RESUMEN
OBJECTIVE: This is the first systematic review aims to build the evidence for the impact of accreditation on quality improvement of healthcare services, as well as identify and develop an understanding of the contextual factors influencing accreditation implementation in the hospital setting through the lens of Normalisation Process Theory (NPT). DATA SOURCES: Data were gathered from five databases; MEDLINE, PUBMED, EMBASE, CINAHL, and the Cochrane Library. And supplemental sources. STUDY DESIGN: This systematic review is reported following PRISMA guidelines with a quality assessment. Data were analysed using a thematic analysis guided by the NPT theoretical framework. DATA COLLECTION/EXTRACTION METHODS: Data were extracted and summarized using prespecified inclusion/exclusion criteria and a data extraction sheet encompassing all necessary information about the studies included in the review. PRINCIPAL FINDINGS: There are inconsistent findings about the impact of accreditation on improving healthcare quality and outcomes, and there is scant evidence about its effectiveness. The findings also provide valuable insights into the key factors that may influence hospital accreditation implementation and develop a better understanding of their potential implications. Using the NPT shows a growing emphasis on the enactment work of the accreditation process and how this may drive improving the quality of healthcare services. However, little focus is given to accreditation's effects on health professionals' roles and responsibilities, strategies and ways for engaging health professionals for effective implementation, and ensuring that the goals and potential benefits of accreditation are made clear and transparent through ongoing evaluation and feedback to all health professionals involved in the accreditation process. CONCLUSIONS: While there are contradictory findings about the impact of accreditation on improving the quality of healthcare services, accreditation continues to gain acceptance internationally as a quality assurance tool to support best practices in evaluating the quality outcomes of healthcare delivered. Policymakers, healthcare organisations, and researchers should proactively consider a set of key factors for the future implementation of accreditation programmes if they are to be effectively implemented and sustained within the hospital setting. Systematic review registration: International Prospective Register of Systematic Reviews PROSPERO 2020 CRD42020172390 Available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=172390.
Asunto(s)
Atención a la Salud , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Hospitales , AcreditaciónRESUMEN
Improvised explosive devices (IEDs), during military operations, has increased the incidence of blast-induced traumatic brain injuries (bTBI). The shock wave is created following detonation of the IED. This shock wave propagates through the atmosphere and may cause bTBI. As a result, bTBI research has gained increased attention since this injury's mechanism is not thoroughly understood. To develop better protection and treatment against bTBI, further studies of soft material (e.g. brain and brain surrogate) deformation due to shock wave exposure are essential. However, the dynamic mechanical behavior of soft materials, subjected to high strain rates from shock wave exposure, remains unknown. Thus, an experimental approach was applied to study the interaction between the shock wave and an unconfined brain surrogate fabricated from a biomaterial (i.e. polydimethylsiloxane (PDMS)). The 1:70 ratio of curing agent-to-base determined the stiffness of the PDMS (Sylgard 184, Dow Corning Corporation). A stretched NACA 2414 (upper airfoil surface) geometry was utilized to resemble the shape of a porcine brain. Digital image correlation (DIC) technique was applied to measure the deformation on the brain surrogate's surface following shock wave exposure. A shock tube was utilized to create the shock wave and pressure transducers measured the pressure in the vicinity of the brain surrogate. A transient structural analysis using ANSYS Workbench was performed to predict the elastic modulus of 1:70 airfoil-shaped PDMS, at a strain rate on the order of 6 × 103 s-1. Both compression and protrusion of the PDMS surface were found due to the shock wave exposure. Negative pressure was found in a semi-ring area, which was the cause of protrusion. Oscillation of the brain surrogate, due to the shock wave loading, was found. The frequency of oscillation does not depend on the geometry. This work will add to the limited data describing the dynamic behavior of soft materials due to shock wave loading.
Asunto(s)
Traumatismos por Explosión , Lesiones Traumáticas del Encéfalo , Lesiones Encefálicas , Animales , Encéfalo , Explosiones , PorcinosRESUMEN
Traumatic brain injuries (TBI) affect millions of people each year. While research has been dedicated to determining the mechanical properties of the uninjured brain, there has been a lack of investigation on the mechanical properties of the brain after experiencing a primary blast-induced TBI. In this paper, whole porcine brains were exposed to a shock wave to simulate blast-induced TBI. First, ten (10) brains were subjected to unconfined compression experiments immediately following shock wave exposure. In addition, 22 brains exposed to a shock wave were placed in saline solution and refrigerated between 30 minutes and 6.0 hours before undergoing unconfined compression experiments. This study aimed to investigate the effect of a time delay on the viscoelastic properties in the event that an experiment cannot be completed immediately. Samples from both soaked and freshly extracted brains were subjected to compressive rates of 5, 50, and 500â¯mm/min during the unconfined compression experiments. The fractional Zener (FZ) viscoelastic model was applied to obtain the brain's material properties. The length of time in the solution statistically influenced three of the four FZ coefficients, E0 (instantaneous elastic response), τ0 (relaxation time), and α (fractional order). Further, the compressive rate statistically influenced τ0 and α.
Asunto(s)
Traumatismos por Explosión/fisiopatología , Lesiones Traumáticas del Encéfalo/fisiopatología , Encéfalo/fisiopatología , Explosiones , Animales , Fenómenos Biomecánicos , Encéfalo/diagnóstico por imagen , Calibración , Fuerza Compresiva , Simulación por Computador , Elasticidad , Modelos Biológicos , Modelos Estadísticos , Reología , Programas Informáticos , Estrés Mecánico , Porcinos , ViscosidadRESUMEN
Traumatic brain injuries (TBI) affect millions of people each year and can result in long-term difficulties in thinking or focusing. Due to the number of people affected by these injuries, significant research has been dedicated to determining the mechanical properties of the brain using postmortem tissue from animals harvested within 24â¯h. The postmortem brain tissue is often stored in a solution until a rheological experiment is ready to begin. However, the effect of storage duration on the mechanical behavior of brain tissue is not understood. In this paper, postmortem porcine brains were placed in normal saline solution (0.9% NaCl) and refrigerated between 30â¯min and 6.5â¯h to allow the brain to absorb the solution. Afterwards, samples from both soaked and freshly extracted brains were subjected to unconfined compression tests at compressive rates of 5, 50, and 500â¯mm/min. The fractional Zener viscoelastic model was applied to obtain the brain's mechanical properties. While the results did not show a significant relationship between absorption and the long-term stiffness (E∞), both the relaxation time (τ0) and fractional order (α) were statistically influenced by both the length of time in the solution and compressive rate. Further, the instantaneous stiffness (E0) was statistically influenced by the length of time in solution, though not the compressive rate.
Asunto(s)
Lesiones Traumáticas del Encéfalo/patología , Encéfalo/patología , Solución Salina/química , Animales , Fenómenos Biomecánicos , Fuerza Compresiva , Elasticidad , Ensayo de Materiales , Presión , Manejo de Especímenes , Estrés Mecánico , Porcinos , ViscosidadRESUMEN
The ongoing conflict against terrorism has resulted in an escalation of blast-induced traumatic brain injuries (bTBI) caused by improvised explosive devices (IEDs). The destructive IEDs create a blast wave that travels through the atmosphere. Blast-induced traumatic brain injuries, attributed to the blast wave, can cause life-threatening injuries and fatalities. This study aims to find a surrogate brain material for assessing the effectiveness of head protection systems designed to mitigate bTBI. Polydimethylsiloxane (PDMS) is considered as the surrogate brain material. The stiffness of PDMS (Sylgard 184, Dow Corning Corp.) can be controlled by varying the ratio of base and curing agent. Cylindrical PDMS specimen with ratios of 1:10, 1:70, and 1:80 were subjected to unconfined compression experiments at linear rates of 5â¯mm/min, 50â¯mm/min, and 500â¯mm/min. A ramp-hold strain profile was used to simulate a stress relaxation experiment. The fractional Zener viscoelastic model was used to describe the stress relaxation response, after optimization of the material constants for the brain surrogate and shock wave exposure brain tissue. The results show that the low cost PDMS can be used as a surrogate brain material to study the dynamic brain response to blast wave exposure.
Asunto(s)
Biomimética/instrumentación , Encéfalo , Fenómenos Mecánicos , Elastómeros de Silicona , Ensayo de MaterialesRESUMEN
Uncommonly affecting the carpus, osteoid osteoma, a benign bone lesion, will involve the hand in 10% of cases. With negative initial radiographs and persistent tenderness in a 15-year-old boy after a fall, a wrist magnetic resonance imaging revealed extensive hamate edema without a fracture line. He was casted for a presumed hamate fracture. Without complaints of dysthesias or weakness, marked localized tenderness over the hamate, mild dorsal carpal edema, and limitation of wrist motion was noted 6 months later despite immobilization and rest. A computed tomography (CT) scan revealed a round, osteolytic lesion ulnarly at the hamate hook's base. Within the classic zone of sclerosis, a central calcification was visualized. Irregular periosteal bone formation is seen on the hamate hook and the dorsal aspect of the hamate. A volar curetting of the lesion was performed without grafting as stability was not threatened. Permanent sections consisted of a bony nidus with compact sclerotic, poorly organized osteoid. The central tissue was vascular with many osteoblasts, fibroblasts and mesenchymal cells. Following surgery, his pain remitted completely. Characteristics of pain and swelling have been consistent among reported cases of osteoid osteoma. Presentation may include warmth, erythema and restriction of motion. A delay in diagnosis is present in all cases involving the hamate usually due to negative plain radiographic findings. Magnetic resonance imaging findings further delayed diagnosis and treatment. Lesions are more accurately and frequently diagnosed in children with the use of CT.