32 research outputs found

    An appreciative inquiry into the transformative learning experiences of students in a family literacy project

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    Educational discourse has often struggled to genuinely move beyond deficit-based language. Even action research, a predominant model for teacher development, starts with the identification of a problem (Cardno 2003). It would appear that the vocabulary for a hope-filled discourse which captures the imagination and infiuences our future educational activity seems to have escaped us. Moreover, we seem bereft of educational contexts where the experience for students is holistic and transformative

    Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

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    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Our main objective is to assess the effectiveness of follow-up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aim to assess the effectiveness in relation to health-related quality of life, mortality, depression and anxiety, post-traumatic stress disorder, physical function, cognitive function, ability to return to work or education and adverse events. Our secondary objectives are, in general, to examine both the various ways that follow-up services are provided and any major influencing factors. Specifically, we aim to explore: the effectiveness of service organisation (physician versus nurse led, face to face versus remote, timing of follow-up service); possible differences in services related to country (developed versus developing country); and whether participants had delirium within the ICU setting

    Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

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    Background: The intensive care unit (ICU) stay has been linked with a number of physical and psychological sequelae, known collectively as post‐intensive care syndrome (PICS). Specific ICU follow‐up services are relatively recent developments in health systems, and may have the potential to address PICS through targeting unmet health needs arising from the experience of the ICU stay. There is currently no single accepted model of follow‐up service and current aftercare programmes encompass a variety of interventions and materials. There is uncertain evidence about whether follow‐up services effectively address PICS, and this review assesses this. Objectives: Our main objective was to assess the effectiveness of follow‐up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aimed to assess effectiveness in relation to health‐related quality of life (HRQoL), mortality, depression and anxiety, post‐traumatic stress disorder (PTSD), physical function, cognitive function, ability to return to work or education and adverse effects. Our secondary objectives were to examine different models of follow‐up services. We aimed to explore: the effectiveness of service organisation (physician‐ versus nurse‐led, face‐to‐face versus remote, timing of follow‐up service); differences related to country (high‐income versus low‐ and middle‐income countries); and effect of delirium, which can subsequently affect cognitive function, and the effect of follow‐up services may differ for these participants. Search methods: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2017. We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles. Selection criteria: We included randomised and non‐randomised studies with adult participants, who had been discharged from hospital following an ICU stay. We included studies that compared an ICU follow‐up service using a structured programme and co‐ordinated by a healthcare professional versus no follow‐up service or standard care. Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesised findings. We used the GRADE approach to assess the certainty of the evidence. Main results: We included five studies (four randomised studies; one non‐randomised study), for a total of 1707 participants who were ICU survivors with a range of illness severities and conditions. Follow‐up services were led by nurses in four studies or a multidisciplinary team in one study. They included face‐to‐face consultations at home or in a clinic, or telephone consultations or both. Each study included at least one consultation (weekly, monthly, or six‐monthly), and two studies had up to eight consultations. Although the design of follow‐up service consultations differed in each study, we noted that each service included assessment of participants' needs with referrals to specialist support if required. It was not feasible to blind healthcare professionals or participants to the intervention and we did not know whether this may have introduced performance bias. We noted baseline differences (two studies), and services included additional resources (two studies), which may have influenced results, and one non‐randomised study had high risk of selection bias. We did not combine data from randomised studies with data from one non‐randomised study. Follow‐up services for improving long‐term outcomes in ICU survivors may make little or no difference to HRQoL at 12 months (standardised mean difference (SMD) ‐0.0, 95% confidence interval (CI) ‐0.1 to 0.1; 1 study; 286 participants; low‐certainty evidence). We found moderate‐certainty evidence from five studies that they probably also make little or no difference to all‐cause mortality up to 12 months after ICU discharge (RR 0.96, 95% CI 0.76 to 1.22; 4 studies; 1289 participants; and in one non‐randomised study 79/259 deaths in the intervention group, and 46/151 in the control group) and low‐certainty evidence from four studies that they may make little or no difference to PTSD (SMD ‐0.05, 95% CI ‐0.19 to 0.10, 703 participants, 3 studies; and one non‐randomised study reported less chance of PTSD when a follow‐up service was used). It is uncertain whether using a follow‐up service reduces depression and anxiety (3 studies; 843 participants), physical function (4 studies; 1297 participants), cognitive function (4 studies; 1297 participants), or increases the ability to return to work or education (1 study; 386 participants), because the certainty of this evidence is very low. No studies measured adverse effects. We could not assess our secondary objectives because we found insufficient studies to justify subgroup analysis. Authors' conclusions: We found insufficient evidence, from a limited number of studies, to determine whether ICU follow‐up services are effective in identifying and addressing the unmet health needs of ICU survivors. We found five ongoing studies which are not included in this review; these ongoing studies may increase our certainty in the effect in future updates. Because of limited data, we were unable to explore whether one design of follow‐up service is preferable to another, or whether a service is more effective for some people than others, and we anticipate that future studies may also vary in design. We propose that future studies are designed with robust methods (for example randomised studies are preferable) and consider only one variable (the follow‐up service) compared to standard care; this would increase confidence that the effect is due to the follow‐up service rather than concomitant therapies

    Automated monitoring for the early detection of sepsis in critically ill patients

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    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate whether automated systems for the early detection of sepsis can reduce the time to appropriate treatment and improve clinical outcomes in critically ill patients in the ICU

    Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly surgical patients

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    This is the protocol for a review and there is no abstract. The objectives are as follows: To compare maintenance of general anaesthesia for elderly surgical patients using total intravenous anaesthesia (TIVA) or inhalational anaesthesia on postoperative cognitive function, mortality, risk of hypotension, length of stay in the postanaesthetic care unit (PACU), and hospital stay

    Colloids versus crystalloids for fluid resuscitation in critically ill people

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    Background Critically ill people may lose fluid because of serious conditions, infections (e.g. sepsis), trauma, or burns, and need additional fluids urgently to prevent dehydration or kidney failure. Colloid or crystalloid solutions may be used for this purpose. Crystalloids have small molecules, are cheap, easy to use, and provide immediate fluid resuscitation, but may increase oedema. Colloids have larger molecules, cost more, and may provide swifter volume expansion in the intravascular space, but may induce allergic reactions, blood clotting disorders, and kidney failure. This is an update of a Cochrane Review last published in 2013. Objectives To assess the effect of using colloids versus crystalloids in critically ill people requiring fluid volume replacement on mortality, need for blood transfusion or renal replacement therapy (RRT), and adverse events (specifically: allergic reactions, itching, rashes). Search methods We searched CENTRAL, MEDLINE, Embase and two other databases on 23 February 2018. We also searched clinical trials registers. Selection criteria We included randomised controlled trials (RCTs) and quasi‐RCTs of critically ill people who required fluid volume replacement in hospital or emergency out‐of‐hospital settings. Participants had trauma, burns, or medical conditions such as sepsis. We excluded neonates, elective surgery and caesarean section. We compared a colloid (suspended in any crystalloid solution) versus a crystalloid (isotonic or hypertonic). Data collection and analysis Independently, two review authors assessed studies for inclusion, extracted data, assessed risk of bias, and synthesised findings. We assessed the certainty of evidence with GRADE. Main results We included 69 studies (65 RCTs, 4 quasi‐RCTs) with 30,020 participants. Twenty‐eight studied starch solutions, 20 dextrans, seven gelatins, and 22 albumin or fresh frozen plasma (FFP); each type of colloid was compared to crystalloids. Participants had a range of conditions typical of critical illness. Ten studies were in out‐of‐hospital settings. We noted risk of selection bias in some studies, and, as most studies were not prospectively registered, risk of selective outcome reporting. Fourteen studies included participants in the crystalloid group who received or may have received colloids, which might have influenced results. We compared four types of colloid (i.e. starches; dextrans; gelatins; and albumin or FFP) versus crystalloids. Starches versus crystalloids We found moderate‐certainty evidence that there is probably little or no difference between using starches or crystalloids in mortality at: end of follow‐up (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.86 to 1.09; 11,177 participants; 24 studies); within 90 days (RR 1.01, 95% CI 0.90 to 1.14; 10,415 participants; 15 studies); or within 30 days (RR 0.99, 95% CI 0.90 to 1.09; 10,135 participants; 11 studies). We found moderate‐certainty evidence that starches probably slightly increase the need for blood transfusion (RR 1.19, 95% CI 1.02 to 1.39; 1917 participants; 8 studies), and RRT (RR 1.30, 95% CI 1.14 to 1.48; 8527 participants; 9 studies). Very low‐certainty evidence means we are uncertain whether either fluid affected adverse events: we found little or no difference in allergic reactions (RR 2.59, 95% CI 0.27 to 24.91; 7757 participants; 3 studies), fewer incidences of itching with crystalloids (RR 1.38, 95% CI 1.05 to 1.82; 6946 participants; 2 studies), and fewer incidences of rashes with crystalloids (RR 1.61, 95% CI 0.90 to 2.89; 7007 participants; 2 studies). Dextrans versus crystalloids We found moderate‐certainty evidence that there is probably little or no difference between using dextrans or crystalloids in mortality at: end of follow‐up (RR 0.99, 95% CI 0.88 to 1.11; 4736 participants; 19 studies); or within 90 days or 30 days (RR 0.99, 95% CI 0.87 to 1.12; 3353 participants; 10 studies). We are uncertain whether dextrans or crystalloids reduce the need for blood transfusion, as we found little or no difference in blood transfusions (RR 0.92, 95% CI 0.77 to 1.10; 1272 participants, 3 studies; very low‐certainty evidence). We found little or no difference in allergic reactions (RR 6.00, 95% CI 0.25 to 144.93; 739 participants; 4 studies; very low‐certainty evidence). No studies measured RRT. Gelatins versus crystalloids We found low‐certainty evidence that there may be little or no difference between gelatins or crystalloids in mortality: at end of follow‐up (RR 0.89, 95% CI 0.74 to 1.08; 1698 participants; 6 studies); within 90 days (RR 0.89, 95% CI 0.73 to 1.09; 1388 participants; 1 study); or within 30 days (RR 0.92, 95% CI 0.74 to 1.16; 1388 participants; 1 study). Evidence for blood transfusion was very low certainty (3 studies), with a low event rate or data not reported by intervention. Data for RRT were not reported separately for gelatins (1 study). We found little or no difference between groups in allergic reactions (very low‐certainty evidence). Albumin or FFP versus crystalloids We found moderate‐certainty evidence that there is probably little or no difference between using albumin or FFP or using crystalloids in mortality at: end of follow‐up (RR 0.98, 95% CI 0.92 to 1.06; 13,047 participants; 20 studies); within 90 days (RR 0.98, 95% CI 0.92 to 1.04; 12,492 participants; 10 studies); or within 30 days (RR 0.99, 95% CI 0.93 to 1.06; 12,506 participants; 10 studies). We are uncertain whether either fluid type reduces need for blood transfusion (RR 1.31, 95% CI 0.95 to 1.80; 290 participants; 3 studies; very low‐certainty evidence). Using albumin or FFP versus crystalloids may make little or no difference to the need for RRT (RR 1.11, 95% CI 0.96 to 1.27; 3028 participants; 2 studies; very low‐certainty evidence), or in allergic reactions (RR 0.75, 95% CI 0.17 to 3.33; 2097 participants, 1 study; very low‐certainty evidence). Authors' conclusions Using starches, dextrans, albumin or FFP (moderate‐certainty evidence), or gelatins (low‐certainty evidence), versus crystalloids probably makes little or no difference to mortality. Starches probably slightly increase the need for blood transfusion and RRT (moderate‐certainty evidence), and albumin or FFP may make little or no difference to the need for renal replacement therapy (low‐certainty evidence). Evidence for blood transfusions for dextrans, and albumin or FFP, is uncertain. Similarly, evidence for adverse events is uncertain. Certainty of evidence may improve with inclusion of three ongoing studies and seven studies awaiting classification, in future updates

    Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery

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    Patients undergoing vascular surgery are a high-risk population with widespread atherosclerosis, an adverse cardiovascular risk profile and often multiple co-morbidities. Postoperative cardiovascular complications, including myocardial infarct (MI), are common. Statins are the medical treatment of choice to reduce high cholesterol levels. Evidence is accumulating that patients taking statins at the time of surgery are protected against a range of perioperative complications, but the specific benefits for patients undergoing noncardiac vascular surgery are not clear

    Using Behavioural Insights to Improve the Uptake of Services for Drug and Alcohol Misuse

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    In the U.K., 270,705 adults were in contact with drug and alcohol treatment services between April 2019 and March 2020. Within the same time period, 118,995 individuals exited the treatment system, and just over a third (36%) left treatment without completing it. The latter includes individuals declining further treatment and unsuccessful transfers between services. The aim of this study was to explore the factors that affect drug and alcohol treatment uptake within a drug and alcohol service in North East England. A mixed-methods approach was adopted. The exploration of factors affecting treatment uptake was captured through a behavioural insights survey and 1:1 in-depth qualitative interviews with service users within one council area within the North East of England. There were 53 survey participants, and a further 15 participants took part in qualitative interviews. We triangulated data sources to report consistencies and discrepancies in the data. Findings show that treatment services aiming to reduce missed appointments and increase retention rates need to implement several strategies. Consistently distributing appointment cards, using text message reminders, displaying a timetable presenting all treatment options, and displaying information in a format to ensure it is accessible to individuals with lower health literacy and reducing wait times for appointments will all improve appointment attendance
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