The work undertaken by mechanically ventilated patients in intensive care : a qualitative meta-ethnography of survivors' experiences

Background: Mechanical ventilation is a routine intervention for the critically ill but patients' experiences of this intervention are largely hidden from clinicians. A comprehensive understanding of Intensive Care Units survivors' accounts is required to provide health professionals with evidence about the patients' experience to deliver patient-centred care. Objectives: To synthesise qualitative findings from international studies to understand Intensive Care Unit survivors' experiences of mechanical ventilation, clarify the components of patient-centred care from the patient perspective and understand what can be done by health professionals to improve care processes. Design: A meta-ethnography of qualitative evidence following ENTREQ recommendations for reporting systematic reviews. Data Sources: Eight databases (MEDLINE, AMED, CINAHL, PsychINFO, Scopus, WileyOnline, PubMed Central, TRIP) were systematically searched using a piloted strategy described in a published protocol. Searches were completed on 31.8.16 and no date restrictions were placed. Searches were updated on 25.4.17. Review Methods: Two researchers independently reviewed studies against pre-determined inclusion criteria to assess their eligibility. Studies were included if they reported on the adult patient experience of mechanical ventilation and used qualitative data collection and analysis methods. All included studies were quality appraised. Participant quotes and concepts, described within the categories and themes of published studies, were extracted by one reviewer and coded by two reviewers. A process of constant comparison, which is central to meta-ethnography, facilitated the re-interpretation of data by a team of researchers to generate the final qualitative synthesis. The Enhancing Transparency in Reporting the Synthesis of Qualitative (ENTREQ) statement was used to ensure that all synthesis stages were comprehensively reported. Results: Findings from 38 studies, with 608 participants, informed a patient-centred trajectory model; three overlapping stages; alienation, hidden work and recovery characterised the experiences of mechanical ventilation survivors. Health professionals could positively influence the patient experience by promoting ‘trust’ and being vigilant so that patients felt ‘safe’. Care provision that promoted ‘personalisation’ helped participants to retain their identity as unique human beings. Conclusions: For the first time the pooling of qualitative findings from international studies, using meta-ethnography, has provided a patient-centred model of mechanical ventilation survivors’ experiences of their care processes. Patients may actively engage or passively endure the treatment burden associated with mechanical ventilation. Keywords: Critical care; mechanical ventilation; patient experience; qualitative synthesis, care processes, meta-ethnograph

Patient Experience of Informed Consent for Diagnostic Coronary Angiogram and Follow-On Treatments

Background/Aims Coronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter. Methods A descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography. Results Female participants reported greater difficulty in recalling treatment information (P<0.03), found discussions about alternative treatments more confusing (P<0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P<0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P<0.002). Conclusions Patients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent

BinCam:designing for engagement with Facebook for behavior change

Abstract. In this paper we continue work to investigate how we can engage young adults in behaviors of recycling and the prevention of food waste through social media and persuasive and ubiquitous computing systems. Our previous work with BinCam, a two-part design combining a system for the collection of waste-related behaviors with a Facebook application, suggested that although this ubiquitous system could raise awareness of recycling behavior, engagement with social media remained low. In this paper we reconsider our design in terms of engagement, examining both the theoretical and practical ways in which engagement can be designed for. This paper presents findings from a new user study exploring the redesign of the social media interface following this analysis. By incorporating elements of gamification, social support and improved data visualization, we contribute insights on the relative potential of these techniques to engage individuals across the lifespan of a system’s deployment

Patient experience of informed consent for diagnostic coronary angiogram and follow-on treatments

Background/Aims Coronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter. Methods A descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography. Results Female participants reported greater difficulty in recalling treatment information (P<0.03), found discussions about alternative treatments more confusing (P<0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P<0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P<0.002). Conclusions Patients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent

The diagnostic value of symptoms of possible oesophagogastric cancers: a systematic review and meta-analysis

Abstracts of the Cancer and Primary Care Research International (Ca-PRI) Network Seventh Annual Meeting: New Partnerships in Primary Care Cancer Research. June 10-13, 2014, Winnipeg, Manitoba, CanadaOral presentation abstractThis is the author accepted manuscript. The final version is available from Wiley via the DOI in this record

Hubungan keterjangkauan makanan terhadap prestasi belajar mahasiswa di Lampung

Latar belakang : Komponen keterjangkauan makan terdiri uang saku, harga makanan dan bantuan program makan. komponen ini di akan mempengatuhi asupan makan yang tidak sehat. asupan makanan menjadi salah satu faktor menurunya produktivitas terutama pada perfoma belajar. Prestasi belajar mahasiswa merupakan salah satu faktor penting dalam kesuksesan mahasiswa dimasa depan. Tujuan penelitian : Penelitian ini adalah mengetahui hubungan keterjangkauan makanan terhadap terhadap prestasi mahasiswa di lampung. Metode penelitian : Penelitian ini dengan metode kuantitatif yang termasuk jenis penelitian empirik observasional analitik dengan desain cross sectional. Teknik sampling yang di gunakan pada penelitian ini menggunakan snowball sampling, jumlah sampel dalam penelitian ini sebanyak 196 mahasiswa aktif di kota lampung. Pengumpulan keterjangkauan makan di peroleh dari kuesioner, sedangkan untuk prestasi belajar diperoleh dengan nilai IPK (Indeks Kumalatif Mahasiswa) satu tahun terakhir dan analisis ini yang di gunakan dalam penelitian ini adalah Analisis uji Independent Sample T-Test. Hasil penelitian : menunjukkan bahwa Tidak ada hubungan keterjangkauan makan dengan prestasi belajar. hasil ini bisa di lihat dari perhitungan Hasil uji Independet t-test di ketahui indikator pengeluaran untuk makan P 0,064 > 0,05, Daya beli P 0,96> 0,05, dan bantuan program makan P 0,24> 0,05, maka Ho diterima menunjukkan tidak ada hubungan. Kesimpulan dan saran : Komponen keterjangkauan makan tidak berhubungan dengan prestasi belajar baik dari indikator Pengeluaran Makan, Daya Beli dan bantuan program makan. Harapannya Mahasiswa Memilih makan sesuai dengan pedoman gizi seimbang membantu lebih berkosentrasi dalam menerima materi yang di berikan sehingga dapat meningkatkan prestasi

Enhancing the early student experience

This paper is concerned with identifying how the early student experience can be enhanced in order to improve levels of student retention and achievement. The early student experience is the focus of this project as the literature has consistently declared the first year to be the most critical in shaping persistence decisions. Programme managers of courses with high and low retention rates have been interviewed to identify activities that appear to be associated with good retention rates. The results show that there are similarities in the way programmes with high retention are run, with these features not being prevalent on programmes with low retention. Recommendations of activities that appear likely to enhance the early student experience are provided