Attitudes towards, and patterns of use, of published research evidence in clinical decision making amongst intensive care clinicians.

An evidence-practice gap is defined as the difference between what we know from the best available research evidence and what actually happens in current practice. The highly respected ARDSNet low-tidal-volume ventilation trial was published in 2000, however, in 2016 an observational study conducted in over 50 countries documented that up to one third of eligible patients failed to receive the ARDSNet low-tidal-volume ventilation strategy. In this thesis, we undertook a sequence of studies to better understand research evidence use in intensive care, with the intention of developing a tool that may help close evidence-practice gaps. To better understand research evidence use, we conducted a self-administered mail-out survey of intensive care specialists in Australia and New Zealand, and a self-administered online survey of a multinational group of intensive care clinicians. Based on knowledge gained from these surveys, we developed a concise evidence summary tool designed to overcome 27 explicit barriers to the use of research evidence. To evaluate the evidence summary tool, we developed a clinical case-based scenario. Ninety-three multinational intensive care clinicians were invited to review the casebased scenario and then read the evidence summary tool. Reading the evidence summary tool led to a significant increase in the belief that the intervention described in the tool would benefit the realistic patient in our case-based scenario (mean score change 0.32, 95% CI 0.19 to 0.46, P<0.001). Interestingly, the group most influenced by the evidence summary tool were those who appeared to be less up to date. Whilst it is not known whether this success in increasing intensive care clinicians’ belief in the benefit of a treatment would translate into a change in clinical practice behaviours, these promising results clearly indicate a need for further investigation into the use of evidence summary tools as an intervention to help close evidence-practice gaps

Genoomsete teadustöötulemuste tagasiside populatsioonipõhise biopanga geenidoonoritele

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Iga inimgenoomi järjestus sisaldab hinnanguliselt kümmet kuni viitkümmet tõenäoliselt patogeenset variatsiooni, millest kuni viis võivad olla kliiniliselt olulisused. Ülegenoomsete meetodite kasutamine teadustöös suurendab tõenäosust avastada nn juhuleide, mis on küll tavaliselt väljaspool konkreetse uuringu eesmärke, kuid siiski kliiniliselt olulised. Laialdane genoomiandmete genereerimine tekitab vajaduse juhiste järele, mis suunaks ja ühtlustaks juhuleidude käsitlust, vastates küsimustele - kuidas peaks ootamatult tuvastatud kliiniliselt olulise leiu puhul käituma, millistel juhtudel on uuritava isiku informeerimine õigustatud ja kuidas peaks kommunikatsioon toimuma. Seejuures tuleb arvestada teadustöö üldisi eesmärke, ressursse ning uuritavate huve ja õigusi. Tõenduspõhiste juhiste loomine eeldab avalikku arutelu, empiirilisi uuringuid huvirühmade suhtumise kaardistamiseks, samuti tagasiside meetodite analüüsi ning uuringuid juhuleidudest informeerimise mõjust osalejatele. Käesolev töö loob nende juhiste koostamise lähtealused. Töö tulemustest järeldub, et nii perearstide kui rahva seas on huvi geneetilise informatsiooni vastu. Senised juhised keskenduvad tagasiside andmisel eelkõige kliiniliselt olulistele ja sekkumistõhusatele leidudele. Perearstide hoiakud ja Geenivaramu uuritavate hinnangud geneetilise informatsiooni suhtes osutusid liberaalsemateks kui olemasolevad soovitused ja juhised. Käesolev töö lisab tõendeid, et uuritavad hindavad geneetilise informatsiooni juures lisaks kliinilistele kaalutlustele ka muid faktoreid. Töö käigus loodi meetod juhuleidude raporteerimiseks Geenivaramu doonoritele, mis on vastavuses Inimgeeniuuringute seaduse ja olemasolevate juhistega. Uuritavate vastukaja tagasiside osas oli positiivne isegi psühhiaatriliste sümptomitega seostatud ning piiratud sekkumistõhususega leidude puhul. Väljatöötatud meetod on kasutusel järgmistes Geenivaramu projektides, mis hõlmavad tagasiside andmist geenidoonoritele.It is estimated that every whole-genome sequence contains around 10 to 50 putatively disease-related variants, with up to five being of high clinical significance. The use of genome-wide approaches to analyze human DNA sequence increases the likelihood of identifying so called incidental findings, clinically significant findings that are outside the scope of the ongoing study. Large volumes of genomic data generated creates a need for guidelines that would guide and standardize the way incidental findings are handled and would address questions such as – how to anticipate and address incidental findings, in which cases is disclosure justified and how to communicate incidental findings. The guidelines should consider the general purpose of research, the resources available, and the interests and rights of the research participants. Establishing evidence-based guidelines requires public debate, empirical research on stakeholder attitudes, as well as analysis of different procedures for communication, and studies on the effect of informing the participants of incidental findings. This dissertation provides input for establishing such guidelines. From the results of this dissertation it follows that the primary care physicians as well as the public demonstrate interest towards genetic information. The existing guidelines support communication of clinically significant and actionable incidental findings. The attitudes of primary care physicians and biobank participants, however, were found to be more liberal than the existing recommendations and guidelines. This thesis adds to the evidence that participants value genetic information not only based on its clinical utility and actionability but also based on other factors. As part of this work a procedure for communicating incidental findings to biobank participants consistent with the Human Genes Research Act and existing guidelines was developed. Participants’ feedback regarding the disclosure was positive, even in the case of conditions associated with psychiatric symptoms and with limited actionability. The method developed is used in the next biobank projects involving communication of research results to biobank participants

Pilot study of crowdsourcing evidence-based practice research for adults with aphasia

textThe purpose of this study is to explore crowdsourcing as a research paradigm for creating evidence-based practice research in the field of speech pathology. Using an Internet survey, respondents provided de-identified information about one patient with aphasia they had treated in the previous year. The respondents were then asked to rate the success of treatment. Analysis and grading of the responses was performed to identify which responses were usable for the purpose of planning a treatment for a patient with similar demographics and diagnostic make-up. Results showed that crowdsourcing is a viable research method; however, further refinements to the collection and analysis are required before it can be an effectively used.Communication Sciences and Disorder

Extended Reality in Flight Attendant Training: Perception and Acceptance

This study aimed to understand the perception of extended reality (XR) technology in flight attendant training. Comparing and contrasting current approaches to flight attendant training in the United States and XR technology yields similarities and many differences. Two common methods require flight attendants to demonstrate proficiency in several areas, such as aircraft familiarization, emergency procedures, and security procedures, to qualify as a working crew member of commercial aircraft. This study examines the views of flight attendants. The data analysis compares demographic information, technology use, and understanding of the technology. Results of the study indicated no significant effects or relationships between age or gaming experience and the influence of those variables on positive or negative perceptions and acceptance of XR in flight attendant training. Many of the participants in this study have experienced some form of XR and many have a moderate view of its implementation in flight attendant training. This moderate view could indicate some openness to try XR in flight attendant training to better understand any benefits or value it might contribute

Use of wearable technology in the treatment of mental health difficulties and chronic pain

This portfolio thesis has three parts: a Systematic Literature Review followed by an empirical research study and finally, a set of appendices. This thesis explored the potential uses of wearable technology in the treatment of mental health difficulties and in the management of chronic pain.The systematic literature review explored recent mental health care research that utilised wearable technology. From this body of literature, three potential areas of use for wearable technology in mental health care were synthesised. Consideration is given to the clinical implications and limitations of the research. Potential areas of future research are also discussed.The empirical section describes a study aimed to investigate the utility of incorporating activity tracking technology into a pain management programme (PMP). This pilot study employed mixed methodology in order to investigate both whether being provided with an activity tracker is beneficial to individuals experiencing chronic pain. No significant improvements on outcome measures for various domains (including sleep, pain levels and mental wellbeing) were found for a group with trackers compared to a group without. However those in the tracker group provided positive feedback about benefits of the trackers. The implications for the findings of this study and avenues for future research are discussed.The appendices section contains a set of appendices for both the preceding sections. It also contains an epistemological statement and reflective statement in order to provide context about the researcher’s experience of conducting the research and the philosophical position from which the design of the research was approached

Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study

Background: Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. Objectives: The study had two main objectives: 1. develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services; 2. assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. Design: The project was a multi-stage mixed methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review; analysis of national surveillance data, and development of a triage algorithm; interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen. Setting: SH clinics in England. Participants: Young people (aged 16-25 years old) and men who have sex with men. Intervention: A three-part intervention package: 1. triage tool to score patients as high or low risk of STI infection using routine data; 2. a study-designed webpage with tailored sexual health information for all patients, regardless of risk; 3. a brief one-to-one session based on motivational interviewing for high risk patients. Main outcome measures: The three outcomes were: acceptability of the intervention to patients and SH providers; feasibility of delivering the interventions within existing resources; and feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). Results: We identified 33 relevant trials from the systematic review, including: videos, peer support, digital, and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% versus 46%). Limitations: Fewer clinics were included in the pilot than planned limiting the ability to make strong conclusions on RCT feasibility. Conclusion: We were unable to conclude whether a definitive RCT would be feasible due to challenges in implementation of a pilot, but have laid the groundwork for future research in the area

Audit of Antenatal Testing of Sexually Transmissible Infections and Blood Borne Viruses at Western Australian Hospitals

In August 2007, the Western Australian Department of Health (DOH) released updated recommendations for testing of sexually transmissible infections (STI) and blood-borne viruses (BBV) in antenates. Prior to this, the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) antenatal testing recommendations had been accepted practice in most antenatal settings. The RANZCOG recommends that testing for HIV, syphilis, hepatitis B and C be offered at the first antenatal visit. The DOH recommends that in addition, chlamydia testing be offered. We conducted a baseline audit of antenatal STI/BBV testing in women who delivered at selected public hospitals before the DOH recommendations. We examined the medical records of 200 women who had delivered before 1st July 2007 from each of the sevenWAhospitals included in the audit. STI and BBV testing information and demographic data were collected. Of the 1,409 women included, 1,205 (86%) were non-Aboriginal and 200 (14%) were Aboriginal. High proportions of women had been tested for HIV (76%), syphilis (86%), hepatitis C (87%) and hepatitis B (88%). Overall, 72% of women had undergone STI/BBV testing in accordance with RANZCOG recommendations. However, chlamydia testing was evident in only 18% of records. STI/BBV prevalence ranged from 3.9% (CI 1.5– 6.3%) for chlamydia, to 1.7% (CI 1–2.4%) for hepatitis C, 0.7% (CI 0.3–1.2) for hepatitis B and 0.6% (CI 0.2–1) for syphilis. Prior to the DOH recommendations, nearly three-quarters of antenates had undergone STI/BBV testing in accordance with RANZCOG recommendations, but less than one fifth had been tested for chlamydia. The DOH recommendations will be further promoted with the assistance of hospitals and other stakeholders. A future audit will be conducted to determine the proportion of women tested according to the DOH recommendations. The hand book from this conference is available for download Published in 2008 by the Australasian Society for HIV Medicine Inc © Australasian Society for HIV Medicine Inc 2008 ISBN: 978-1-920773-59-

Improving Mental Health Literacy: a Single-Subject Design Experiment Examining the Effects of Text Messaging on Adolescent Mental Health Literacy

The purpose of the study is to determine the feasibility of delivering a text-based mental health literacy intervention for adolescent children who have family members with mental illness. The effectiveness of the text message intervention was measured using a single subject, multiple baseline study design. Each participant received three text messages per week for a total of 6 weeks, containing information regarding mental illness, managing crisis, resources, stigma, and assertiveness. The subjects were evaluated using qualitative and quantitative measures at multiple periods throughout the study. Assessments utilized include: Schizophrenia Vignette quiz developed by Jorm et. al. (1997), Perceived Stress Scale-14(PSS-14) (Cohen et. al., 1983) , 10-point Likert Scale to measure the quality of the relationship with their loved one, and the Weekly Check-In Script. All 3 participants reported decreased perceived stress, improved or no change in relationship quality, and changes in perceived causes of and treatment for mental illness