Healthcare Biotechnology: A Practical Guide

The latter is particularly relevant for small hospitals, which do not always divide their hospital departments into high- and low risk departments. Secondly, it is important to phrase the guideline carefully, with sufficient urgency, while avoiding language that is too technical. The guideline should provide recommendations about what to do when confronted with insufficient hospital capacity, and when distinctions between high-risk and low-risk departments are unclear.

Secondly, one of the crucial elements of the RIVM guideline recommends a good database to register individual and aggregate HCW immune status information. This study showed, however, that these databases are present in only a minority of hospitals and that current databases are not able to provide complete clarity of immune status to the hospital professionals.

Therefore, it is pivotal that hospitals upgrade their databases to meet the challenges they face during outbreak situations, while guaranteeing HCW privacy. The need for digital human resource databases is underscored by research done by Bertin et al. The HCWs could indicate their vaccination status with regard to the annual influenza vaccination.

The Intranet site was linked to a digital database, available on both the individual and department level. Data were kept confidential by making use of unique identification numbers. HCWs declining vaccination received an automatic message with information about the vaccination. This digital method of obtaining HCW immune status, linked to digital databases, could not only increase policy uptake in hospitals by addressing individual HCWs, but could also enable heads of departments to take control of their department, thereby counteracting potential feelings of loss of autonomy.

Thirdly, it is important that ethical and legal guidance is provided on a national level to decide which measures hospitals can take without compromising the rights of HCWs. This includes whether it is justified to make vaccination against measles obligatory upon employment and to register immune status of new HCWs. Since seven out of ten hospitals indicated they are looking into the possibilities for these measures, it is clear that a change in culture is visible. The importance of mandating vaccination becomes clear from a study conducted by Nowalk et al.

Furthermore, having state laws regulate HCW vaccination for influenza was associated with nearly a threefold increase in rates for mandates with consequences compared to mandates without consequences [ 29 ]. The pros and cons of mandatory vaccination of HCWs should be taken into account in the future, in the light of the worldwide efforts to eradicate vaccine-preventable diseases.

This study has several strengths and has provided insights into vaccination policies in Dutch hospitals and the extent to which the MG has contributed to these policies. Participants belonged to different professions within infection prevention, thereby broadening the scope of this research through a wide variety of perspectives. Secondly, these professionals represented both academic and non-academic hospitals, located in the three different regions of the Netherlands, thereby increasing the external validity of this research.

However, this study has several limitations. First of all, it is unclear to what extent the Dutch setting can be generalised to other countries both in and outside of Europe. Second, thirteen hospitals were approached for participation, while only ten are included. The missing three hospitals that did not respond might differ in their positive and negative performances with regard to MG implementation. From unpublished research it can be concluded, however, that the included ten hospitals provide a good reflection of the Dutch hospitals.

The current qualitative study was conducted simultaneously with a quantitative study that aimed to assess the uptake and adaptation of the RIVM guideline. The quantitative study provided a cross-sectional picture of guideline uptake, rather than explore in depth its performance.

Systematic Reviews and Meta-analysis: Understanding the Best Evidence in Primary Healthcare

As part of this quantitative study a questionnaire with 70 questions was sent to infection prevention specialists of Dutch hospitals. It revealed that 68 participants Since these findings show trends that correspond with the findings of this research, the sample of 12 participants can be considered a good reflection of the general population of professionals working in infection prevention. Thirdly, although recommendations for improvement are made, the authors acknowledge that several aspects of guideline implementation cannot be influenced.

These include non-complying HCWs e. The implementation of the MG in the healthcare setting was hampered by a total of 17 different barriers. The most important barriers related to knowledge and attitude reflect lack of agreement, issues related to evidence-based decision making and leadership. Barriers related to characteristics of the guideline are mostly due to unclear or missing content of the MG. Seven elements of the guideline were reason for discussion: For barriers related to contextual and social factors, the most prominent barriers relate to finances and work pressure, physical infrastructure and national views on vaccination policies.

The authors believe this study has provided valuable insights into the barriers infection prevention specialists encounter during the implementation of new policies concerning the vaccination of HCWs. Moreover, this study exposed the complexity and numerousness of barriers that are of importance when implementing vaccination policies in the hospital setting.

In order to further increase knowledge in this area, further research is needed into the reasons underlying non-compliance of HCWs in hospitals and into the self-reporting of immune status. The authors make eight recommendations for future guidelines in the field of public health. All authors contributed to the study design. SB collected the data. SB and AT analysed the data. SB wrote the first draft of the manuscript. AT contributed to further drafts of the manuscript. All authors read and approved the final manuscript. Fievez RIVM for their help with contacting the participants, and for providing useful insights during the data collection and data analysis stage of this research.

We also thank Prof. We are grateful to the participants who anonymously agreed to participate in the interviews. We have no funding sources to declare. Stephanie Jessica Borggreve, Email: National Center for Biotechnology Information , U. Published online Dec Stephanie Jessica Borggreve and Aura Timen. Author information Article notes Copyright and License information Disclaimer. Received Sep 18; Accepted Nov Abstract Background In the Netherlands faced a measles epidemic, during which more than individuals were infected, including 19 health care workers HCW.

Results The implementation of the MG was impeded by several types of barriers. Conclusions This study has provided valuable insights into the barriers infection prevention specialists encounter during the implementation of new policies concerning vaccination of HCWs in times of a major outbreak. Background Measles caused approximately Methods This research was conducted in the Netherlands between February and July of The measles guideline MG According to the guideline, the hospital should review the immune status of employees of high-risk departments paediatrics, neonatology, obstetrics and the maternity ward, internal medicine, intensive care, and emergency departments.

Sampling of participants In-depth semi-structured interviews were conducted to understand barriers encountered by hospital health care professionals responsible for implementing the MG. Data collection Interview invitations were sent by post to the boards of 13 hospitals and were followed up by a telephone call.

Data analysis The interviews were transcribed verbatim by one researcher S. Results Three hospitals did not respond to the invitation to participate in this research, despite extensive follow-ups. Open in a separate window. Barriers related to knowledge and attitude Barrier: As one participant indicated: Barriers related to the guideline itself Barrier: Distinguishing immune from non-immune HCWs It was not clear where to draw a line concerning immune or non-immune HCWs; the cut-off point at lead to discussion.

Visitors of high-risk departments Four participants indicated to have had some discussion about how to deal with visitors of high-risk departments. The guideline does not discuss this aspect of infection prevention. External personnel The guideline was not clear on how to deal with external personnel, such as midwives.

Immunocompromised HCW In the guideline, immunocompromised HCWs are indicated to be at increased risk of severe course of disease after measles infection. Isolation type It was not clear why the RIVM guideline proposed strict isolation for measles cases as opposed to aerogenic, which is the standard form of isolation for measles. When it is not clear to the professionals, they indicate that they cannot convince their HCWs to follow protocol.

One participant indicated that obtaining funds for prevention is difficult: Discussion The objective of this research was to identify barriers that Dutch hospital professionals encountered during the implementation of the policy guideline on measles. Barriers related to knowledge and attitude With regard to barriers related to knowledge and attitude, several changes can be made in future guidelines.

Barriers related to characteristics of the guideline With regard to barriers related to characteristics of the guideline, several changes can be made in future guidelines. Barriers related to contextual and social factors The guideline should provide recommendations about what to do when confronted with insufficient hospital capacity, and when distinctions between high-risk and low-risk departments are unclear.

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Strengths and limitations This study has several strengths and has provided insights into vaccination policies in Dutch hospitals and the extent to which the MG has contributed to these policies. Conclusions The implementation of the MG in the healthcare setting was hampered by a total of 17 different barriers. Recommendations The authors make eight recommendations for future guidelines in the field of public health. The guideline should be explicit about the risks associated with introduction and transmission of vaccine-preventable diseases in the hospital setting.

The guideline should incorporate advice on how to deal with HCWs who do not cooperate with vaccination policies either due to non-response or resistance.

The guideline should provide advice on how to distinguish between the roles of different professionals during outbreak situations; i. This includes the decision-making, the implementation and evaluation of the employed strategy. A strategy should be designed on how to involve the hospital board early during outbreak situations. The guideline should be phrased carefully, while paying attention to avoiding language that includes too much jargon or wording the recommendations with insufficient urgency.

The guideline should provide recommendations on what to do in the face of insufficient capacity and in the face of lacking clear distinctions between high-risk and low-risk departments specifically in small hospitals. The guideline should clearly advise professionals to use digital databases to register HCW immune status. Region specific information on the number of disease cases should be provided during outbreak situations, to allow hospital professionals to make informed decisions about the course of their policies. Acknowledgements We thank H.

Competing interests The author s declare that they have no competing interests. Accessed 21 Nov Rijksinstituut voor Volksgezondheid en Milieu. Measuring vaccination coverage in a hard to reach minority. Eur J Public Health. The national immunisation programme in the Netherlands: Mazelen surveillance overzicht, 1 mei —12 feb week 7. The importance of nosocomial transmission of measles in the propagation of a community outbreak. Infect Control Hosp Epidemiol. Health Care—associated measles outbreak in the united states after an importation: Supercritical CO2 Based Techn Run your small scale chiral purification and analysis in a single, easy-to-use platform.

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View the complete course list. View US Courses Schedule. Meet the Experts Webinar Series. Beginners Guide to Preparative LC. Practical Approaches to Peptide Isolation. Search Waters KnowledgeBase - find answers to your troubleshooting questions. Ideally, clinical decision making ought to be based on the latest evidence available.

However, to keep abreast with the continuously increasing number of publications in health research, a primary healthcare professional would need to read an insurmountable number of articles every day, covered in more than 13 million references and over biomedical and health journals in Medline alone. With the view to address this challenge, the systematic review method was developed. Systematic reviews aim to inform and facilitate this process through research synthesis of multiple studies, enabling increased and efficient access to evidence.

Systematic reviews and meta-analyses have become increasingly important in healthcare settings. Clinicians read them to keep up-to-date with their field and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research and some healthcare journals are moving in this direction. This article is intended to provide an easy guide to understand the concept of systematic reviews and meta-analysis, which has been prepared with the aim of capacity building for general practitioners and other primary healthcare professionals in research methodology and day-to-day clinical practice.

What is the effect of antiviral treatment in dengue fever? Most often a primary care physician needs to know convincing answers to questions like this in a primary care setting. To find out the solutions or answers to a clinical question like this, one has to refer textbooks, ask a colleague, or search electronic database for reports of clinical trials. Doctors need reliable information on such problems and on the effectiveness of large number of therapeutic interventions, but the information sources are too many, i.

Because no study, regardless of its type, should be interpreted in isolation, a systematic review is generally the best form of evidence. There are two fundamental categories of research: Primary research and secondary research. Primary research is collecting data directly from patients or population, while secondary research is the analysis of data already collected through primary research. A review is an article that summarizes a number of primary studies and may draw conclusions on the topic of interest which can be traditional unsystematic or systematic.

A systematic review is a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue. It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and random errors. The evidence-based practitioner, David Sackett, defines the following terminologies.

Systematic reviews adhere to a strict scientific design based on explicit, pre-specified, and reproducible methods. Because of this, when carried out well, they provide reliable estimates about the effects of interventions so that conclusions are defensible. Systematic reviews can also demonstrate where knowledge is lacking. This can then be used to guide future research.

Systematic reviews are usually carried out in the areas of clinical tests diagnostic, screening, and prognostic , public health interventions, adverse harm effects, economic cost evaluations, and how and why interventions work. Cochrane reviews are systematic reviews undertaken by members of the Cochrane Collaboration which is an international not-for-profit organization that aims to help people to make well-informed decisions about healthcare by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of healthcare interventions.

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Cochrane Primary Health Care Field is a systematic review of primary healthcare research on prevention, treatment, rehabilitation, and diagnostic test accuracy. The overall aim and mission of the Primary Health Care Field is to promote the quality, quantity, dissemination, accessibility, applicability, and impact of Cochrane systematic reviews relevant to people who work in primary care and to ensure proper representation in the interests of primary care clinicians and consumers in Cochrane reviews and review groups, and in other entities.

This field would serve to coordinate and promote the mission of the Cochrane Collaboration within the primary healthcare disciplines, as well as ensuring that primary care perspectives are adequately represented within the Collaboration. A meta-analysis is the combination of data from several independent primary studies that address the same question to produce a single estimate like the effect of treatment or risk factor.

It is the statistical analysis of a large collection of analysis and results from individual studies for the purpose of integrating the findings. The fundamental rationale of meta-analysis is that it reduces the quantity of data by summarizing data from multiple resources and helps to plan research as well as to frame guidelines.

It also helps to make efficient use of existing data, ensuring generalizability, helping to check consistency of relationships, explaining data inconsistency, and quantifies the data.

It helps to improve the precision in estimating the risk by using explicit methods. Following are the six fundamental essential steps while doing systematic review and meta-analysis. The research question for the systematic reviews may be related to a major public health problem or a controversial clinical situation which requires acceptable intervention as a possible solution to the present healthcare need of the community. This step is most important since the remaining steps will be based on this.

To select the relevant studies from the searches, we need to sift through the studies thus identified.

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The first sift is pre-screening, i. The next step is selecting the eligible studies based on similar study designs, year of publication, language, choice among multiple articles, sample size or follow-up issues, similarity of exposure, and or treatment and completeness of information. It is necessary to ensure that the sifting includes all relevant studies like the unpublished studies desk drawer problem , studies which came with negative conclusions or were published in non-English journals, and studies with small sample size.

The steps undertaken in evaluating the study quality are early definition of study quality and criteria, setting up a good scoring system, developing a standard form for assessment, calculating quality for each study, and finally using this for sensitivity analysis. For example, the quality of a randomized controlled trial can be assessed by finding out the answers to the following questions:. We need a standard measure of outcome which can be applied to each study on the basis of its effect size. Based on their type of outcome, following are the measures of outcome: Homogeneity of different studies can be estimated at a glance from a forest plot explained below.

For example, if the lower confidence interval of every trial is below the upper of all the others, i. If some lines do not overlap at all, these trials may be said to be heterogeneous. The definitive test for assessing the heterogeneity of studies is a variant of Chi-square test Mantel—Haenszel test. The final step is calculating the common estimate and its confidence interval with the original data or with the summary statistics from all the studies.

The best estimate of treatment effect can be derived from the weighted summary statistics of all studies which will be based on weighting to sample size, standard errors, and other summary statistics.