Thromboprophylaxis prescribing among junior doctors:the impact of educational interventions

BACKGROUND: Venous thromboembolism (VTE) prophylaxis in an important aspect of the care of hospitalised patients, for which the National Institute for Health and Care Excellence (NICE) has issued guidance. Guidance compliance continues to be a concern. Junior doctors are the main group responsible for prescribing thromboprophylaxis. We aimed to compare local pharmacological thromboprophylaxis prescribing against NICE guidelines in a surgical department at a district general hospital, and determine whether interventions aimed at improving compliance were effective. METHODS: Over four months, a two cycle audit of prescribing patterns for VTE prophylaxis was performed using data collected at four intervals: 1. Baseline 2. Following pro-forma introduction and feedback 3. A second baseline data collection. 4. Following VTE prophylaxis teaching. RESULTS: A total of 394 admissions were included. Correct identification and prescribing for at-risk patients ranged between 76 and 93 %, whilst risk assessment documentation and explanation to patients occurred in fewer than 50 and 66 % respectively. Prescribing and risk assessment improved in the first cycle (chi2 = 6.75, p = 0.009 and chi2 = 10.70, p = 0.001 respectively), a consequence of one specialty improving following additional feedback. Teaching was not associated with improvements. Overall compliance with NICE guidelines was achieved in no more than 25 % of admissions. CONCLUSIONS: Despite junior doctors generally prescribing VTE thromboprophylaxis appropriately, overall compliance with guidelines remained poor regardless of educational interventions. Verbal feedback was the only intervention associated with modest improvements. A pressurised work environment may limit the impact of educational interventions. Guidance simplification or devolving responsibility to other members of staff may improve compliance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1480-9) contains supplementary material, which is available to authorized users

Protest Medicine: How To Leverage Your Role As A Provider During Civil Unrest

Research presentation describing the following event: This was an interdisciplinary event educating and informing participants on how different health care providers can leverage their role to provide basic First Aid and Medical support to communities during civil unrest. The event was inspired by the protests following the death of George Floyd in Minneapolis and discusses the role of a Street Medic. The event was led by a team of University of New England (UNE) students hailing from: the College of Osteopathic Medicine, the Doctor of Physical Therapy program, the Masters of Occupational Therapy program, the Accelerated Bachelors of Science in Nursing program, and the Westbrook College of Health Professionals.https://dune.une.edu/cecespring2021/1004/thumbnail.jp

Spectrally distinct ejecta in Syrtis Major, Mars: Evidence for environmental change at the Hesperian-Amazonian boundary

Analysis of visible and near-infrared (VNIR) imaging spectrometer data of the Syrtis Major volcanic complex on Mars shows spectrally distinct ejecta (SDE) around a subset of the region's impact craters. We explore the nature of this spectral difference with the intention of constraining the physical cause of the distinction and the significance of their near random spatial distribution. Crater counting performed by Baratoux et al. (2007) indicated that the craters with SDE are systematically younger than craters without SDE. Extensive crater counts of the craters with SDE show that they fit a consistent Hartmann (2005) isochron indicting that they represent temporally continuous population. This population was dated near 2 Ga, consistent with the counts of Baratoux et al. (2007). This modeled age corresponds to just after the Hesperian-Amazonian boundary, indicating that it may be related to a global event. We explore possible explanations for the lack of SDE around older craters, including atmospheric changes, significant but brief regional emplacement of materials, and volcanic activity. We conclude that the preferred explanation is that the SDE represent the true composition of the Syrtis Major volcanics and that surfaces older than 2 Ga were altered by interactions with water vapor or volcanic gases under different Hesperian climatic and atmospheric conditions leading to all craters formed after this alteration event to display SDE

Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey

Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. Objective: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. Methods: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. Results: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than –2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. Conclusions: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations.Open Access Fundin

Advancing the Scientific Frontier with Increasingly Autonomous Systems

A close partnership between people and partially autonomous machines has enabled decades of space exploration. But to further expand our horizons, our systems must become more capable. Increasing the nature and degree of autonomy - allowing our systems to make and act on their own decisions as directed by mission teams - enables new science capabilities and enhances science return. The 2011 Planetary Science Decadal Survey (PSDS) and on-going pre-Decadal mission studies have identified increased autonomy as a core technology required for future missions. However, even as scientific discovery has necessitated the development of autonomous systems and past flight demonstrations have been successful, institutional barriers have limited its maturation and infusion on existing planetary missions. Consequently, the authors and endorsers of this paper recommend that new programmatic pathways be developed to infuse autonomy, infrastructure for support autonomous systems be invested in, new practices be adopted, and the cost-saving value of autonomy for operations be studied.Comment: 10 pages (compared to 8 submitted to PSADS), 2 figures, submitted to National Academy of Sciences Planetary Science and Astrobiology Decadal Survey 2023-203

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570