84 research outputs found
Mutation Testing as a Safety Net for Test Code Refactoring
Refactoring is an activity that improves the internal structure of the code
without altering its external behavior. When performed on the production code,
the tests can be used to verify that the external behavior of the production
code is preserved. However, when the refactoring is performed on test code,
there is no safety net that assures that the external behavior of the test code
is preserved. In this paper, we propose to adopt mutation testing as a means to
verify if the behavior of the test code is preserved after refactoring.
Moreover, we also show how this approach can be used to identify the part of
the test code which is improperly refactored
Considering Polymorphism in Change-Based Test Suite Reduction
With the increasing popularity of continuous integration, algorithms for
selecting the minimal test-suite to cover a given set of changes are in order.
This paper reports on how polymorphism can handle false negatives in a previous
algorithm which uses method-level changes in the base-code to deduce which
tests need to be rerun. We compare the approach with and without polymorphism
on two distinct cases ---PMD and CruiseControl--- and discovered an interesting
trade-off: incorporating polymorphism results in more relevant tests to be
included in the test suite (hence improves accuracy), however comes at the cost
of a larger test suite (hence increases the time to run the minimal
test-suite).Comment: The final publication is available at link.springer.co
Did we do everything we could have? Nursesâ contributions to medicines optimisation: a mixed method study
Aim
To explore UK professionalsâ interpretations of medicines optimization and expansion of nursesâ roles.
Design
This mixedâmethods study sought professionalsâ views on nursesâ involvement, competency and engagement in monitoring patients for adverse effects of medicines, monitoring adherence, prescribing and patient education.
Method
An online survey and interviews were undertaken with nurses, doctors and pharmacists in Wales and England, May 2018 to July 2019.
Results
In all, 220 nurses, 17 doctors and 62 pharmacists responded to the online survey, and 24 professionals were interviewed. Nurses were divided over extending their roles, with 123/220 (55.9%) wishing to extend roles in monitoring patients for possible adverse drug reactions (ADRs), 111/220 (50.5%) in adherence monitoring, 121/220 (55.0%) in prescribing and 122/220 (55.4%) in patient education. The bestâqualified nurses were the most willing to increase involvement in monitoring patients for ADRs (aOR 13.00, 1.56â108.01). Interviews revealed that both nurses and doctors assumed the other profession was undertaking this monitoring. Respondents agreed that increasing nursesâ involvement in medicines optimization would improve patient care, but expressed reservations about nursesâ competencies. Collaboration between nurses and doctors was suboptimal (rated 7/10 at best) and between nurses and pharmacists even more so (6/10 at best).
Conclusion
Juxtaposition of datasets identified problems with medicines optimization: although most respondents agreed that increasing nursesâ involvement would positively impact practice, their educational preparation was a barrier. Only ~50% of nurses were willing to expand their roles to fill the hiatus in care identified and ensure that at least one profession was taking responsibility for ADR monitoring.
Impact
To improve multiprofessional team working and promote patient safety, nurse leaders should ensure patients are monitored for possible ADRs by at least one profession. Initiatives expanding nursesâ roles in medicines optimization and prescribing might be best targeted towards the more educated nurses, who have multidisciplinary support
Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results
BACKGROUND: Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. AIM: To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care. METHODS: Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+âDSS) versus assessment without (-Â DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the "gold standard" against which theâ+âDSS, -Â DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated. RESULTS: One hundred ninety-four participants (age range 25-85, meanâ=â57.7, SDâ=â16.7Â years) were assigned to theâ+âDSS (Nâ=â100) and to the -Â DSS group (Nâ=â94). The diagnosis suggested by theâ+âDSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the -Â DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in theâ+âDSS vs. the -Â DSS group. The standalone DSS had better diagnostic and management accuracy than theâ+âDSS group. CONCLUSION: There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care. TRIAL REGISTRATION NUMBER: NCT02704819 (clinicaltrials.gov)
Nicotine replacement therapy for agitation and delirium management in the intensive care unit: a systematic review of the literature.
BACKGROUND: Active smokers are prevalent within the intensive care setting and place a significant burden on healthcare systems. Nicotine withdrawal due to forced abstinence on admission may contribute to increased agitation and delirium in this patient group. The aim of this systematic review was to determine whether management of nicotine withdrawal, with nicotine replacement therapy (NRT), reduces agitation and delirium in critically ill patients admitted to the intensive care unit (ICU). METHODS: The following sources were used in this review: MEDLINE, EMBASE, and CINAHL Plus databases. Included studies reported delirium or agitation outcomes in current smokers, where NRT was used as management of nicotine withdrawal, in the intensive care setting. Studies were included regardless of design or number of participants. Data were extracted on ICU classification; study design; population baseline characteristics; allocation and dose of NRT; agitation and delirium assessment methods; and the frequency of agitation, delirium, and psychotropic medication use. RESULTS: Six studies were included. NRT was mostly prescribed for smokers with heavier smoking histories. Three studies reported an association between increased agitation or delirium and NRT use; one study could not find any significant benefit or harm from NRT use; and two described a reduction of symptomatic nicotine withdrawal. A lack of consistent and validated assessment measures, combined with limitations in the quality of reported data, contribute to conflicting results. CONCLUSIONS: Current evidence for the use of NRT in agitation and delirium management in the ICU is inconclusive. An evaluation of risk versus benefit on an individual patient basis should be considered when prescribing NRT. Further studies that consider prognostic balance, adjust for confounders, and employ validated assessment tools are urgently needed
EUPRON: nursesâ practice in interprofessional pharmaceutical care in Europe. A cross-sectional survey in 17 countries
Abstract Objectives Safe pharmaceutical care (PC) requires an interprofessional team approach, involving physicians, nurses and pharmacists. Nursesâ roles however, are not always explicit and clear, complicating interprofessional collaboration. The aim of this study is to describe nursesâ practice and interprofessional collaboration in PC, from the viewpoint of nurses, physicians and pharmacists. Design A cross-sectional survey. Setting The study was conducted in 17 European countries, each with their own health systems. Participants Pharmacists, physicians and nurses with an active role in PC were surveyed. Main outcome measures Nursesâ involvement in PC, experiences of interprofessional collaboration and communication and views on nursesâ competences. Results A total of 4888 nurses, 974 physicians and 857 pharmacists from 17 European countries responded. Providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 78%, 73%, 69% and 15% of nurses, respectively. Most respondents were convinced that quality of PC would be improved by increasing nursesâ involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, â€4/10, <6/10 for all four aspects of PC. Conclusions ME, MMA, PEI and prescribing are part of nursesâ activities, and most healthcare professionals felt their involvement should be extended. Collaboration between nurses and physicians on PC is limited and between nurses and pharmacists even more
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Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study
Purpose
Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients.
Methods
A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The ten predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 h after ICU admission. The confusion assessment method for the intensive care unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data.
Results
A total of 2,852 adult ICU patients were screened of which 1,824 (64 %) were eligible for the study. Main reasons for exclusion were length of stay <1 day (19.1 %) and sustained coma (4.1 %). CAM-ICU compliance was mean (SD) 82 ± 16 % and inter-rater reliability 0.87 ± 0.17. The median delirium incidence was 22.5 % (IQR 12.8â36.6 %). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the eight participating centers remained good: 0.77 (95 % CI 0.74â0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved re-calibration of the PRE-DELIRIC model.
Conclusions
In this multinational study, we recalibrated the PRE-DELIRIC model. Despite differences in the incidence of predictors between the centers in the different countries, the performance of the PRE-DELIRIC-model remained good. Following validation of the PRE-DELIRIC model, it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients
Jugular bulb diverticulum dehiscence towards the vestibular aqueduct in a patient with otosclerosis
Abstract: Objectives: To demonstrate the need for computed tomography imaging of the temporal bone before considering revision stapes surgery in patients with recurrent or residual conductive hearing loss. Case report: We report the case of a high-riding jugular bulb with an associated jugular bulb diverticulum, which was dehiscent towards the vestibular aqueduct, in a patient with confirmed otosclerosis who did not experience hearing improvement after stapedotomy. Conclusion: This case demonstrates the usefulness of temporal bone computed tomography in the evaluation of patients with otosclerosis in whom stapedotomy has not improved hearing. In such patients, revision surgery to address residual hearing loss would eventually prove unnecessary and avoidable
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