Nurses’ experiences of a screening and associated psychosomatic consultation service for mental comorbidities in somatic care inpatients – a qualitative study

BackgroundScreening for mental comorbidities and related liaison service can reduce hospital length of stay in somatic hospital care. To develop, test and sustain such health care services, stakeholder feedback is required. One of the most important stakeholders in general hospital care and health care processes are nurses.AimThe aim of this study is to explore nurses’ experiencess on standardized nurse-led screening for mental comorbidities and associated psychosomatic consultation service in routine somatic inpatient care.MethodSemi-structured qualitative interviews were conducted with 18 nurses that were involved in a nurse-led screening service for mental comorbidities on internal medicine or dermatological wards. Data were analyzed using thematic analysis.ResultsEight thematic groups were developed. On the one hand, participants reported benefits of screening: mental health education, general mental health awareness, holistic treatment approach, opportunity to build rapport with patients and reduction in workload. On the other hand, possible psychological effects of the intervention, reasons why patients may not want to be referred and application requirements to facilitate delivery were identified. None of the nurses opposed screening and associated psychosomatic consultation service.ConclusionAll nurses endorsed the screening intervention and considered it meaningful. Nurses particularly emphasized the potential for holistic patient care and nurses’ improved skills and competencies, but partly critizised current application requirements.Relevance to clinical practiceThis study adds on existent evidence on nurse-led screening for mental comorbidities and associated psychosomatic consultation service by emphasizing its potential to improve both patient care as well as nurses’ perceived self-efficacy and job satisfaction. To take full advantage of this potential, however, usability improvements, regular supervision, and ongoing training for nurses need to be considered

Comparison of elastic moduli from seismic diving-wave and ice-core microstructure analysis in Antarctic polar firn

We compared elastic moduli in polar firn derived from diving wave refraction seismic velocity analysis, firn-core density measurements and microstructure modelling based on firn-core data. The seismic data were obtained with a small electrodynamic vibrator source near Kohnen Station, East Antarctica. The analysis of diving waves resulted in velocity–depth profiles for different wave types (P-, SH- and SV-waves). Dynamic elastic moduli of firn were derived by combining P- and S-wave velocities and densities obtained from firn-core measurements. The structural finite-element method (FEM) was used to calculate the components of the elastic tensor from firn microstructure derived from X-ray tomography of firn-core samples at depths of 10, 42, 71 and 99 m, providing static elastic moduli. Shear and bulk moduli range from 0.39 to 2.42 GPa and 0.68 to 2.42 GPa, respectively. The elastic moduli from seismic observations and the structural FEM agree within 8.5% for the deepest achieved values at a depth of 71 m, and are within the uncertainty range. Our observations demonstrate that the elastic moduli of the firn can be consistently obtained from two independent methods which are based on dynamic (seismic) and static (tomography and FEM) observations, respectively, for deeper layers in the firn below ∼10 m depth

Comparison of elastic moduli from seismic diving-wave and ice-core microstructure analysis in Antarctic polar firn

The densification of firn depends on the elastic properties of firn, processes which are still not fully explained by the usual models. Geophysical methods provide spatially distributed data, while the analysis of firn cores is restricted to finite locations, but with a different vertical resolution. In this study, we compared elastic moduli in polar firn derived from refraction seismic velocity analysis and vertical density profiles from the firn-core measurements to elastic properties derived from microstructure modelling based on firn-core data. The seismic data were obtained with a small electrodynamic vibrator source (ElViS) near Kohnen Station, East Antarctica. The analysis of divingwaves resulted in velocity–depth profiles for P-, SH- and SV-wave velocities. Elastic moduli of firn were derived by combining P- and S-wave velocities and densities obtained from firn-core measurements. P-wave velocities derived from diving-wave analysis range from 2060 m s−1at 10 m depth to 3400 m s−1at 70 m depth, S-wave velocities from 1250 m s−1 to 1700 m s−1, respectively. The structural finite-element method (FEM) was used to calculate the components of the elastic tensor from firn microstructure derivedfrom X-ray tomography of firn-core samples at depths of 10, 42, 71 and 99 m. Shear and bulk moduli range from 0.39 GPa to 2.42 GPa and 0.68 GPa to 2.42 GPa, respectively. The elastic moduli from seismic observations and the structural FEM agree within 8.5% for the values derived at a depth of 71 m, and are within the uncertainty range. Our study demonstrates that elastic moduli of firn can be consistently obtained from two independent methods, which are based on dynamic (seismic) and static (tomography and FEM) observations, respectively. The agreement of the results for both methods indicates that elastic properties in firn can be acquired as spatially distributed data with the seismic approach, supported by local density information. Thus, information about elastic properties can be derived over larger lateral distances than would be possible with the static method. This enables the analysis of the firn and conclusions of the densification models might be drawn from observations of spatial and temporal changes in elastic properties

Multi-tracer study of gas trapping in an East Antarctic ice core

We study a firn and ice core drilled at the new "Lock-In" site in East Antarctica, located 136 km away from Concordia station towards Durmont d'Urville. High resolution chemical and physical measurements were performed on the core, with a particular focus on the trapping zone of the firn where air bubbles are formed. We measured the air content in the ice, closed and open porous volumes in the firn, firn density, firn liquid conductivity and major ion concentrations, as well as methane concentrations in the ice. The closed and open porosity volumes of firn samples were obtained by the two independent methods of pycnometry and tomography, that yield similar results. The measured increase of the closed porosity with density is used to estimate the air content trapped in the ice with the aid of a simple gas trapping model. Results show a discrepancy, with the model trapping too much air. Experimental errors have been considered but do not explain the discrepancy between the model and the observations. The model and data can be reconciled with the introduction of a reduced compression of the closed porosity compared to the open porosity. Yet, it is not clear if this limited compression of closed pores is the actual mechanism responsible for the low amount of air in the ice. High resolution density measurements reveal the presence of a strong layering, manifesting itself as centimeter scale variations. Despite this heterogeneous stratification, all layers, including the ones that are especially dense or less dense compared to their surroundings, display similar pore morphology and closed porosity as function of density. This implies that all layers close in a similar way, even though some close in advance or later compared to the bulk firn. Investigation of the chemistry data suggests that in the trapping zone, the observed stratification is partly related to the presence of chemical impurities

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

The Heidelberg Milestones Communication Approach (MCA) for patients with prognosis <12 months: protocol for a mixed-methods study including a randomized controlled trial

Background: The care needs of patients with a limited prognosis (<12 months median) are complex and dynamic. Patients and caregivers must cope with many challenges, including physical symptoms and disabilities, uncertainty. and compromised self-efficacy. Healthcare is often characterized by disruptions in the transition between healthcare providers. The Milestones Communication Approach (MCA) is a structured, proactive, interprofessional concept that involves physicians and nurses and is aimed at providing coherent care across the disease trajectory. This study aims to evaluate these aspects of MCA: (1) the training of healthcare professionals, (2) implementation context and outcomes, (3) patient outcomes, and (4) effects on interprofessional collaboration. Methods/design: A multiphase mixed-methods design will be used for the study. A total of 100 patients and 120 healthcare professionals in a specialized oncology hospital will be involved. The training outcomes will be documented using a questionnaire. Implementation context and outcomes will be explored through semi-structured interviews and written questionnaires with healthcare professionals and with the training participants and through a content analysis of patient files. Patient outcomes will be assessed in a pragmatic non-blinded randomized controlled trial and in qualitative interviews with patients and caregivers. Trial outcomes are supportive care needs (SCNS-SF34-G), quality of life (SeiQol and Fact-L), depression and anxiety symptoms (PHQ-4), and distress (Distress Thermometer). Qualitative semi-structured interviews on patients’ views will focus on shared decision-making, communication needs, feeling empathy, and further utilization of healthcare services. Interprofessional collaboration will be explored using the UWE-IP-D before the implementation of MCA (t0) and after 3 (t1), 9 (t2), and 12 (t3) months. Discussion: Using guideline-concordant early palliative care, MCA aims to foster patient-centered communication with shared decision-making and facilitation of advance care planning including end-of-life decisions, thus increasing patient quality of life and decreasing aggressive medical care at the end of life. It is assumed that the communication skills training and interprofessional coaching will improve the communication behavior of healthcare providers and influence team communications and team processes. Trial registration German Clinical Trials Register, DRKS00013649 and DRKS00013469. Registered on 22 December 2017

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

p-Adaptive Discontinuous Galerkin Method in CODA

Adaptation is an important tool in modern computational fluid dynamics software, which can reduce the computational cost of a simulation and simplifies the process of mesh generation. Important flow features (e.g. internal layers, shocks or vortices) do not need to be incorporated in the initial mesh design manually. In this paper we present results of the adaptive discontinuous Galerkin method in CODA with support for locally varying discretization order and a basic small scale energy adaptation indicator