting on financial distress, two published on financial toxicity. Of the two trials that had a priori planned to do a cost-effective analysis, one was published. However, overall 3/9 had published a cost-effective analysis. Conclusions: Less than one percent of oncology RCTs have pre-specified plans to evaluate economic outcomes associated with personal financial distress or cost-effectiveness. For the trials that had pre-planned reporting on financial toxicity, the instrument used to evaluate financial toxicity is a single question which has not been validated as a standalone assessment. Cost-effectiveness analyses were more likely to be published than on financial toxicity and were often completed as a post-hoc analysis. Given that many newly investigated therapies increase the financial burden on patients and add cost to the healthcare system more broadly, pre-planned evaluation of economic outcomes in RCTs is imperative in order to create a value-based framework in assessing new therapies.

Abstract: This article describes key challenges experienced and addressed during the evaluation of the Government of Alberta’s 10-Year Fetal Alcohol Spectrum Disorder (FASD) Strategic Plan (2007–2017). The purpose was to understand how the strategic plan was progressing toward outcomes at the fifth year of its implementation. Following a description of the system change initiative and evaluation context, an account of key challenges for one outcome is presented, including attempts to address and the effects on the evaluation. The implications for evaluation practice focused on encouraging evaluation participation and enhancing usefulness of data highlight the need for infrastructure to support evaluation of system change initiatives.

Purpose Although the construction industry is known for its low level of innovation and slow pace of change, some of its characteristics not only make this sector unique but also provide some opportunities to innovate. Innovation evaluation has become one of the priorities for building practitioners. This study aims to develop a practical methodology to evaluate the outcomes of innovation in small building and construction projects. Design/methodology/approach The research used three real case projects and information along with what was found in the literature. A framework was developed based on an extensive literature review of innovation outcomes evaluation. Findings The outcomes of the building projects were categorized into six categories of economic, quality, social, environmental, satisfaction and soft and organizational impacts. It was found that the outcomes of innovative practices in construction projects could be evaluated if subjective assessment is tolerated. The findings of this research are limited to the domestic and medium-density building projects, thus the outcomes might be generalized with appropriate care. The proposed practical framework would assist practitioners in the field of building and construction to realize the impacts of innovation introduced in their projects. The project owners and developers could be the main users of this framework. Originality/value Previously developed models or frameworks have mainly remained at the abstract level that could be used as guidelines, but the proposed framework in this study is practical and applicable to real building projects.

The aim of this study was to explore the impact of incorporating a physician at triage (PAT) and the implementation of a medical assessment unit (MAU) on emergency department (ED) patient throughput.A retrospective comparative analysis of two additional models of care (standard care, T1; PAT, T2 and PATplusMAU, T3) was undertaken. Patient presentations to a large public teaching hospital in South-East Queensland between 10th January 2013 and 25th February 2013, and the same time period in 2012, were included. The impact of these care models on ED length of stay and other outcomes (time to be seen by a clinician, time from bed request to ward transfer, meeting 4 hour transit targets, admission rates and the proportion of patients who did not wait) were compared.Compared to standard care, ED length of stay appeared to decrease with the introduction of both models, but was only significantly decreased after PATplusMAU was implemented (2013; T1, 186 min; T2, 181 min; T3, 175 min: T1 vs T3, P 0.001). Outcomes that improved included: time to be seen by a clinician, proportion of patients who did not wait; increase in meeting 4-hour length of stay target for both admitted and not-admitted patients.Placing a physician at triage and implementing a medical assessment unit were viable models of care that promoted patient flow and helped meet several time-sensitive health service targets.

The series of Power Management Lab Kits (PMLK), released by Texas Instruments (TI), have been globally adopted in classroom settings. We propose a cognitive graph-based method to assist better adoption of TI-PMLK in Chinese power electronics education and specifically assessment of the experiment-based learning experience. First, construct a power management cognitive graph. Then, identify knowledge weaknesses using a Deterministic Inputs Noisy And Gate (DINA) model based cognitive diagnosis method. An Automatic Items Generation System (AIG) is then developed to generate personalized experiment items for any given student. Finally, learning outcomes evaluation is generated from the AIG experimental items using Bayesian psychometric models.

Students learning results prediction is one of the “hottest” problems in modern learning process. We describe mathematical framework of students learning results assessment on the basis of mixed diagnostic tests (MDT). This framework includes cognitive graphic tools 2-simplex and 2-simplex prism, being the powerful means of data visualization for learning outcomes evaluation and efficient goal-setting. A new approach to the prediction of students’ learning results based on MDT and cognitive graphic tools is proposed. Students test results for the e-learning course “Selected Chapters of Electronics” and examples of their learning outcomes cognitive visualization are given. The proposed approach to prediction and cognitive visualization is discussed. Cross-platform software implementation specificity of cognitive graphic tools invariant to problem areas is described.

In recent years, there has been a shift in the type of repair for tetralogy of Fallot (ToF) with a preference for valve-sparing (VS) surgery over transannular patching (TAP). However, long-term outcomes evaluation is lacking. The objective was to compare long-term outcomes of patients with ToF

Introduction Macedonia has one of the highest rates of tobacco use in the world. An estimated 37% of the adult population are tobacco consumers (46.5% for men and 26.7% for women). Tobacco is inexpensive and is a part of the socio-economic life for a significant number of Macedonian residents. The country lacks the public health and clinical infrastructure needed to deliver effective tobacco cessation counseling. To address this critical medical, training, and education gap, we implemented a comprehensive, culturally appropriate modified Certified Tobacco Treatment Specialist (CTTS) training program for Macedonian physicians. Methods Utilizing formative qualitative data, the CTTS program was adapted to meet the context of tobacco use and access to preventive measures (e.g., counseling, pharmaceuticals) in Macedonia. An evaluation survey was developed based on a ‘systems model for clinical care’. Evaluation data were collected at baseline, two days post, and six months post. Process evaluation includes physician log-books for recording weekly encounters with patients who are former or current smokers. Results Macedonian physician champions and US partners trained 97 physicians in the counseling methodology. Statistically significant improvements (p

Introduction The CTTS program has been shown to decrease smoking in populations within the United States. The program was adapted into a 1 ½ day training for Macedonian physicians. The overall program aim was to train 100 medical providers in the aCTTS curriculum. The objectives were to: 1) increase provider knowledge and self-efficacy for patient counseling; and, 2) counsel at least 500 patients to quit tobacco use over a one-year period. Methods A longitudinal survey was conducted at baseline, immediate post-intervention (knowledge only), and 6- and 12-months post-intervention. Data were analyzed in SPSS (version 25). Data are analyzed through 6-months post-intervention. Analysis included descriptive data, bivariate analysis to determine significant changes across time, and multivariate analysis to further refine associations between physician demographic characteristics, physician personal smoking history, and changes in knowledge and self-efficacy for counseling between baseline and 6-months post-intervention. In addition, weekly data has been collected from physicians regarding their engagement in tobacco counseling with patients. Results On a 30-item knowledge scale, scores increased between baseline and immediate post-intervention from 10.9 to 17.4 (t=-10.04, p

The development process of engineering program accreditation in China is briefly introduced, then it put more attention to describe the accreditation exploration and practice experiences for hydraulic engineering program in past 10 years, such as the construction of accreditation standard system, how to do the survey at site and selection and training for experts, student outcomes evaluation and the problems to be solved.

Purpose – The purpose of this paper is to retrospectively evaluate outcomes measured for patients attending the Leeds Addiction Unit (LAU) for cannabis use disorders. Design/methodology/approach – The authors performed a retrospective evaluation of data for clients referred to LAU for cannabis use disorders. These clients are routinely allocated to a programme of social behaviour and network therapy (SBNT), and methods of monitoring treatment include four questionnaires completed by clients, and the collection of treatment outcomes profile (TOP) data. Data were compared using non-parametric statistical methods. Findings – Of 158 clients included in the study, 20 completed the four questionnaires at assessment and follow-up. A statistically significant improvement was found for the outcome measuring level of dependence (p=0.013). TOP data showed significant reduction in the average number of days of cannabis use over the past four weeks (pp Practical implications – These findings suggest that treatment using SBNT can result in clinical improvement in cannabis use disorders. The promising results of the UK Alcohol Treatment Trial naturally raised the question as to whether SBNT can be adapted to treat substance use disorders other than alcoholism. This study aims to add to the body of evidence for this proposal. Originality/value – This is the first evaluation of the service to measure outcomes for the treatment of cannabis misuse. This study is especially relevant given the recent changes made to the Diagnostic and Statistical Manual of Mental Disorders regarding cannabis use disorders, and has triggered another evaluation of cannabis treatment at LAU looking into specific pharmacotherapy.

In this paper, we discuss the relevance of students’ learning outcomes evaluation using computer-based testing. The learning process is based on mixed diagnostic tests. For the purpose of evaluation, we use the threshold, fuzzy logic and cognitive graphic tools. The construction of mixed diagnostic tests, representing a compromise between unconditional and conditional components, in order to develop students’ knowledge evaluation is proposed for a number of disciplines. We suggest a technique for optimal mixed diagnostic tests construction based on the expert knowledge of the subjects for effective learning. The developed approach is used for a number of both the humanities and technical disciplines. One of useful outcomes of mixed diagnostic tests application is the learning trajectory design for each individual. We construct students’ learning trajectory using the intelligent learning and testing system and suggest defining their inherent approach to the learning process within the problem area.

Supplemental Digital Content is available in the text., Background: A standardized evaluation tool is needed for the assessment of surgical outcomes in cleft lip surgery. Current scales for evaluating unilateral cleft lip/nose (UCL/N) aesthetic outcomes are limited in their reliability, ease of use, and application. The Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE) scale measures symmetry of 4 components and sums these for a total score. The purpose of this study was to validate the SOE as a reliable tool for use by both surgeons and laypersons. Methods: Twenty participants (9 surgeons and 12 laypeople) used the SOE to evaluate 25 sets of randomly selected presurgical and postsurgical standardized photographs of UCL/N patients. Interrater reliability for surgeon and laypeople was determined using an intraclass correlation coefficient (ICC). Results: Individual surgeons and laypeople both reached an ICC in the "fair to good" range (ICC = 0.42 and 0.59, respectively). Averaging 2 evaluators in the surgeon group improved the ICC to 0.58 and in the laypeople group to 0.74, respectively. Averaging 3 evaluators increased the ICC for surgeons to the "good" range (ICC = 0.71) and the ICC for laypeople to the "very good" range (ICC = 0.82). Conclusions: Surgeon and layperson raters can reliably use the SOE to assess the aesthetics results after surgical repair of UCL/N, and improved reliability and reproducibility is achieved by averaging the scores of multiple reviewers.

Purpose: To evaluate the efficacy, safety, and indirect financial outcomes of pharmacist face-to-face warfarin management with telephone-based distance management utilizing local laboratories or patient self-testing (PST). Methods: A retrospective analysis of a clinic population of 336 patients on established warfarin therapy distributed statewide in rural and urban settings over a 6-month period was conducted. Participants were stratified into face-to-face management, telephone-based management utilizing local laboratory testing, and telephone-based management utilizing PST. Results: The primary outcome of international normalized ratio (INR) time in therapeutic range (TTR) for face-to-face management was significantly greater than distance management utilizing local laboratory testing (69.0% vs 60.5%, P = .0032). No difference was observed between face-to-face management and PST (69.0% vs 68.0%, P = .25). No significant difference in bleeding or thromboses was observed. Although increased clinician time was utilized during face-to-face encounters compared to telephone encounters (8.7-minute face-to-face, 5.5-minute local laboratory, and 5.4-minute PST), face-to-face encounters tended to be billable at lower levels, whereas telephone-based encounters were billable at higher levels. Conclusion: A multimodal approach to pharmacist warfarin management of a patient population distributed statewide in rural and urban locations is effective despite TTR differences associated with INR testing used in distance management. PST may improve warfarin treatment outcomes and adherence in distance management, particularly when the use of alternative oral anticoagulants is inappropriate. Although time and billing differences between face-to-face and distance management exist, clinical and safety outcomes remain acceptable despite encounter complexity and support reimbursement of pharmacist anticoagulation management in all settings.

The aim of this study was to assess patients' satisfaction based on gender and age using the Rhinoplasty Outcomes Evaluation (ROE) post-rhinoplasty from both functional and aesthetic outcomes. The study design was a prospective observational study. A total of 103 patients who underwent Rhinoplasty were prospectively investigated from January 2011 through December 2013 at King Abdulaziz University Hospital in Riyadh, Saudi Arabia. The sample included 61 males (59.2%) and 42 females (40.7%). The overall mean age was (25.2 ± 5.9) years (range 17-48 years). ROE was distributed pre- and post-surgery. The overall difference in satisfaction was significant (p 0.0001). The mean satisfaction difference of function was increased by 21.5%, raising the satisfaction percentage from 57.1% initially to 78.5% post-surgery (mean -0.215, CI -0.269, -0.161). Satisfaction of shape post-rhinoplasty showed that the mean satisfaction increased by 31.3% (mean -0.313, CI -0.369, -0.256), which changed the satisfaction from a mean of 44.2% before surgery to 75.5% post-rhinoplasty (p = 0.000). There was no significant difference in satisfaction between males and females, nor was there a significant difference in satisfaction among different age groups (p 0.05). There was a significant overall increase in patients' satisfaction from functional and aesthetic outcomes post-surgery based on ROE. Our study showed that age and gender did not significantly affect satisfaction. The ROE was a useful tool to implement for assessing the quality-of-life post-rhinoplasty.

Oklahoma's health status has been ranked among the worst in the country. In 1972, the University of Oklahoma established the Tulsa branch of its College of Medicine (COM) to expand the physician workforce for northeastern Oklahoma and to provide care for the uninsured patients of the area. In 2008, the Tulsa branch launched a distinct educational track, the University of Oklahoma COM's School of Community Medicine (SCM), to prepare providers equipped and committed to addressing prevalent health disparities.The authors describe the Tulsa branch's Summer Institute (SI), a signature program of the SCM, and how it is part of SCM's process of institutional transformation to align its education, service, and research missions toward improving the health status of the entire region. The SI is a weeklong, prematriculation immersion experience in community medicine. It brings entering medical and physician assistant students together with students and faculty from other disciplines to develop a shared culture of community medicine. The SI uses an unconventional curriculum, based on Scharmer's Theory U, which emphasizes appreciative inquiry, critical thinking, and collaborative problem solving. Also, the curriculum includes Professional Meaning conversations, small-group sessions to facilitate the integration of students' observations into their professional identities and commitments. Development of prototypes of a better health care system enables participants to learn by doing and to bring community medicine to life.The authors describe these and other curricular elements of the SI, present early evaluation data, and discuss the curriculum's incremental evolution. A longitudinal outcomes evaluation is under way.

SummaryTherapeutic patient education programmes on heart failure have been widely proposed for many years for heart failure patients, but their efficiency remains questionable, partly because most articles lack a precise programme description, which makes comparative analysis of the studies difficult. To analyse the degree of precision in describing therapeutic patient education programmes in recent randomized controlled trials. Three major recent recommendations on therapeutic patient education in heart failure inspired us to compile a list of 23 relevant items that an ‘ideal’ description of a therapeutic patient education programme should contain. To discover the extent to which recent studies into therapeutic patient education in heart failure included these items, we analysed 19 randomized controlled trials among 448 articles published in this field from 2005 to 2012. The major elements required to describe a therapeutic patient education programme were present, but some other very important pieces of information were missing in most of the studies we analysed: the patient's educational needs, health literacy, projects, expectations regarding therapeutic patient education and psychosocial status; the educational methodology used; outcomes evaluation; and follow-up strategies. Research into how therapeutic patient education can help heart failure patients will be improved if more precise descriptions of patients, educational methodology and evaluation protocols are given by authors, ideally in a standardized format.

The majority of children suffering from heart disease in Namibia receive treatment as outpatients, with their caregivers taking responsibility for their continuing care. To provide the care required by these children, the caregiver has to remain vigilant. Many of these children live in rural areas and their caregivers may have only a limited educational background, as well as limited financial resources, as they depend on subsistence agriculture for a living. The development of the support programme discussed in this article originated from the results of a qualitative, exploratory, phenomenological study that addressed the issue of how these caregivers managed this responsibility. The findings of this study revealed that the caregivers generally had poor coping experiences. Subsequently, these findings formed the basis for the proposal about a support programme for the rural caregivers of children with heart disease in Namibia. As part of the study, interventions for home-based health care were developed, implemented and evaluated in order to facilitate the caregiver’s coping with the demands of home care. The findings of an outcomes evaluation indicated that the caregivers’ knowledge of the child’s condition, as well as the skills for providing care at home and the information about community-based resources that could provide them with support to cope, increased. If the programme were to be extended to other families in similar contexts, the programme interventions could make a difference in terms of their coping with the demands of care. This paper describes the implementation process involved in a home-based health care programme intervention of the study, and the subsequent outcomes of the programme evaluation.

Introduction:This work reviews the current state of patient-reported outcomes research in periocular cosmetic plastic surgery.Materials and Methods:A systematic review of the English-language medical literature from January 1946 through March 2013 was conducted for patient-reported outcomes measures used in periocular cosmetic plastic surgery patient populations. These measures were assessed for adherence to minimum standards recommended by the International Society for Quality of Life Research.Results:Thirteen outcome measures were identified. Upper-lid blepharoplasty was the only procedure for which an instrument, the Blepharoplasty Outcomes Evaluation, had been formally developed in the target patient group (periocular cosmetic surgery), and that met or exceeded minimum standards of reporting. Nine formally developed instruments were identified in the following applications: general facial cosmetic surgery (instruments that may be applied to periocular surgery, which are not restricted to any single fa...