1,711 research outputs found

    Physical Rehabilitation Core Outcomes In Critical illness (PRACTICE): protocol for development of a core outcome set

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    Open Access: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Existing data on physical rehabilitation interventions in critical illness are challenged by outcome heterogeneity that limits data synthesis and translation of research findings into clinical practice. This protocol describes the PRACTICE study to develop a core outcome set (COS) for trials of physical rehabilitation interventions delivered across the continuum of a patient's recovery from the intensive care unit until reintegration in the community following hospital discharge. Methods: Mixed methods will be used including: systematic reviews of quantitative and qualitative literature; qualitative interviews with patients and caregivers; a modified Delphi consensus process with researcher, clinician and patient/caregiver stakeholder groups; and consensus meetings for ratification of findings, resolving uncertainty, or developing an action plan for COS implementation. Discussion: The PRACTICE COS will inform relevant stakeholders about important outcomes regarding physical rehabilitation in critical illness, and may enhance the future design and conduct of trials in this area.Peer reviewe

    Overview of pedal cyclist traffic casualties in South Australia

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    Characteristics of pedal cycle crashes (as reported to the police) in South Australia, and how they have changed over the period 1981-2004, are examined. The paper describes both the present situation (2001-2004) and how it has changed since 1981; both child and adult casualties; both the numbers of casualties and the proportions seriously injured; and both factors that are commonly tabulated and some that are relatively unusual. In 1981, pedal cyclist casualties were mostly children and teenagers, but in 2004, pedal cyclist casualties were mostly spread across the age range from 16 to 49. Child pedal cyclist casualties reached a maximum in 1982-1987, and have fallen sharply since. Adult pedal cyclist casualties reached a maximum in 1987-1990, and then fell. Concerning the proportion of casualties seriously injured (i.e., killed or admitted to hospital), in 2001-2004 this proportion among adults (16+) was 12% when the speed limit was 60 km/h or less, and 33% when the speed limit was 70 km/h or higher. Among the four most frequent types of crashes (right angle, side swipe, right turn, and rear end), the proportions of adult casualties seriously injured were 11%, 11%, 16%, and 18%. The proportion was 14% for male drivers of the motor vehicle and 9% for female drivers; it was 17%, 15%, 15%, 14%, 10%, and 11% for motor vehicle driver age groups 16-19, 20-29, 30-39, 40-49, 50-59, and 60-99.T. P. Hutchinson, C. N. Kloeden, and A. D. Lon

    The changing nature of risk

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    http://www.ergonomics.org.au/downloads/EA_Journals/EA_March_June_08.pdfInternational audienceThe crucial change that took place in the 19th century was that accidents became associated with the technological systems that people designed, built, and used as part of work, in the name of progress and civilisation. Suddenly, accidents happened not only because the people involved, today referred to as people at the sharp end, did something wrong or because of an act of nature, but also because a human-made system failed. Furthermore, the failures were no longer simple, such as a scaffolding falling down or a wheel axle breaking. The failures were complex, in the sense that they usually defied the immediate understanding of the people at the sharp end. In short, their knowledge and competence was about how to do their work, and not about how the technology worked or functioned. Before this change happened, people could take reasonable precautions against accidents at work because they understood the tools and artefacts they used sufficiently well. After this change had happened, that was no longer the case

    Training interventions for improving telephone consultation skills in clinicians

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    The objectives are as follows: To assess the effectiveness of training interventions on clinician telephone skills

    Discharge Summary Hospital Course Summarisation of In Patient Electronic Health Record Text with Clinical Concept Guided Deep Pre-Trained Transformer Models

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    Brief Hospital Course (BHC) summaries are succinct summaries of an entire hospital encounter, embedded within discharge summaries, written by senior clinicians responsible for the overall care of a patient. Methods to automatically produce summaries from inpatient documentation would be invaluable in reducing clinician manual burden of summarising documents under high time-pressure to admit and discharge patients. Automatically producing these summaries from the inpatient course, is a complex, multi-document summarisation task, as source notes are written from various perspectives (e.g. nursing, doctor, radiology), during the course of the hospitalisation. We demonstrate a range of methods for BHC summarisation demonstrating the performance of deep learning summarisation models across extractive and abstractive summarisation scenarios. We also test a novel ensemble extractive and abstractive summarisation model that incorporates a medical concept ontology (SNOMED) as a clinical guidance signal and shows superior performance in 2 real-world clinical data sets

    Dying and death in the electronic patient record. A qualitative analysis of textual practices

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    All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission.In Norway, over one in four deaths occur in hospitals, places that operate primarily according to curative logic. One aim of the Norwegian health care system is that patients, at the end of life, should receive high-quality palliative care as defined by the World Health Organization, independent of whether they are dying at home or in a nursing home, hospice or hospital. Against this potentially challenging background, this project investigates the role of the texts about such patients written into the electronic patient record (EPR). Starting from the view of (EPR) texts as active contributors to the whereabouts of (dying) patients, the EPR can be seen as an essential communication and coordination tool contributing to the types of knowledge that circulate about the dying patient and their treatment. This thesis aims to provide insights into how and what knowledge the EPR proposes as relevant by asking: What kind of textual practices of dying and death in medical wards are present in the EPR, and what do these practices achieve? The selected methods were a qualitative document analysis combining elements from the fields of linguistics, literary criticism and science and technology studies. This effort resulted in three articles elaborating different aspects of how dying and death are documented in the EPR. The first article investigated the negotiations of the transition from curative to palliative care. It argued that the text often changes from being technical and conclusive to being uncertain and open to negotiations as a need to align the involved parties in the decision. The second article explored which aspects of dying the text is attuned to in patients’ last 24 hours of life. It argued that the text has three hegemonic modes of ordering – numbering, timing, and classifying – which perform a dominant narrative in which dying is concealed. Yet, in between, there are traces of caring attention to and compassion for the dying patient. The third article considered how the moment of death is documented. It argued for what seem to be established ways of recording this moment as being manageable and portraying it as uneventful or good. This exploration of textual practices suggests that, first, the EPR treats dying and death as observations and tasks to be solved in general biomedical terms, rather than probing the needs of the individual patient. Second, the EPR seems to avoid difficult topics, deliberations, and disagreements, and it never admits to failure. Finally, the EPR sometimes shows professionals’ attempts to reveal individual patients’ needs and suffering and the troubles of dying in a curative context. Paper I: Hov, L., Synnes, O., & Aarseth, G. (2020). Negotiating the turning point in the transition from curative to palliative treatment: A linguistic analysis of medical records of dying patients. BMC Palliative Care, 19 (1), 1–13. https://doi.org/10.1186/s12904-020-00602-4 Paper II: Hov, L., Pasveer, B., & Synnes, O. (2020). Modes of dying in the electronic patient record, Mortality, https://doi.org/10.1080/13576275.2020.1865294 Paper III: Hov, L., Tveit, B., & Synnes O. (2021, May). Nobody dies alone in the electronic patient record – A qualitative analysis of the textual practices of documenting dying and death. OMEGA-Journal of Death and Dying. https://doi.org/10.1177/00302228211019197publishedVersio

    A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT

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    BACKGROUND: High numbers of patients experience severe acute stress in critical care units. Acute stress has been linked to post-critical care psychological morbidity, including post-traumatic stress disorder (PTSD). Previously, a preventive, complex psychological intervention [Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI)] was developed by this research team, to be led by nurses, to reduce the development of PTSD symptom severity at 6 months. OBJECTIVES: The objectives were to (1) standardise and refine the POPPI intervention, and, if feasible, (2) evaluate it in a cluster randomised clinical trial (RCT). DESIGN: Two designs were used – (1) two feasibility studies to test the delivery and acceptability (to patients and staff) of the intervention, education package and support tools, and to test the trial procedures (i.e. recruitment and retention), and (2) a multicentre, parallel-group, cluster RCT with a baseline period and staggered roll-out of the intervention. SETTING: This study was set in NHS adult, general critical care units. PARTICIPANTS: The participants were adult patients who were > 48 hours in a critical care unit, receiving level 3 care and able to consent. INTERVENTIONS: The intervention comprised three elements – (1) creating a therapeutic environment in critical care, (2) three stress support sessions for patients identified as acutely stressed and (3) a relaxation and recovery programme for patients identified as acutely stressed. MAIN OUTCOMES MEASURES: Primary outcome – patient-reported symptom severity using the PTSD Symptom Scale – Self Report (PSS-SR) questionnaire (to measure clinical effectiveness) and incremental costs, quality-adjusted life-years (QALYs) and net monetary benefit at 6 months (to measure cost-effectiveness). Secondary outcomes – days alive and free from sedation to day 30; duration of critical care unit stay; PSS-SR score of > 18 points; depression, anxiety and health-related quality of life at 6 months; and lifetime cost-effectiveness. RESULTS: (1) A total of 127 participants were recruited to the intervention feasibility study from two sites and 86 were recruited to the RCT procedures feasibility study from another two sites. The education package, support tools and intervention were refined. (2) A total of 24 sites were randomised to the intervention or control arms. A total of 1458 participants were recruited. Twelve sites delivered the intervention during the intervention period: > 80% of patients received two or more stress support sessions and all 12 sites achieved the target of > 80% of clinical staff completing the POPPI online training. There was, however, variation in delivery across sites. There was little difference between baseline and intervention periods in the development of PTSD symptom severity (measured by mean PSS-SR score) at 6 months for surviving patients in either the intervention or the control group: treatment effect estimate −0.03, 95% confidence interval (CI) −2.58 to 2.52; p = 0.98. On average, the intervention decreased costs and slightly improved QALYs, leading to a positive incremental net benefit at 6 months (£835, 95% CI −£4322 to £5992), but with considerable statistical uncertainty surrounding these results. There were no significant differences between the groups in any of the secondary outcomes or in the prespecified subgroup analyses. LIMITATIONS: There was a risk of bias because different consent processes were used and as a result of the lack of blinding, which was mitigated as far as possible within the study design. The intervention started later than anticipated. Patients were not routinely monitored for delirium. CONCLUSIONS: Among level 3 patients who stayed > 48 hours in critical care, the delivery of a preventive, complex psychological intervention, led by nurses, did not reduce the development of PTSD symptom severity at 6 months, when compared with usual care. FUTURE WORK: Prior to development and evaluation of subsequent psychological interventions, there is much to learn from post hoc analyses of the cluster RCT rich quantitative and qualitative data. TRIAL REGISTRATION: This trial is registered as ISRCTN61088114 and ISRCTN53448131. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 23, No. 30. See the NIHR Journals Library website for further project information

    ERS statement: A core outcome set for clinical trials evaluating the management of COPD exacerbations

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    Clinical trials evaluating the management of acute exacerbations of COPD assess heterogeneous outcomes, often omitting those that are clinically relevant or more important to patients. We have developed a core outcome set, a consensus-based minimum set of important outcomes that we recommend are evaluated in all future clinical trials on exacerbations management, to improve their quality and comparability. COPD exacerbations outcomes were identified through methodological systematic reviews and qualitative interviews with 86 patients from 11 countries globally. The most critical outcomes were prioritised for inclusion in the core outcome set through a two-round Delphi survey completed by 1063 participants (256 patients, 488 health professionals and 319 clinical academics) from 88 countries in five continents. Two global, multi-stakeholder, virtual consensus meetings were conducted to 1) finalise the core outcome set and 2) prioritise a single measurement instrument to be used for evaluating each of the prioritised outcomes. Consensus was informed by rigorous methodological systematic reviews. The views of patients with COPD were accounted for at all stages of the project. Survival, treatment success, breathlessness, quality of life, activities of daily living, the need for a higher level of care, arterial blood gases, disease progression, future exacerbations and hospital admissions, treatment safety and adherence were all included in the core outcome set. Focused methodological research was recommended to further validate and optimise some of the selected measurement instruments. The panel did not consider the prioritised set of outcomes and associated measurement instruments to be burdensome for patients and health professionals to use
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