1,408 research outputs found

    Success Factors Facilitating Care During Escalation (the SUFFICE study)

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    Ede, J., Watkinson, P., Endacott, R., (2021) Protocol for a mixed methods exploratory study of success factors to escalation of care: the SUFFICE study. medRxiv 2021.11.01.21264875. Ede J, Petrinic T, Westgate V, Darbyshire J, Endacott R, Watkinson PJ. (2021) Human factors in escalating acute ward care: a qualitative evidence synthesis. BMJ Open Qual 10. Bedford, J. P., Ede, J. and Watkinson, P. J. (2021) ‘Triggers for new-onset atrial fibrillation in critically ill patients’, Intensive and Critical Care Nursing. Elsevier Ltd, 67, p. 103114. doi: 10.1016/j.iccn.2021.103114. Ede, J. et al. (2023) ‘Patient and public involvement and engagement (PPIE) in research: The Golden Thread’, Nursing in critical care, (April), pp. 16–19. doi: 10.1111/nicc.12921. Ede, J., Hutton, R., Watkinson, P., Kent, B. and Endacott, R. (2023) ‘Improving escalation of deteriorating patients through cognitive task analysis: Understanding differences between work-as-prescribed and work-as-done’, International Journal of Nursing Studies.BACKGROUND: In the United Kingdom, there continues to be preventable National Health Service (NHS) patient deaths. Contributory factors include inadequate recognition of deterioration, poor monitoring, or delayed escalation to a higher level of care. Strategies to improve care escalation, such as vital sign scoring systems and specialist teams who manage deterioration events, have shown variable impact on patient mortality. The need for greater care improvements has consistently been identified in NHS care reviews as well as patient stories. Furthermore, current research informing escalation improvements predominantly comes from examining failure to rescue events, neglecting what can be learned from rescue or successful escalation. AIM: The focus of this study was to address this knowledge gap by examining rescue and escalation events, and from this, to develop a Framework of Escalation Success Factors that can underpin a multi-faceted intervention to improve outcomes for deteriorating patients. METHODS: Escalation success factors, hospital and patient data were collected in a mixed methods, multi-site exploratory sequential study. Firstly, 151 ward care escalation events were observed to generate a theoretical understanding of the process. To identify escalation success factors, 390 care records were also reviewed from unwell ward patients in whom an Intensive Care Unit admission was avoided and compared to the records for patients who became unwell on the ward, admitted to an Intensive Care Unit, and died. Finally, thirty Applied Cognitive Task Analysis interviews were conducted with clinical experts (defined as greater than four years’ experience) including Ward Nurses (n= 7), Outreach Nurses (n= 5), Nurse Managers (n=5), Physiotherapists (n=4), Sepsis Nurses (n=3), Advanced Nurse Practitioners and Educators (n=2), Advance Clinical Practitioners (n=2), Nurse Consultant (n=1) and Doctor (n=1) to examine process of escalation in a Functional Resonance Analysis Model. RESULTS: In Phase 1, over half (n= 77, 51%) of the 151 escalation events observed were not initiated through an early warning score but other clinical concerns. The data demonstrated four escalation communication phenotypes (Informative, Outcome Focused, General Concern and Spontaneous Interaction) utilised by staff in different clinical contexts for different escalation purposes. In Phase 2, the 390 ward patient care record reviews (Survivors n=340, Non-survivors admitted to ICU n=50) identified that care and quality of escalation in the Non-survivor’s group was better overall than those that survived. Reviews also identified success factors present within deterioration events including Visibility, Monitoring, Adaptability, and Adjustments, not dissimilar to characteristics of high reliability organisations. Finally, Phase 3 interview data were dynamically modelled in a Functional Resonance Analysis Method. This illustrated differences in the number of escalation tasks contained in the early warning scoring system (n=8) compared to how escalation is successfully completed by clinical staff (n=24). Interview participants identified that 28% (9/32) of these tasks were cognitively difficult, also indicating how they overcome system complexity and challenges to successfully escalate. Interactions between escalation tasks were also examined, including Interdependence (how one affects another), Criticality (how many downstream tasks are initiated), Preconditions (what system factors need to be present), and Variability (factors which affect output reliability). This approach developed a system-focused understanding of escalation and signposted to process improvements. CONCLUSION: This research uniquely contributes to international evidence by presenting new elements to escalation of care processes. This includes indicating how frequently early warning scores trigger an escalation, the different ways in which escalation is communicated, that patient outcomes may inaccurately portray the quality of care delivered and examining the interaction between escalation tasks can identify areas of improvement. This is the first study to develop a preliminary Framework of Escalation Success Factors, which will be refined and used to underpin evidenced based care improvements. A key recommendation would be for organisations to use, when tested, the Framework of Escalation Success Factors to make system refinements that will promote successful escalation of care. PPI: This study has had Patient and Public Involvement and Engagement (PPIE) through a SUFFICE PPI Advisory Group

    Review of flexible energy harvesting for bioengineering in alignment with SDG

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    To cater to the extensive body movements and deformations necessitated by biomedical equipment flexible piezoelectrics emerge as a promising solution for energy harvesting. This review research delves into the potential of Flexible Piezoelectric Materials (FPM) as a sustainable solution for clean and affordable energy, aligning with the United Nations' Sustainable Development Goals (SDGs). By systematically examining the secondary functions of stretchability, hybrid energy harvesting, and self-healing, the study aims to comprehensively understand these materials' mechanisms, strategies, and relationships between structural characteristics and properties. The research highlights the significance of designing piezoelectric materials that can conform to the curvilinear shape of the human body, enabling sustainable and efficient mechanical energy capture for various applications, such as biosensors and actuators. The study identifies critical areas for future investigation, including the commercialization of stretchable piezoelectric systems, prevention of unintended interference in hybrid energy harvesters, development of consistent wearability metrics, and enhancement of the elastic piezoelectric material, electrode circuit, and substrate for improved stretchability and comfort. In conclusion, this review research offers valuable insights into developing and implementing FPM as a promising and innovative approach to harnessing clean, affordable energy in line with the SDGs.</p

    Review of flexible energy harvesting for bioengineering in alignment with SDG

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    To cater to the extensive body movements and deformations necessitated by biomedical equipment flexible piezoelectrics emerge as a promising solution for energy harvesting. This review research delves into the potential of Flexible Piezoelectric Materials (FPM) as a sustainable solution for clean and affordable energy, aligning with the United Nations' Sustainable Development Goals (SDGs). By systematically examining the secondary functions of stretchability, hybrid energy harvesting, and self-healing, the study aims to comprehensively understand these materials' mechanisms, strategies, and relationships between structural characteristics and properties. The research highlights the significance of designing piezoelectric materials that can conform to the curvilinear shape of the human body, enabling sustainable and efficient mechanical energy capture for various applications, such as biosensors and actuators. The study identifies critical areas for future investigation, including the commercialization of stretchable piezoelectric systems, prevention of unintended interference in hybrid energy harvesters, development of consistent wearability metrics, and enhancement of the elastic piezoelectric material, electrode circuit, and substrate for improved stretchability and comfort. In conclusion, this review research offers valuable insights into developing and implementing FPM as a promising and innovative approach to harnessing clean, affordable energy in line with the SDGs.</p

    Wearable Sensors as a Preoperative Assessment Tool: A Review

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    Surgery is a common first-line treatment for many types of disease, including cancer. Mortality rates after general elective surgery have seen significant decreases whilst postoperative complications remain a frequent occurrence. Preoperative assessment tools are used to support patient risk stratification but do not always provide a precise and accessible assessment. Wearable sensors (WS) provide an accessible alternative that offers continuous monitoring in a non-clinical setting. They have shown consistent uptake across the perioperative period but there has been no review of WS as a preoperative assessment tool. This paper reviews the developments in WS research that have application to the preoperative period. Accelerometers were consistently employed as sensors in research and were frequently combined with photoplethysmography or electrocardiography sensors. Pre-processing methods were discussed and missing data was a common theme; this was dealt with in several ways, commonly by employing an extraction threshold or using imputation techniques. Research rarely processed raw data; commercial devices that employ internal proprietary algorithms with pre-calculated heart rate and step count were most commonly employed limiting further feature extraction. A range of machine learning models were used to predict outcomes including support vector machines, random forests and regression models. No individual model clearly outperformed others. Deep learning proved successful for predicting exercise testing outcomes but only within large sample-size studies. This review outlines the challenges of WS and provides recommendations for future research to develop WS as a viable preoperative assessment tool

    Combined Nutrition and Exercise Interventions in Community Groups

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    Diet and physical activity are two key modifiable lifestyle factors that influence health across the lifespan (prevention and management of chronic diseases and reduction of the risk of premature death through several biological mechanisms). Community-based interventions contribute to public health, as they have the potential to reach high population-level impact, through the focus on groups that share a common culture or identity in their natural living environment. While the health benefits of a balanced diet and regular physical activity are commonly studied separately, interventions that combine these two lifestyle factors have the potential to induce greater benefits in community groups rather than strategies focusing only on one or the other. Thus, this Special Issue entitled “Combined Nutrition and Exercise Interventions in Community Groups” is comprised of manuscripts that highlight this combined approach (balanced diet and regular physical activity) in community settings. The contributors to this Special Issue are well-recognized professionals in complementary fields such as education, public health, nutrition, and exercise. This Special Issue highlights the latest research regarding combined nutrition and exercise interventions among different community groups and includes research articles developed through five continents (Africa, Asia, America, Europe and Oceania), as well as reviews and systematic reviews

    Effects of trunk-focused exercise programs and how the training program and the individuals’

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    Trunk-focused exercise programs (TEP) refer to those training programs in which the main target of the exercises resides in the active and/or passive trunk/core structures. Although these programs have shown a positive impact in sport and health contexts throughout recent years, there are several limitations in the literature that hinder the understanding of TEP effect and their relationship to the individual and to the training load characteristics. In this sense, TEP are sometimes compared to exercise control groups and/or other exercise programs that include trunk-focused exercises. Furthermore, although the individual and the training program features are a basic aspect to optimize training programs, experimental TEP studies not always provide this information properly. To address these constraints, the present doctoral thesis includes two systematic reviews and an experimental study. The two systematic reviews aimed at an in-depth analysis of the literature on TEP both, to improve the knowledge about the trunk-focused exercise contribution to increase trunk physical fitness and ameliorate stroke and low back pain symptoms, and to better understand how the individuals and exercise programs characteristics modulate TEP effectiveness. Overall, although the quality of evidence was low, their results showed that TEP were effective to ameliorate stroke and patients’ non-specific chronic low back pain condition, with positive effects in all the outcomes analysed. Furthermore, the analysis of moderator factors revealed that TEP effectiveness in stroke patients seems to be higher when the initial trunk impairment is greater, the patients are older, and the intervention starts earlier. Importantly, the TEP impact on low back pain symptoms (mainly pain reduction) seems higher when a greater improvement in trunk and/or hip range of motion is recorded after the training program and participants have a lower body mass index. These results reinforce the importance of paying close attention to the individuals and to the exercise programs characteristics when designing this type of interventions. On the other hand, the experimental study overcomes some of the problems found in the systematic reviews, especially the lack of experimental works that objectively controlled the training load intensity. This study aimed at the comparison of the effects of a higher intensity and a higher volume core stability exercise (CSE) program on core stability, core endurance and whole-body dynamic balance in young physically active males, using a smartphone-accelerometer to control the CSE intensity. These study results showed the specificity of the effects caused by the CSE programs, with a larger increase in the lumbopelvic postural control during the execution of isometric CSE for the higher intensity CSE program and a larger core endurance increase for the higher volume CSE program. Interestingly, the performance of conventional isometric CSE in lying and quadruped positions during the CSE programs did not have a significant impact on the unstable sitting test, a sudden loading protocol and several whole-body dynamic balance tests. Altogether, the results of the studies included in this doctoral thesis highlight the importance of performing TEP to improve trunk performance, functional capacity,and health status in different populations. Specifically, the two systematic reviews showed how moderator factors related to both, the individual and the training program characteristics can play an important role in modulating TEP effectiveness, which should be considered to maximize and tailor the TEP benefits in stroke and low back pain patients. However, the quality of the evidence for all the outcomes analysed in these systematic reviews was low, and thus, higher quality studies are required to strengthen the evidence on the impact of performing trunk-focused exercises in stroke and low back pain rehabilitation programs. Regarding the experimental study, the training load control performed through the smartphone-accelerometer allowed to describe the specificity of the effects caused by a higher intensity and a higher volume CSE program in young physically active males. Further research is needed to characterize the dose-response relationship of CSE programs in different populations properly.Los programas de ejercicio focalizados en el tronco (PET) son aquellos programas de entrenamiento cuyo foco principal son las estructuras activas y/o pasivas del tronco/core. A pesar de que estos programas han mostrado un efecto positivo tanto en contextos deportivos como de salud a lo largo de los últimos años, se observan varias limitaciones en la literatura que dificultan entender adecuadamente el efecto que tienen estos programas y su relación tanto con las características de los participantes, como con las características de los programas de entrenamiento. En este sentido, los PET son comparados en ocasiones con grupos control y/u otros programas de entrenamiento que incluyen ejercicios focalizados en el tronco. Además, a pesar de que las características de los participantes y de los programas de entrenamiento son aspectos clave para su optimización, los estudios experimentales no siempre aportan esta información. Para abordar estas limitaciones, la presente tesis doctoral incluye dos revisiones sistemáticas y un estudio experimental. Las dos revisiones sistemáticas presentan un análisis detallado de la literatura relacionadas con los PET para, a) mejorar el conocimiento sobre la contribución de los ejercicios focalizados en el tronco sobre el desarrollo de la condición física del tronco y la mejora de los síntomas tanto en personas que han sufrido un ictus, como en pacientes con dolor lumbar, y b) comprender mejor cómo las características de los participantes y de los programas de entrenamiento modulan la efectividad de los PET. En general, a pesar de que la calidad de la evidencia fue baja, los resultados de estas revisiones mostraron la efectividad de los PET para mejorar la condición tanto de las personas que han sufrido un ictus, como de aquellas con dolor lumbar crónico inespecífico, obteniendo efectos positivos sobre todas las variables analizadas. Además, el análisis de los factores moderadores reveló que la efectividad de los PET en personas que han sufrido un ictus parece ser mayor cuando la afectación inicial del tronco es mayor, las personas son mayores o el programa de ejercicio comienza antes. Con respecto a las personas con dolor lumbar, el impacto de los PET sobre la reducción de los síntomas (especialmente la reducción del dolor), parece ser mayor cuando hay un mayor incremento del rango de movimiento del tronco y/o de la cadera y los participantes tienen un menor índice de masa corporal. Estos resultados refuerzan la importancia de prestar atención a las características de los participantes y de los programas de ejercicios cuando se diseñan este tipo de programas. Por otro lado, el estudio experimental que incluye esta tesis doctoral aborda algunos de los problemas observados en las revisiones sistemáticas, especialmente la falta de estudios experimentales que controlen de manera objetiva la carga de entrenamiento de los PET. En este sentido, este estudio tuvo como objetivo comparar los efectos de dos programas de ejercicios de estabilidad del tronco (EET), uno de mayor intensidad y otro de mayor volumen, sobre la estabilidad y resistencia del tronco y el equilibrio dinámico general en hombres jóvenes y físicamente activos, utilizando el acelerómetro integrado en un smartphone para controlar la intensidad de los EET. Los resultados mostraron la especificidad de los efectos de los programas de EET, con mayores mejoras sobre el control lumbo-pélvico durante la ejecución de EET isométricos en el grupo de mayor intensidad y un mayor efecto sobre la resistencia de los músculos tronco en el grupo de mayor volumen. Destacar también que la realización de EET isométricos en posiciones de tumbado y cuadrupedia no tuvo un impacto significativo sobre el test del asiento inestable, sobre un protocolo de perturbaciones súbitas y sobre varios test de equilibrio dinámico general. En resumen, los resultados de los estudios incluidos en esta Tesis Doctoral destacan la importancia de realizar PET para mejorar la condición física del tronco, la capacidad funcional y el estado de salud en diferentes poblaciones. Específicamente, las dos revisiones sistemáticas mostraron cómo factores moderadores relacionados con las características de los participantes y de los programas de entrenamiento pueden jugar un papel importante en la modulación de la efectividad de los PET, lo cual debería tenerse en cuenta para maximizar sus beneficios en personas que han sufrido un ictus y en pacientes con dolor lumbar. Sin embargo, la calidad de la evidencia de los estudios en los parámetros analizados fue baja y, por lo tanto, es necesario que estudios de mayor calidad refuercen y mejoren los resultados obtenidos sobre el impacto de los PET en estas poblaciones. Con respecto al estudio experimental, el control de la carga de entrenamiento a través del acelerómetro integrado en un smartphone permitió describir la especificidad de los efectos de un programa de EET de mayor intensidad y de otro de mayor volumen en hombres jóvenes y físicamente activos. Futuros estudios son necesarios para caracterizar de manera adecuada la relación dosis-respuesta de los programas de EET en diferentes poblaciones

    The effects of running, cycling, and duathlon exercise performance on cardiac function, haemodynamics and regulation

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    This thesis examined the effects of prolonged exercise, specifically Olympic Distance (OD)duathlon upon ultrasound derived indices of cardiac function, cardiac autonomic regulation measured via heart rate variability (HRV), and high-sensitivity cardiac troponin T (hs-cTnT)release. The primary aims were to (1) ascertain the influence of Olympic distance (OD) duathlon performance on cardiac function; (2) to investigate potential relationships between autonomic regulation, hs-cTnT release, and cardiac function, and (3) to investigate the effect of the individual legs of an OD duathlon on post-exercise cardiac function and to quantify the potential performance reserve of highly-trained endurance athletes when completing standalone legs of the duathlon. Findings from a systematic review and meta-analysis(Chapter 1) on research that performed serial echocardiographic and troponin measurements before and after exercise, intensity predicted changes in post-exercise cardiac troponin release and diastolic function. The findings agreed with previous meta-analyses using a more recent sample of studies; however, the recommendation for future studies to implement advanced cardiac imaging techniques, such as myocardial speckle tracking into their data collection would provide a more sensitive measure of post-exercise cardiac function. Whilst a large degree of heterogeneity in the results exists, this was in part explained by study exercise heart rate, participant age, and the prevalence of cardiac troponin release above the clinical detection threshold. The study performed in Chapter 3 was the first to investigate the effects of OD duathlon exercise on immediate and 24 hours post-exercise cardiac function. Additionally, a second OD duathlon was performed by participants with intra-leg measurements of cardiac function. In a highly trained cohort, there was evidence of transient post-exercise reductions in cardiac function and elevated serum high-sensitivity cardiac troponin T (hs-cTnT) above the clinical reference value, which was largely resolved within 24h of recovery. This study also demonstrated the reliability of lab-based duathlon exercise in a highly trained cohort and identified the pacing features of experienced multi-sport athletes that partially explained the different findings between the running and cycling legs of the duathlon. By investigating each leg of the duathlon individually (10k run, 5k run, 40k cycle), both at duathlon race-pace (DM) and maximal (Max) intensity on separate occasions, the performance reserve of the highly-trained cohort was quantified and further explored. The studies presented in Chapters 4 and 5 revealed that experienced duathletes were able to improve their speed across each leg by between 5-15% in a laboratory setting, compared to the duathlon effort. Additionally, the maximal effort 10k run leg provoked the most persistent changes to cardiac function that were present at 6h of recovery. Changes in cardiac function post DM 10k confirmed the findings of Chapter 3 that the greatest magnitude of cardiac perturbations occur following the initial 10k run leg. Aside from the Max 10k run and 40k cycle trials, all perturbations had resolved within 6h of recovery after each bout of exercise, highlighting the importance of recovery following maximal intensity efforts. The lack of 6h and 24h recovery data in Chapter 4, and Chapters 5 and 6, respectively is a shortcoming of these findings and therefore limits interpretation in the context of providing athletic guidance. Future research in this area should endeavour to include 6h and 24h recovery measures as standard, as multi-sport athletes typically perform multiple daily training sessions. The implications of substantial cardiac fatigue accumulation over many years of endurance training history are still unclear, and athletes may benefit from preventingits occurrence

    Wearable technology in the sports medicine clinic to guide the return-to-play and performance protocols of athletes following a COVID-19 diagnosis

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    The coronavirus disease 2019 (COVID-19) pandemic has enabled the adoption of digital health platforms for self-monitoring and diagnosis. Notably, the pandemic has had profound effects on athletes and their ability to train and compete. Sporting organizations worldwide have reported a significant increase in injuries manifesting from changes in training regimens and match schedules resulting from extended quarantines. While current literature focuses on the use of wearable technology to monitor athlete workloads to guide training, there is a lack of literature suggesting how such technology can mediate the return to sport processes of athletes infected with COVID-19. This paper bridges this gap by providing recommendations to guide team physicians and athletic trainers on the utility of wearable technology for improving the well-being of athletes who may be asymptomatic, symptomatic, or tested negative but have had to quarantine due to a close exposure. We start by describing the physiologic changes that occur in athletes infected with COVID-19 with extended deconditioning from a musculoskeletal, psychological, cardiopulmonary, and thermoregulatory standpoint and review the evidence on how these athletes may safely return to play. We highlight opportunities for wearable technology to aid in the return-to-play process by offering a list of key parameters pertinent to the athlete affected by COVID-19. This paper provides the athletic community with a greater understanding of how wearable technology can be implemented in the rehabilitation process of these athletes and spurs opportunities for further innovations in wearables, digital health, and sports medicine to reduce injury burden in athletes of all ages. © The Author(s) 2023

    Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review

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    Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data
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