Andrea Pokorná

Towards an international language for incontinence-associated dermatitis (IAD): Design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries

Incontinence‐associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research.

Curriculum Mapping with Academic Analytics in Medical and Healthcare Education.

Background No universal solution, based on an approved pedagogical approach, exists to parametrically describe, effectively manage, and clearly visualize a higher education institution’s curriculum, including tools for unveiling relationships inside curricular datasets. Objective We aim to solve the issue of medical curriculum mapping to improve understanding of the complex structure and content of medical education programs. Our effort is based on the long-term development and implementation of an original web-based platform, which supports an outcomes-based approach to medical and healthcare education and is suitable for repeated updates and adoption to curriculum innovations. Methods We adopted data exploration and visualization approaches in the context of medical curriculum innovations in higher education institutions domain. We have developed a robust platform, covering detailed formal metadata specifications down to the level of learning units, interconnections, and learning outcomes, in accordance with Bloom’s taxonomy and direct links to a particular biomedical nomenclature. Furthermore, we used selected modeling techniques and data mining methods to generate academic analytics reports from medical curriculum mapping datasets. Results We present a solution that allows users to effectively optimize a curriculum structure that is described with appropriate metadata, such as course attributes, learning units and outcomes, a standardized vocabulary nomenclature, and a tree structure of essential terms. We present a case study implementation that includes effective support for curriculum reengineering efforts of academics through a comprehensive overview of the General Medicine study program. Moreover, we introduce deep content analysis of a dataset that was captured with the use of the curriculum mapping platform; this may assist in detecting any potentially problematic areas, and hence it may help to construct a comprehensive overview for the subsequent global in-depth medical curriculum inspection. Conclusions We have proposed, developed, and implemented an original framework for medical and healthcare curriculum innovations and harmonization, including: planning model, mapping model, and selected academic analytics extracted with the use of data mining.

Assessment and documentation of non-healing, chronic wounds in inpatient health care facilities in the Czech Republic: an evaluation study.

The foundation of health care management of patients with non‐healing, chronic wounds needs accurate evaluation followed by the selection of an appropriate therapeutic strategy. Assessment of non‐healing, chronic wounds in clinical practice in the Czech Republic is not standardised. The aim of this study was to analyse the methods being used to assess non‐healing, chronic wounds in inpatient facilities in the Czech Republic. The research was carried out at 77 inpatient medical facilities (8 university/faculty hospitals, 63 hospitals and 6 long‐ term hospitals) across all regions of the Czech Republic. A mixed model was used for the research (participatory observation including creation of field notes and content analysis of documents for documentation and analysis of qualitative and quantitative data). The results of this research have corroborated the suspicion of inconsistencies in procedures used by general nurses for assessment of non‐healing, chronic wounds. However, the situation was found to be more positive with regard to evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of a wound) compared with the evaluation of more specific parameters (e.g. exudate or signs of infection). This included not only the number of observed variables, but also the action taken. Both were significantly improved when a consultant for wound healing was present (P = 0·047). The same applied to facilities possessing a certificate of quality issued by the Czech Wound Management Association (P = 0·010). In conclusion, an effective strategy for wound management depends on the method and scope of the assessment of non‐healing, chronic wounds in place in clinical practice in observed facilities; improvement may be expected following the general introduction of a ‘non‐healing, chronic wound assessment’ algorithm.

Wound Curriculum for Nurses

The European Wound Management Association (EWMA) has just finalised the first curriculum in a series of several curricula intended for use in levels 5-7 of the European Qualifications Framework (EQF)1. The aim of these is to support a common approach to post-registration qualification in wound management for nurses across Europe. EWMA hopes and will work towards a close collaboration with European nurse organisations as well as educational institutions to implement these common curricula.

Wound centres—how do we obtain high quality? The EWMA wound centre endorsement project

OBJECTIVE Different types of multidisciplinary concepts for treating non-healing wounds have been developed. However, there is insufficient evidence on the quality of multidisciplinary wound centres, and a limited number of evaluation systems have so far been developed. The lack of an international wound centre evaluation/certification system is the basis for the European Wound Management Association (EWMA) Wound Centre Endorsement Project. The project aims to describe the minimum requirements for a wound management centre. These requirements have been defined as a basis for evaluation and endorsement of wound centres inside as well as outside a hospital setting (in- and outpatient clinics). METHOD The endorsement programme focused on wound centre characteristics such as: target population; types of centres; and choice of model used. The method used to develop the EWMA wound centre endorsement programme was an evaluation of the quality of the different types of established wound centres across and outside Europe. Criteria and procedures for endorsement of wound centres were developed and pilot projects were performed outside Europe in two in-patient centres in China and one outpatient centre in Brazil. RESULTS The EWMA endorsement procedure includes the following steps: initial application; review of centre data provided via the application form and follow-up dialogue; visit to the wound centre; final report and endorsement; and re-endorsement. A follow-up visit was arranged in connection with the re-endorsement. Experiences from the pilot studies have so far indicated that the endorsement process is not only a quality declaration, but may also result in positive developments, such as increased visibility, increased patient flow, increased healing rates, and decreased amputation rate. CONCLUSION Development of endorsement systems focusing on the minimum requirements for a wound management centre is required to support the development of high-quality wound centres which provide health-care services according to recent evidence of current best practice. The EWMA Wound Centre Endorsement Project is the first international programme of its kind and this may, in the future, support the establishment of international collaboration and knowledge sharing about the development and maintenance of high-quality wound centres.

建立失禁相关性皮炎(IAD)相关国际通用术语:在30个国家/地区进行根特全球(IAD)分类工具(GLOBIAD)心理测量特性的设计和评估

几十年来,婴儿尿布皮炎(尿布疹)的最佳预防和治疗方法一直都是研究热点。然而,这种皮肤问题也会出现在成人身上,这时被称作失禁相关性皮炎(IAD)。它是刺激性接触性皮炎(一种由接触刺激物而非致敏物导致的湿疹)的一种特殊类型,由皮肤与尿液或粪便长时间接触导致。很难确切知道IAD患者究竟有多少,因为目前尚无一套国际公认的诊断标准(例如,一份可用于鉴别疾病的特定症状和标准清单)将其与其他有类似症状的皮肤病(如压力性溃疡)区分开来。目前存在十种不同的量表/工具(即疾病诊断和严重程度排序方法),但有些十分复杂,因而需要有一种量表/工具来确保研究结果具有可比性。因此,来自13个国家/地区的34位专家携手合作,共同开发出了一款工具,取名为GLOBIAD,于2015年启用。该工具随后被翻译成14种不同的语言。30个国家/地区的823位专家使用GLOBIAD对34张IAD照片进行了分类,并检验结果是否匹配,从而测试了该工具的准确性。该研究发现,GLOBIAD的开发是一项重大进展,有助于在全球临床实践和研究中,对IAD进行更好的系统评估。但是,这种工具还有待进一步验证。

Pressure Injuries in Inpatient Care Facilities in the Czech Republic: Analysis of a National Electronic Database

PURPOSE: The purpose of this study was to analyze pressure injury (PI) occurrence upon admission and at any time during the hospital course inpatients care facilities in the Czech Republic. Secondary aims were to evaluate demographic and clinical data of patients with PI and the impact of a PI on length of stay (LOS) in the hospital. DESIGN: Retrospective, cross-sectional analysis. SETTING AND SUBJECTS: The sample comprised data of hospitalized patients entered into the National Register of Hospitalized Patients (NRHOSP) database of the Czech Republic between 2007 and 2014 with a diagnosis L89 (pressure ulcer of unspecified site based on the International Classification of Diseases, Tenth Revision, ICD-10). Electronic records of 17,762,854 hospitalizations were reviewed. METHOD: Data from the NRHOSP from all acute and non–acute care hospitals in the Czech Republic were analyzed. Specifically, we analyzed patients admitted to acute and non–acute care facilities with a primary or secondary diagnosis of PI. RESULTS: The NRHOSP database included 17,762,854 cases, of which 46,224 cases (33,342 cases in acute care hospitals; 12,882 in non–acute care hospitals) had the L89 diagnosis (0.3%). The mean age of patients admitted with a PI was 73.8 ± 15.3 years (mean ± SD), and their average LOS was 33.2 ± 76.9 days. The mean LOS of patients hospitalized with L89 code as a primary diagnosis (n = 6877) was significantly longer compared to those patients for whom L89 code was a secondary diagnosis (25.8 vs 20.2 days, P < .001) in acute care facilities. In contrast, we found no difference in the mean LOS for patients hospitalized in non–acute care facility (58.7 days vs 65.1 days; P = .146) with ICD code L89. CONCLUSION: Pressure injuries were associated with significant LOS in both acute and non–acute care settings in the Czech Republic. Despite the valuable insights we obtained from the analysis of NRHOSP data, we advocate creation of a more valid and reliable electronic reporting system that enables policy makers to evaluate the quality and safety concerning PI and its impact on patients and the healthcare system.

Data Sources for Monitoring of Non-healing Wounds in a NationalHealth Information System – Epidemiology of Non-healing Wounds– Analysis of the National Register of Hospitalized Patients in2007–2015

he aim of this study is to analyse possibilities for using data from the National Health Information system to monitor the epidemiology of non-healing wounds. Hospital stays related to non-healing wounds (according to ICD-10) in acute and long-term care facilities in the Czech Republic (2007-2015), medical interventions and causes of death in patients with monitored diagnosis related to non-healing wounds were analysed.

Automatic keyword extraction from medical and healthcare curriculum

Medical and healthcare study programmes are quite complicated in terms of branched structure and heterogeneous content. In logical sequence a lot of requirements and demands placed on students appear there. This paper focuses on an innovative way how to discover and understand complex curricula using modern information and communication technologies. We introduce an algorithm for curriculum metadata automatic processing - automatic keyword extraction based on unsupervised approaches, and we demonstrate a real application during a process of innovation and optimization of medical education. The outputs of our pilot analysis represent systematic description of medical curriculum by three different approaches (centrality measures) used for relevant keywords extraction. Further evaluation by senior curriculum designers and guarantors is required to obtain an objective benchmark.

Evaluation of Selected Pres­sure Ulcer Management International Guidelines (AGREE II Tool)

Aim: The aim of this study was to analyse methodological quality of selected clinical guidelines for the management of pres sure ulcers with the use of AGREE II tool. Material and methods: Descriptive study with qualitative research methodology. The evaluated clinical guidelines were identified and selected through a literature search and accord ing to suggestions from international scientifi c societies focused on wound management. In total, four pairs of as ses sors evaluated methodological quality of four international clinical guidelines us ing the AGREE II tool (the Appraisal of Guidelines for REsearch & Evaluation). Six domains of quality were evaluated: Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability, Editorial Independence. Results: The selected clinical guidelines had relatively high methodological quality and all of them were suggested for use in clinical practice by the as ses sors after some minor cor rections with respect to the Czech clinical practice. All of the evaluated guidelines had the highest score in the Scope and Purpose domain (more than 80%). There were rather substential diff erences in other domains. The lowest score was in the fol low ing domains : Applicability Rigour of Development and Editorial Independence. Conclusion: Methodological quality of all selected and evaluated clinical guidelines for the management of pressure ulcer was quite high except the Editorial Independence and Rigour of Development domains. Evaluation of clinical guidelines with the use of AGRE II was conducted as part of a process of adaptation of clinical guidelines for the Czech healthcare settings. Over all methodological quality was the highest for the Prevention and Treatment of Pres sure Ulcers : Quick Reference Guide (85.71%). V práci byly citovány všechny použité bibliografi cké zdroje. Autorky deklarují, že studie nemá žádný konfl ikt zájmu. Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy. The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers. S. Saibertová, A. Pokorná, S. Vasmanská, P. Búřilová, N. Müllerová, L. Fiedlerová, D. Svobodová, P. Camprová, G. Šmelková, L. Kubátová 1 Katedra ošetřovatelství, LF MU, Brno 2 LF UK a FN Plzeň 3 1. LF UK a VFN v Praze 4 ÚVN – VFN Praha PhDr. Simona Saibertová Katedra ošetřovatelství, LF MU Kamenice 5 625 00 Brno e-mail: saibert@med.muni.cz Přijato k recenzi: 19. 5. 2016 Přijato do tisku: 12. 6. 2016