Patients, family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping: a qualitative focus group study

PurposeWhile studies report on perceptions of family participation in delirium prevention, little is known about the use of family-administered delirium detection tools in the care of critically ill patients. This study sought the perspectives of patients, their family members, and healthcare providers on the use of family-administered delirium detection tools to detect delirium in critically ill patients and barriers and facilitators to using family-administered delirium detection tools in patient care.MethodsIn this qualitative study, critical care providers (five physicians, six registered nurses) and participants from the Family ICU Delirium Detection Study (seven past patients and family members) took part in four focus groups at one hospital in Calgary, Alberta.ResultsKey themes identified following thematic analysis from 18 participants included: 1) perceptions of acceptability of family-administered delirium detection (e.g., family feels valued, intensive care unit (ICU) care team may not use a family member's results, intensification of work load), 2) considerations regarding feasibility (e.g., insufficient knowledge, healthcare team buy-in), and 3) overarching strategies to support implementation into routine patient care (e.g., value of family-administered delirium detection for patients and families is well understood in the clinical context, regular communication between the family and ICU providers, an electronic version of the tool).ConclusionsPatients, family members and healthcare providers who participated in the focus groups perceived family participation in delirium detection and the use of family-administered delirium detection tools at the bedside as feasible and of value to patient care and family member coping.Trial registrationwww.ClinicalTrials.gov (NCT03379129); registered 15 December 2017

Representing biodiversity: data and procedures for identifying priority areas for conservation

Biodiversity priority areas together should represent the biodiversity of the region they are situated in. To achieve this, biodiversity has to be measured, biodiversity goals have to be set and methods for implementing those goals have to be applied. Each of these steps is discussed. Because it is impossible to measure all of biodiversity, biodiversity surrogates have to be used. Examples are taxa sub-sets, species assemblages and environmental domains. Each of these has different strengths and weaknesses, which are described and evaluated. In real-world priority setting, some combination of these is usually employed. While a desirable goal might be to sample all of biodiversity from genotypes to ecosystems, an achievable goal is to represent, at some agreed level, each of the biodiversity features chosen as surrogates. Explicit systematic procedures for implementing such a goal are described. These procedures use complementarity, a measure of the contribution each area in a region makes to the conservation goal, to estimate irreplaceability and flexibility, measures of the extent to which areas can be substituted for one another in order to take competing land uses into account. Persistence and vulnerability, which also play an important role in the priority setting process, are discussed briefly