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Unadjusted analyses revealed reduction in mortality (unadjusted odds ratio (UAOR): 0.83, 95% confidence interval (CI): 0.63, 0.98), severe retinopathy (UAOR: 0.68, 95% CI: 0.50 to 0.92), but increase in bronchopulmonary dysplasia (UAOR: 1.61, 95% CI: 1.39 to 1.86) and patent ductus arteriosus (UAOR: 1.22, 95% CI: 1.07 to 1.39). Adjusted analyses revealed increases in the later cohort for bronchopulmonary dysplasia (adjusted odds ratio (AOR): 1.88, 95% CI: 1.60 to 2.20) and severe neurological injury (AOR: 1.49, 95% CI: 1.22 to 1.80). However, the ascertainment methods for neurological findings and ductus arteriosus differed between the two time periods.Conclusion: Improvements in prenatal care has resulted in improvement in the quality of care, as reflected by reduced severity of illness and mortality. However, after adjustment of prenatal factors, no improvement in any of the outcomes was observed and on the contrary bronchopulmonary dysplasia increased. There is need for identification and application of postnatal strategies to improve outcomes of extreme preterm infants.

A lthough methods for continuous quality improvement have been used to improve outcomes, 1-3 some, such as the National Institutes of Child Health and Human Development Quality Collaborative, 4 have reported little or no effect in neonatal intensive care units (ICUs). These methods have been criticized for being based on intuition and anecdotes rather than on evidence.5 To address these concerns, researchers have developed methods aimed at improving the use of evidence in quality improvement. Tarnow-Mordi and colleagues, 6 Sankaran and colleagues 7 and others [8][9][10] have used benchmarking instruments 6,8,11 to show risk-adjusted variations in outcomes in neonatal ICUs. Synnes and colleagues 12 reported that variations in the rates of intraventricular hemorrhage could be attributed to practice differences. MacNab and colleagues 13 showed how multi level modelling methods can be used to identify practice differences associated with variations in outcomes for targeted interventions and to quantify their attributable risks.Building on these results, we developed the Evidence-based Practice for Improving Quality method for continuous quality improvement. This method is based on 3 pillars: the use of evidence from published literature; the use of data from participating hospitals to identify hospital-specific practices for targeted intervention; and the use of a national network to share expertise. By selectively targeting hospital-specific practices for intervention, this method reduces the reliance on intuition and anecdotes that are associated with existing quality-improvement methods.Our objective was to evaluate the efficacy of the Evidencebased Practice for Improving Quality method by conducting a prospective cluster randomized controlled trial to reduce nosocomial infection and bronchopulmonary dysplasia among infants born at 32 or fewer weeks' gestation and admitted to 12 Canadian Neonatal Network hospitals 14 over a 36-month period. We hypothesized that the incidence of nosocomial infection would be reduced among infants in ICUs randomized to reduce infection but not among those in ICUs randomized to reduce bronchopulmonary dysplasia. We also hypothesized that the incidence of bronchopulmonary dysplasia would be reduced among infants in the ICUs randomized to reduce this outcome but not among those in ICUs randomized to reduce infections. Background: We developed and tested a new method, called the Evidence-based Practice for Improving Quality method, for continuous quality improvement.

BackgroundThe National Health Service Health Check (NHS HC) is a population level public health programme. It is a primary prevention initiative offering cardiovascular risk assessment and management for adults aged 40–74 years (every five years). It was designed to reduce the incidence of major vascular disease events by preventing or delaying the onset of diabetes, heart and kidney disease, stroke and vascular dementia . Effectiveness of the programme has been modelled on a national uptake of 75 % however in 2012/13 uptake, nationally, was 49 %. Ensuring a high percentage of those offered an NHS HC actually receive one is key to optimising the clinical and cost effectiveness of the programme.MethodsA pragmatic quasi-randomised controlled trial was conducted in four general practitioner practices in Medway, England with randomisation of 3511 patients. The aim was to compare attendance at the NHS HC using the standard national invitation template letter (control) compared to an enhanced invitation letter using insights from behavioural science (intervention). The intervention letter includes i) simplification - reducing letter content for less effortful processing ii) behavioural instruction - action focused language iii) personal salience - appointment due rather than invited and iv) addressing implementation intentions with a tear off slip to record the date, time and location of the appointment. Logistic Regression explored the association between control and intervention group and attendance at a health check.Results29.3 % of patients who received the control letter and 33.5 % of those who received the intervention letter attended their NHS HC (adjusted odds ratio 1.26, 95 % confidence interval 1.09–1.47, p < 0.01). This was an absolute difference in uptake of 4.2 percentage points for those receiving the intervention letter.ConclusionsAn invitation letter applying behavioural insights was more effective than the existing national template letter at encouraging attendance at an NHS HC. Making small, no cost behaviourally informed changes to letter invitations can improve uptake of the NHS HC. Further research is required to replicate the effect with more robust methodology and powered for sub-group analysis including socio-economic status.Trial RegistrationCurrent Controlled Trials ISRCTN66757664, date of registration 28/3/2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0426-y) contains supplementary material, which is available to authorized users.

synopsisA plot of principal stress difference versus principal extension ratios has been used as a graphic representation of general deformation. Two analytic forms of the strain energy function for isotropic, incompressible materials are suggested. These involve five or nine terms, the coefficients of which are found by regression to the general deformation plot. The resulting stressstrain equations are used to predict particular deformations, for example, simple extension, and are also evaluated in model engineering design experiments. These experiments use iterative techniques to predict the shapes and pressures of inflated diaphragms and tubes, and it is shown that the equations lead to accurate results even at relatively high extensions. 2033