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

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

Patient observation skills in critical care nursing : A Theoretical construction and evaluation

This two-phase study focused on critical care nurses’ skills. The purpose was first to describe and create a theoretical construction of patient observation skills in critical care nursing, and second, to evaluate the current level of Finnish critical care nurses’ patient observation skills using subjective and objective assessment and investigate the factors associated with the skills. The aim was to deepen the understanding of critical care nurses’ skills, and ultimately to develop their skills to enhance quality of care and patient safety in intensive care units. In the first study phase, patient observation skills were described and a preliminary theoretical construction was created based on the semi-structured interviews among experienced critical care nurses (n=20). Thematic analysis was used to analyse the data. The second phase utilized cross-sectional correlational design to evaluate critical care nurses’ patient observation skills and to investigate associated factors. An instrument, Patient Observation Skills in Critical Care Nursing (POS-CCN) consisting of self-assessment and knowledge test, was developed. Critical care nurses (n=372, response rate 49%) in Finnish intensive care units in university hospitals answered the questionnaire. The methods of data analysis included descriptive and inferential statistics and general linear model. Patient observation skills in critical care nursing consist of information-gaining, information-processing, decision-making and co-operation skills. The evaluation of critical care nurses’ skills was limited to information-gaining and informationprocessing skills. Critical care nurses assessed their information-gaining skills as excellent, whereas knowledge test assessment suggested that information-processing skills are suboptimal. Critical care nurses who were highly confident in their competence and educated for special tasks in intensive care units had higher level of patient observation skills. There is a need for improving critical care nurses’ patient observation skills especially in information processing. Systematic education and training in patient observation is needed in intensive care units, and skills evaluation practices need to be developed further.Potilaan kliinisen tilan tarkkailutaidot tehohoitotyössä – Teoreettinen rakenne ja arviointi Tämä kaksivaiheinen tutkimus kohdentui tehosairaanhoitajien taitoihin. Tarkoituksena oli ensin kuvailla ja muodostaa teoreettinen rakenne tarkkailutaidoille tehohoitotyössä ja sitten arvioida tehosairaanhoitajien tarkkailutaitojen tasoa subjektiivisesti ja objektiivisesti sekä tunnistaa taitoihin yhteydessä olevia tekijöitä. Tavoitteena oli syventää ymmärrystä tehosairaanhoitajien taidosta, ja lopulta kehittää taitoja hoidon laadun ja potilasturvallisuuden varmistamiseksi. Ensimmäisessä vaiheessa tarkkailutaidot kuvailtiin ja alustava teoreettinen rakenne luotiin kokeneiden tehosairaanhoitajien (n=20) puolistrukturoitujen haastattelujen perusteella. Aineisto analysoitiin temaattisella analyysilla. Tutkimuksen toisessa vaiheessa korrelatiivisessa poikkileikkeusasetelmassa arvioitiin tehosairaanhoitajien tarkkailutaitoja ja tunnistettiin niihin yhteydessä olevia tekijöitä. Arviointia varten kehitettiin mittari Tarkkailutaidot Tehohoitotyössä (TarkkaTeho), joka koostui taitojen itsearvioinnista ja tietotestistä. Suomalaisten yliopistosairaaloiden teho-osastoilla työskentelevät sairaanhoitajat vastasivat kyselyyn (n=372, vastausprosentti 49%). Aineisto analysoitiin tilastollisin menetelmin hyödyntäen yleistä lineaarista mallia monimuuttujamenetelmänä. Potilaan kliinisen tilan tarkkailutaidot koostuvat taidoista hankkia ja käsitellä tietoa, taidoista tehdä päätöksiä sekä yhteistyötaidoista. Arviointi rajoittui tiedonhankinta- ja -käsittelytaitoihin. Tehosairaanhoitajat arvioivat tiedonhankintataitonsa eriomaiseksi, kun taas tietotestin perusteella tiedonkäsittelytaidot eivät olleet optimaalisella tasolla. Taidot olivat paremmat tehosairaanhoitajilla, jotka olivat luottavaisia omaan tehohoitotyön osaamiseensa, ja jotka olivat saaneet koulutuksen erityistehtäviin teho-osastolla. Tehosairaanhoitajien tarkkailutaitoja tulisi parantaa erityisesti tiedonkäsittelyn osalta. Potilaan tilan tarkkailun koulutusta tulisi olla järjestelmällisesti tarjolla teho-osastoilla, ja taitojen arviointia on tarve kehittää edelleen

Design and Evaluation of User-Centered Explanations for Machine Learning Model Predictions in Healthcare

Challenges in interpreting some high-performing models present complications in applying machine learning (ML) techniques to healthcare problems. Recently, there has been rapid growth in research on model interpretability; however, approaches to explaining complex ML models are rarely informed by end-user needs and user evaluations of model interpretability are lacking, especially in healthcare. This makes it challenging to determine what explanation approaches might enable providers to understand model predictions in a comprehensible and useful way. Therefore, I aimed to utilize clinician perspectives to inform the design of explanations for ML-based prediction tools and improve the adoption of these systems in practice. In this dissertation, I proposed a new theoretical framework for designing user-centered explanations for ML-based systems. I then utilized the framework to propose explanation designs for predictions from a pediatric in-hospital mortality risk model. I conducted focus groups with healthcare providers to obtain feedback on the proposed designs, which was used to inform the design of a user-centered explanation. The user-centered explanation was evaluated in a laboratory study to assess its effect on healthcare provider perceptions of the model and decision-making processes. The results demonstrated that the user-centered explanation design improved provider perceptions of utilizing the predictive model in practice, but exhibited no significant effect on provider accuracy, confidence, or efficiency in making decisions. Limitations of the evaluation study design, including a small sample size, may have affected the ability to detect an impact on decision-making. Nonetheless, the predictive model with the user-centered explanation was positively received by healthcare providers, and demonstrated a viable approach to explaining ML model predictions in healthcare. Future work is required to address the limitations of this study and further explore the potential benefits of user-centered explanation designs for predictive models in healthcare. This work contributes a new theoretical framework for user-centered explanation design for ML-based systems that is generalizable outside the domain of healthcare. Moreover, the work provides meaningful insights into the role of model interpretability and explanation in healthcare while advancing the discussion on how to effectively communicate ML model information to healthcare providers

Expertise and the interpretation of computerized physiological data: implications for the design of computerized monitoring in neonatal intensive care

This paper presents the outcomes from a cognitive engineering project addressing the design problems of computerized monitoring in neonatal intensive care. Cognitive engineering is viewed, in this project, as a symbiosis between cognitive science and design practice. A range of methodologies has been used: interviews with neonatal staff, ward observations and experimental techniques. The results of these investigations are reported, focusing specifically on the differences between junior and senior physicians in their interpretation of monitored physiological data. It was found that the senior doctors made better use of the different knowledge sources available than the junior doctors. The senior doctors were able to identify more relevant physiological patterns and generated more and better inferences than did their junior colleagues. Expertise differences are discussed in the context of previous psychological research in medical expertise. Finally, the paper discusses the potential utility of these outcomes to inform the design of computerized decision support in neonatal intensive care

Aligning use of intensive care with patient values in the USA: past, present, and future.

For more than three decades, both medical professionals and the public have worried that many patients receive non-beneficial care in US intensive care units during their final months of life. Some of these patients wish to avoid severe cognitive and physical impairments, and protracted deaths in the hospital setting. Recognising when intensive care will not restore a person’s health, and helping patients and families embrace goals related to symptom relief, interpersonal connection, or spiritual fulfilment are central challenges of critical care practice in the USA. We review trials from the past decade of interventions designed to address these challenges, and present reasons why evaluating, comparing, and implementing these interventions have been difficult. Careful scrutiny of the design and interpretation of past trials can show why improving goal concordant care has been so elusive, and suggest new directions for the next generation of research

Family Views of End-of-Life Care in Acute and Community Hospitals

The Hospice friendly Hospitals Programme (HfH) commissioned this study to assess the quality of end-of-life care in acute and community hospitals from the perspectives of bereaved relatives. A major rationale for the study was to develop and test methodology to survey bereaved relatives' views of end-of-life care that covers the HfH Programme themes of Integrated Care, Communication, Patient Autonomy and Design & Dignity. Another driver was to inform the set-up of a Nationwide Audit of End-of-Life Care (McKeown et al., 2010).The overall aim of the study was to assess the quality of end-of-life care in two acute and two community hospitals from the perspectives of bereaved relatives. Study subobjectives were to conduct a literature review to ascertain important ethical and methodological issues; to describe a census of deaths across study sites; to field test a survey instrument aimed evaluating the impact of the Hospice friendly Hospitals (HfH) Programme; to collect data about HfH Programme themes; and to establish if there were any differences in the pattern of results between acute and community hospitals

Advancing Critical Care in the ICU: A Human-Centered Biomedical Data Visualization Systems

The purpose of this research is to provide medical clinicians with a new technology for interpreting large and diverse datasets to expedite critical care decision-making in the ICU. We refer to this technology as the medical information visualization assistant (MIVA). MIVA delivers multivariate biometric (bedside) data via a visualization display by transforming and organizing it into temporal resolutions that can provide contextual knowledge to clinicians. The result is a spatial organization of multiple datasets that allows rapid analysis and interpretation of trends. Findings from the usability study of the MIVA static prototype and heuristic inspection of the dynamic prototype suggest that using MIVA can yield faster and more accurate results. Furthermore, comments from the majority of the experimental group and the heuristic inspectors indicate that MIVA can facilitate clinical task flow in context-dependent health care settings

Factors associated with self-efficacy for managing recovery in the trauma intensive care population: A prospective cohort study

Objective: The aim of this paper was to identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. Introduction: Injury accounts for 6.5% of disease burden in Australia, with similar levels being reported in other developed countries. While some studies regarding self-efficacy have identified a relationship to patient recovery post acute injury, others have been inconclusive. This study will identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. Methods: A prospective cohort study of patients aged ≥18 years, admitted to a metropolitan tertiary hospital in South East Queensland between June 2008 and August 2010 for the acute treatment of injury. Demographic, injury, acute care and psychosocial factors were considered. The primary outcome was self-efficacy measured by the 6-item self-efficacy scale (SES) 1 and 6 months post hospital discharge. All factors significant (p < 0.10) on univariate analysis were included in multivariable modelling where p < 0.05 was considered significant. Results: A total of 88 patients were included. The mean self-efficacy score at 1 and 6 months was similar (6.8 vs 6.9 respectively). Self-efficacy at 1 month, psychological distress (K-10) Score and illness perception (K10) Score accounted for 68.4% (adjusted R2) of the variance in 6 month self-efficacy (F3,75) = 57.17, p < 0.001. Illness perception was the strongest contributor to 6 month self-efficacy (beta = −0.516), followed by psychological distress (beta = −0.243) and self-efficacy at 1 month (beta = 0.205). Conclusion: Significant factors associated with self-efficacy for managing recovery at 6 months included 1 month self-efficacy, illness perception and psychological distress. To promote patient recovery, screening patients at 1 month in order to commence relevant interventions could be beneficial

A Substruction Approach to Assessing the Theoretical Validity of Measures

Background Validity is about the logic, meaningfulness, and evidence used to defend inferences made when interpreting results. Substruction is a heuristic or process that visually represent the hierarchical structure between theory and measures. Purpose To describe substruction as a method for assessing the toretical validity of research measures. Methods Using Fawcett\u27s Conceptual-Theoretical-Empirical Structure. an exemplar is presented of substruction from the Individual and Family Self-Management Theory to the Striving to be strong study concepts and empirical measures. Results Substruction tables display evidence supporting theoretical validity of the instruments used in the study. Conclusion A high degree of congruence between theory and measure is critical to support the validity of the theory and to support attributions made about moderating, mediating, causal relationships, and intervention effects