The Schedule for the Evaluation of Individual Quality of Life (SEIQoL). Administration Manual.

Advances in the clinical sciences this century have resulted in an impressive range of diagnostic procedures, therapies, drugs and surgical techniques which have revolutionised the management of heretofore fatal conditions. In addition to being concerned about life expectancy, people are also concerned about the quality of their lives. Partly in response to the views of patients, assessment of patient Quality of Life (QoL) is becoming increasingly important in medicine, nursing and in the behavioural sciences. It has already become an important outcome variable in assessing the impact of disease, illness and treatment (Spilker, 1990; Walker and Rosser, 1993; Bowling 1991; O\u27Boyle, 1992). QoL is a multi-dimensional construct and there are various approaches to its evaluation. The approach varies depending on the aims of the exercise. Health economists, for example, use techniques such as the QALY (Quality Adjusted Life Year), standard gamble and time-trade-off techniques in order to incorporate QoL measures into economic analysis and clinical trials. Clinical research has utilised standardised and disease specific measures, usually in the form of questionnaires, in order to determine the impact of disease and treatment on patients\u27 QoL. One of the problems of conducting research in this area is that there is no single agreed definition of QoL nor is there a single \u27gold standard\u27 measurement technique. However, there is broad agreement that studies of health related QoL should include assessments of physical functioning, including somatic sensations such as physical symptoms and pain; psychological function including concentration and mood; social and sexual functioning and occupational status. Many researchers also assess patients\u27 global satisfaction and the economic impact of the condition. While QoL scales and questionnaires, as well as the methods of rating and analysing them, have been developed by assessing the QoL of individuals, the specific items and the response categories do not represent the free choice of individuals who are subsequently investigated using the scale. Furthermore, the measures will often have been standardised in samples other than those currently being assessed. Results are generally presented as group statistics and provide little or no data on the QoL of individual patients

The Design of Student Training Resources to Enhance the Student Voice in Academic Quality Assurance and Quality Enhancement Processes

Without appropriate training and recognition, students – in particular Class Representatives – often struggle to engage fully with a University’s quality assurance and quality enhancement processes. Through the “Our Student Voice” project in Technological University Dublin (TU Dublin), a suite of digital training resources were designed to provide training for students to help develop the requisite knowledge and skills for effective participation there processes, thus strengthening student engagement and enhancing the student voice. The resources are organised into thirteen accessible episodes that each commence with an animated scenario that sets out key messages. The remainder of the episode provides detailed guidance for students and learning activities to help students develop their skillset. Upon completion of the learning activities, and having satisfactorily undertaken one of three specific student role in the quality processes, students can apply for recognition through a digital badge. The training resources and digital badges have been co-designed by a project team comprised of staff and students from across the University guided by best practice internationally. This paper describes the co-design process and presents a set of lessons learned that may assist other higher education institutions in enabling impactful student engagement in their academic quality assurance and quality enhancement processes

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

Meeting Abstracts: Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo Clearwater Beach, FL, USA. 9-11 June 201

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Technical Report: Music Lounge

My fourth year project is a music based web application. It allows a user of the website to register an account, and once logged in, they are brought to a number of features on different pages that are of interest to anyone with a passion for music. As more users register and more profiles build up on the site, more activity and discussion can take place online, therefore my site is heavily reliant on user activity. Features given to users are mainly based around API’s, such as the Google Maps API which displays upcoming live events based on the area the user is in. Also contained on the site is a discussion page where users can create posts and generate a discussion in comments on a range of topics such as their favourite bands, previous shows they’ve been to, instruments they play etc. – much like a forum. They are also given a resource which allows them to search for their favourite artists, and be given a bio of that artist as well as being shown similar artists, recent news/blogs/reviews about their search. Chat rooms are available for online discussion, and users of the site can add each other as friends – an important feature for getting an online community and social website up and running

Keltoi rehabilitation programme: post-discharge outcome study.

Aims: This article presents the results of a survey of clients of Keltoi, a residential rehabilitation facility for former opiate-dependent individuals. The survey was carried out to evaluate the success of its unique programme in assisting participants to pursue a drug-free life. Methods: Between 1- and 3-years post-discharge, 53.7% (n = 80) of all former Keltoi clients (n = 149 at the time of study), were interviewed with respect to abstinence, health, crime and employment measures. This was an uncontrolled cohort study. Findings: Abstinence from all illicit drugs and alcohol in 30 days pre-interview was reported by 51.3% (n = 41) of the cohort; 60.0% (n = 48) reported abstinence from all illicit drugs excluding alcohol. Only 5.4% (n = 5) reported injecting behaviour. Outcomes are presented with respect to crime, health and risk behaviours, social and personal functioning and employment. Conclusions: The percentage of those reporting abstinence from illicit drugs was high at 60.0%, and was associated with minimal criminal activity and higher positive outcomes than non-abstinence. Exploring the association between the Keltoi approach and these encouraging results has implications for the design, delivery and evaluation of drug treatment services in Ireland, particularly in the context of the treatment and rehabilitation pillar of the Irish National Drugs Strategy 2009–2016