3,170 research outputs found

    Undergraduate Catalog of Studies, 2023-2024

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    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

    Advanced glycation end products and age-related diseases in the general population

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    In this thesis, epidemiological, nutritional, and gut microbiome related studies are presented to illustrate the relation of advanced glycation end products (AGEs) with age-related diseases. The studies are embedded in the Rotterdam Study, a cohort of the Dutch general population of middle-aged and elderly adults. The amount of skin AGEs measured as SAF was used as a representative of the long-term AGE burden. Chapter 1 gives an overview of the whole thesis (Section 1.1) and gives a brief introduction to AGEs and their implications in disease pathophysiology. Chapter 2 focuses on the interplay of AGEs in the skin and clinical and lifestyle factors, and Chapter 3 concerns the link of skin and dietary AGEs with age-related diseases. Chapter 4 discusses the interpretations and implications of the findings, major methodological considerations, and pressing questions for future research

    Advanced glycation end products and age-related diseases in the general population

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    In this thesis, epidemiological, nutritional, and gut microbiome related studies are presented to illustrate the relation of advanced glycation end products (AGEs) with age-related diseases. The studies are embedded in the Rotterdam Study, a cohort of the Dutch general population of middle-aged and elderly adults. The amount of skin AGEs measured as SAF was used as a representative of the long-term AGE burden. Chapter 1 gives an overview of the whole thesis (Section 1.1) and gives a brief introduction to AGEs and their implications in disease pathophysiology. Chapter 2 focuses on the interplay of AGEs in the skin and clinical and lifestyle factors, and Chapter 3 concerns the link of skin and dietary AGEs with age-related diseases. Chapter 4 discusses the interpretations and implications of the findings, major methodological considerations, and pressing questions for future research

    UMSL Bulletin 2023-2024

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    The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp

    Forschungsbericht / Hochschule Mittweida

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    Multidisciplinary perspectives on Artificial Intelligence and the law

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    This open access book presents an interdisciplinary, multi-authored, edited collection of chapters on Artificial Intelligence (‘AI’) and the Law. AI technology has come to play a central role in the modern data economy. Through a combination of increased computing power, the growing availability of data and the advancement of algorithms, AI has now become an umbrella term for some of the most transformational technological breakthroughs of this age. The importance of AI stems from both the opportunities that it offers and the challenges that it entails. While AI applications hold the promise of economic growth and efficiency gains, they also create significant risks and uncertainty. The potential and perils of AI have thus come to dominate modern discussions of technology and ethics – and although AI was initially allowed to largely develop without guidelines or rules, few would deny that the law is set to play a fundamental role in shaping the future of AI. As the debate over AI is far from over, the need for rigorous analysis has never been greater. This book thus brings together contributors from different fields and backgrounds to explore how the law might provide answers to some of the most pressing questions raised by AI. An outcome of the Católica Research Centre for the Future of Law and its interdisciplinary working group on Law and Artificial Intelligence, it includes contributions by leading scholars in the fields of technology, ethics and the law.info:eu-repo/semantics/publishedVersio

    UMSL Bulletin 2022-2023

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    The 2022-2023 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1087/thumbnail.jp

    Undergraduate Catalog of Studies, 2022-2023

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    Under construction: infrastructure and modern fiction

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    In this dissertation, I argue that infrastructural development, with its technological promises but widening geographic disparities and social and environmental consequences, informs both the narrative content and aesthetic forms of modernist and contemporary Anglophone fiction. Despite its prevalent material forms—roads, rails, pipes, and wires—infrastructure poses particular formal and narrative problems, often receding into the background as mere setting. To address how literary fiction theorizes the experience of infrastructure requires reading “infrastructurally”: that is, paying attention to the seemingly mundane interactions between characters and their built environments. The writers central to this project—James Joyce, William Faulkner, Karen Tei Yamashita, and Mohsin Hamid—take up the representational challenges posed by infrastructure by bringing transit networks, sanitation systems, and electrical grids and the histories of their development and use into the foreground. These writers call attention to the political dimensions of built environments, revealing the ways infrastructures produce, reinforce, and perpetuate racial and socioeconomic fault lines. They also attempt to formalize the material relations of power inscribed by and within infrastructure; the novel itself becomes an imaginary counterpart to the technologies of infrastructure, a form that shapes and constrains what types of social action and affiliation are possible
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