Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future

Evaluation of the impact of annealing on gelatinisation at intermediate water content of wheat and potato starches: A differential scanning calorimetry and small angle X-ray scattering study

The DSC (differential scanning calorimetry) thermograms of wheat and potato starches at 50% (w/w) wa.ter content are characterised by two gelatinisation endotherms, Two separate phenomena coinciding with the two DSC endotherms can be distinguished in the SAXS patterns of 50% (w/w) suspensions of wheat and potato starches during heating from 25 to 95 degrees C at 2 degrees C/min: an increase in peak integral in the temperature domain of the first (G) endotherm and a marked decrease in peak integral in the temperature domain of the second (M1) endotherm, One- and two-step annealing affect only the G endotherm, leading to a shift to a higher temperature of up to 8 degrees C, sharpening of the peak and an increase in enthalpy, while the completion temperature of the M1 endotherm remains unchanged, Static SAXS measurements indicate that the repeat distances of crystalline and amorphous lamellae in wheat (105 Angstrom) and potato (99 Angstrom) starch granules are unaffected by annealing, One- and two-step annealing intensify the SAXS peaks, The most striking difference between the SAXS gelatinisation profiles of native and annealed starches is that there is no increase in peak integral at the onset of gelatinisation of annealed starches, The effects following annealing are interpreted as a decreased water absorption during gelatinisation. Annealing leads to a retardation of the initial swelling and cooperative melting of the granules, without altering the stability of the most perfect crystallites. (C) 1998 Elsevier Science Ltd. All rights reserved.status: publishe

Impact of a brief intervention on physical activity and social cognitive determinants among working mothers: A randomized trial.

Working mothers exhibit high levels of inactivity, and theory-based interventions to bolster physical activity within this population are needed. This study examined the effectiveness of a brief social cognitive theory-based intervention designed to increase physical activity among working mothers. Participants (N = 141) were randomly assigned to an intervention only, intervention plus follow-up support, or waitlist control condition. The intervention consisted of two group-based workshop sessions designed to teach behavior modification strategies using social cognitive theory. Data were collected at baseline, immediately post-intervention, and 6-month follow-up. Results showed intervention participants exhibited short-term increases in physical activity, which were partially maintained 6 months later. Improvements in physical activity were mediated by increases in self-regulation and self-efficacy. This study provides some support for the effectiveness of a brief intervention to increase physical activity among working mothers. Future programs should explore alternative support mechanisms which may lead to more effective maintenance of initial behavior changes

Reversed-phase separation methods for glycan analysis

Reversed-phase chromatography is a method that is often used for glycan separation. For this, glycans are often derivatized with a hydrophobic tag to achieve retention on hydrophobic stationary phases. The separation and elution order of glycans in reversed-phase chromatography is highly dependent on the hydrophobicity of the tag and the contribution of the glycan itself to the retention. The contribution of the different monosaccharides to the retention strongly depends on the position and linkage, and isomer separation may be achieved. The influence of sialic acids and fucoses on the retention of glycans is still incompletely understood and deserves further study. Analysis of complex samples may come with incomplete separation of glycan species, thereby complicating reversed-phase chromatography with fluorescence or UV detection, whereas coupling with mass spectrometry detection allows the resolution of complex mixtures. Depending on the column properties, eluents, and run time, separation of isomeric and isobaric structures can be accomplished with reversed-phase chromatography. Alternatively, porous graphitized carbon chromatography and hydrophilic interaction liquid chromatography are also able to separate isomeric and isobaric structures, generally without the necessity of glycan labeling. Hydrophilic interaction liquid chromatography, porous graphitized carbon chromatography, and reversed-phase chromatography all serve different research purposes and thus can be used for different research questions. A great advantage of reversed-phase chromatography is its broad distribution as it is used in virtually every bioanalytical research laboratory, making it an attracting platform for glycan analysis. [Figure not available: see fulltext.