Research suggests that feedback in Emergency Medical Services (EMS) positively affects quality of care and professional development. However, the mechanisms by which feedback achieves its effects still need to be better understood across healthcare settings. This study aimed to understand how United Kingdom (UK) ambulance services provide feedback for EMS professionals and develop a programme theory of how feedback works within EMS, using a mixed-methods, realist evaluation framework. A national cross-sectional survey was conducted to identify feedback initiatives in UK ambulance services, followed by four in-depth case studies involving qualitative interviews and documentary analysis. We used qualitative content analysis and descriptive statistics to analyse survey responses from 40 prehospital feedback initiatives, alongside retroductive analysis of 17 interviews and six documents from case study sites. Feedback initiatives mainly provided individual patient outcome feedback through \"pull\" initiatives triggered by staff requests. Challenges related to information governance were identified. Our programme theory of feedback to EMS professionals encompassed context (healthcare professional and organisational characteristics), mechanisms (feedback and implementation characteristics, psychological reasoning) and outcomes (implementation, staff and service outcomes). This study suggests that most UK ambulance services use a range of feedback initiatives and provides 24 empirically based testable hypotheses for future research.

This article describes an interdisciplinary community resilience research project and presents a case study that supports bringing researchers together before a disaster to develop plans, procedures, and preapproved Institutional Review Board (IRB) protocols. In addition, this article explains how researchers from various academic institutions and their federal agency partners can effectively collaborate by creating an IRB Authorization Agreement (IAA). Such preparations can support interdisciplinary rapid response disaster fieldwork that is timely, ethically informed, and scientifically rigorous. This fieldwork preplanning process can also advance interdisciplinary team formation and data collection efforts over the long term.

BACKGROUND: With the mandate to review all available literature in the study\'s inclusion parameters, systematic review projects are likely to require full-text access to a significant number of articles that are not available in a library\'s collection, thereby necessitating ordering content via interlibrary loan (ILL). The aim of this study is to understand what effect a systematic review service has on the copyright royalty fees accompanying ILL requests at an academic health sciences library.
METHODS: The library created a custom report using ILLiad data to look specifically at 2018 ILL borrowing requests that were known to be part of systematic reviews. This subset of borrowing activity was then analyzed to determine its impact on the library\'s copyright royalty expenditures for the year. In 2018, copyright eligible borrowing requests that were known to be part of systematic reviews represented only approximately 5% of total filled requests that involved copyright eligible borrowing. However, these systematic review requests directly or indirectly caused approximately 10% of all the Spencer S. Eccles Library copyright royalty expenditures for 2018 requests.
CONCLUSIONS: Based on the sample data set, the library\'s copyright royalty expenditures did increase, but the overall financial impact was modest.

In the absence of definitive diagnosis, healthcare providers are likely to prescribe empirical antibacterials to those who test negative for malaria. This problem is of critical importance in Southern Asia (SA) and South-eastern Asia (SEA) where high levels of antimicrobial consumption and high prevalence of antimicrobial resistance have been reported. To improve management and guide further diagnostic test development, better understanding is needed of the true causative agents of fever and their geographical variability.
We conducted a systematic review of published literature (1980-2015) to characterise the spectrum of pathogens causing non-malarial febrile illness in SA and SEA. We searched six databases in English and French languages: MEDLINE, EMBASE, Global Health (CABI) database, WHO Global Health Library, PASCAL, and Bulletin de la Société Française de Parasitologie (BDSP). Selection criteria included reporting on an infection or infections with a confirmed diagnosis, defined as pathogens detected in or cultured from samples from normally sterile sites, or serological evidence of current or past infection.
A total of 29,558 records from 19 countries in SA and SEA were screened, of which 2410 (8.1%) met the selection criteria. Bacterial aetiologies were reported in 1235 (51.2%) articles, viral in 846 (35.1%), parasitic in 132 (5.5%), and fungal in 54 (2.2%), and 143 (6.0%) articles reported more than one pathogen group. In descending order of frequency, Salmonella Typhi, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and coagulase negative Staphylococcus were the commonly reported bacteria, while dengue virus, chikungunya virus, Japanese encephalitis virus, hepatitis B virus, and hepatitis C virus were common viral pathogens reported. Reports of rarely reported or emerging pathogens included a case report of Borrelia burgdorferi (Lyme disease) in India in 2010 and reports of Nipah virus in Singapore and India.
This review summarises the reported non-malaria pathogens that may cause febrile illness in SA and SEA. The findings emphasise the need of standardising the reporting of aetiological studies to develop effective, evidence-based fever management and improved surveillance. Research and development of diagnostic tools would benefit from up-to-date epidemiological reporting of the regional diversities of non-malaria fever aetiologies.
PROSPERO registration, CRD42016049281.

BACKGROUND: The authors present efforts to build capacity at our institution for conducting systematic reviews and other forms of evidence synthesis through partnerships and a recharge model. This report describes how we successfully created and launched a for-fee systematic review core at our library.
METHODS: Throughout 2014 and 2015, library leadership proposed different models for getting institutional and financial support for librarians and staff to better support university researchers conducting systematic reviews. Though well received, initial requests for financial support were not funded. The executive director of the Health Sciences Library released two years\' worth of salary and benefits to fund an evidence synthesis and retrieval librarian position. With this new position, the team formed a charge-back core facility in partnership with our university\'s Clinical Translation and Science Award hub. A series of procedural decisions and operational changes helped the group achieve success. Within eighteen months after launching the Systematic Review Core, we reached maximum capacity with more than twenty ongoing reviews.
CONCLUSIONS: Assigning a dollar value to our expertise put us on par with other subject matter experts on campus and actually drove demand. We could act as paid consultants in research projects and shifted the perception of librarians from service providers to research partners. Affiliating with our partners was key to our success and boosted our ability to strengthen our campus\' research infrastructure.

To survey network analyses of datasets collected in the course of routine operations in health care settings and identify driving questions, methods, needs, and potential for future research.
A search strategy was designed to find studies that applied network analysis to routinely collected health care datasets and was adapted to 3 bibliographic databases. The results were grouped according to a thematic analysis of their settings, objectives, data, and methods. Each group received a methodological synthesis.
The search found 189 distinct studies reported before August 2016. We manually partitioned the sample into 4 groups, which investigated institutional exchange, physician collaboration, clinical co-occurrence, and workplace interaction networks. Several robust and ongoing research programs were discerned within (and sometimes across) the groups. Little interaction was observed between these programs, despite conceptual and methodological similarities.
We use the literature sample to inform a discussion of good practice at this methodological interface, including the concordance of motivations, study design, data, and tools and the validation and standardization of techniques. We then highlight instances of positive feedback between methodological development and knowledge domains and assess the overall cohesion of the sample.

BACKGROUND: Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems.
METHODS: We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources.
RESULTS: Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety.
CONCLUSIONS: Study findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs.

The Accreditation Council for Graduate Medical Education (ACGME) requires programs to report learner progress using specialty-specific milestones. It is unclear how milestones can best identify critical deficiencies (CDs) in trainee performance. Specialties developed milestones independently of one another; not every specialty included CDs within milestones ratings. This study examined the proportion of ACGME milestone sets that include CD ratings, and describes one residency program\'s experiences using CD ratings in assessment.
The authors reviewed ACGME milestones for all 99 specialties in November 2015, determining which rating scales contained CDs. The authors also reviewed three years of data (July 2012-June 2015) from the University of Cincinnati Medical Center (UCMC) internal medicine residency assessment system based on observable practice activities mapped to ACGME milestones. Data were analyzed by postgraduate year, assessor type, rotation, academic year, and core competency. The Mantel-Haenszel chi-square test was used to test for changes over time.
Specialties demonstrated heterogeneity in accounting for CDs in ACGME milestones, with 22% (22/99) of specialties having no language describing CDs in milestones assessment. Thirty-three percent (63/189) of UCMC internal medicine residents received at least one CD rating, with CDs accounting for 0.18% (668/364,728) of all assessment ratings. The authors identified CDs across multiple core competencies and rotations.
Despite some specialties not accounting for CDs in milestone assessment, UCMC\'s experience demonstrates that a significant proportion of residents may be rated as having a CD during training. Identification of CDs may allow programs to develop remediation and improvement plans.

There is little evidence available in the research literature as to how to undertake an implementation process that ensures electronic medical record (EMR)/electronic health record (EHR) implementation success (i.e. high levels of clinician adoption). The research literature has documented the presence of a direct relationship between how systems are implemented and their level of adoption by clinicians after implementation. In order to develop recommendations for systems implementation to enhance the level of clinician adoption and to ensure EHR/EMR success, researchers need to analyze implementation failures (i.e. where there has been a low level of adoption among clinicians) and successes (i.e. where there has been a high level of clinician adoption). This paper examines EMR/EHR system implementation in the context of adoption success, by conducting a scoping review of the EMR/EHR case study literature. The paper attempts to answer the following: \"How does the published, case study research literature provide insights into the success and/or failure of EMR/EHR implementations?\" Case studies can provide insights that allow researchers to identify best practice approaches to EMR/EHR implementations that may turn the tide towards reducing the number failed EMR/EHR implementation projects.

To reduce the probability of failures and to improve outcomes of safety-critical human-intensive processes, such as health care processes, it is important to be able to rigorously analyze such processes. The quality of that analysis often depends on having an accurate, detailed, and sufficiently complete understanding of the process being analyzed, where this understanding is typically represented as a formal process model that could then drive various rigorous analysis approaches. Developing this understanding and the corresponding formal process model may be difficult and, thus, a variety of process elicitation methods are often used. The work presented in this paper evaluates the effectiveness of five common elicitation methods in terms of their ability to elicit detailed process information necessary to support rigorous process analysis. These methods are employed to elicit typical steps and steps for responding to exceptional situations in a safety-critical health care process, the chemotherapy treatment plan review process. The results indicate strengths and weaknesses of each of the elicitation methods and suggest that it is preferable to apply multiple elicitation methods.