The development of a half-day workshop to assist novice nurses in the identification and management of clinical deterioration

Background: Patient safety is an essential part of quality nursing care. Promoting a culture of patient safety has been shown to improve patient outcomes. To provide quality patient care, it is important for registered nurses to have the assessment skills to detect when a patient’s condition is deteriorating. The surgical inpatient unit at Carbonear General Hospital (CGH) has seen a high turnover of staff in recent years. An increased number of novice nurses employed on the unit has contributed to patient safety issues. An educational workshop, provided as part of the orientation program, would benefit novice nurses working on this unit as a strategy to promote patient safety by increasing their knowledge and expertise in the early identification and management of the deteriorating patient. Purpose: The purpose of this practicum project was to develop an educational workshop to help novice nurses identify and manage the deteriorating patient. Methods: Three methods were used in the development of this workshop. A literature review and consultations with key stakeholders (e.g., nurses, nurse educators, and nurse managers) was conducted to determine the factors influencing novice nurses’ ability to identify and manage the deteriorating patient. Stakeholders were also asked to provide feedback on the content and delivery of the workshop. An environmental scan was completed with clinical educators within Eastern Health to determine what resources are available to assist novice nurses in the identification and management of clinical deterioration. Results: Key findings were assimilated to guide the development of the one-day workshop. The lack of knowledge, experience, and confidence of novice nurses combined with organizational problems such as unit practices, communication issues, poor staffing levels, and inconsistent patient assignments contribute to their inability to determine a change in patient status. Within Eastern Health, there are limited resources available related to the identification and management of clinical deterioration. Conclusion: Using Morrison, Ross, Kalman and Kemp’s (2013) instructional design model, Knowles’ Principles of Adult Learning (1984) and Benner’s Novice to Expert Theory (1982), an interactive, half-day educational workshop was developed to assist novice nurses in the early identification and management of clinical deterioration

Optimizing Radiant Systems for Energy Efficiency and Comfort

Radiant cooling and heating systems provide an opportunity to achieve significant energy savings, peak demand reduction, load shifting, and thermal comfort improvements compared to conventional all-air systems. As a result, application of these systems has increased in recent years, particularly in zero-net-energy (ZNE) and other advanced low-energy buildings. Despite this growth, completed installations to date have demonstrated that controls and operation of radiant systems can be challenging due to a lack of familiarity within the heating, ventilation, and air-conditioning (HVAC) design and operations professions, often involving new concepts (particularly related to the slow response in high thermal mass radiant systems). To achieve the significant reductions in building energy use proposed by California Public Utilities Commission’s (CPUC’s) Energy Efficiency Strategic Plan that all new non-residential buildings be ZNE by 2030, it is critical that new technologies that will play a major role in reaching this goal be applied in an effective manner. This final report describes the results of a comprehensive multi-faceted research project that was undertaken to address these needed enhancements to radiant technology by developing the following: (1) sizing and operation tools (currently unavailable on the market) to provide reliable methods to take full advantage of the radiant systems to provide improved energy performance while maintaining comfortable conditions, (2) energy, cost, and occupant comfort data to provide real world examples of energy efficient, affordable, and comfortable buildings using radiant systems, and (3) Title-24 and ASHRAE Standards advancements to enhance the building industry’s ability to achieve significant energy efficiency goals in California with radiant systems. The research team used a combination of full-scale fundamental laboratory experiments, whole-building energy simulations and simplified tool development, and detailed field studies and control demonstrations to assemble the new information, guidance and tools necessary to help the building industry achieve significant energy efficiency goals for radiant systems in California

Investigating Embryonic Expression Patterns and Evolution of AHI1 and CEP290 Genes, Implicated in Joubert Syndrome

Joubert syndrome and related diseases (JSRD) are developmental cerebello-oculo-renal syndromes with phenotypes including cerebellar hypoplasia, retinal dystrophy and nephronophthisis (a cystic kidney disease). We have utilised the MRCWellcome Trust Human Developmental Biology Resource (HDBR), to perform in-situ hybridisation studies on embryonic tissues, revealing an early onset neuronal, retinal and renal expression pattern for AHI1. An almost identical pattern of expression is seen with CEP290 in human embryonic and fetal tissue. A novel finding is that both AHI1 and CEP290 demonstrate strong expression within the developing choroid plexus, a ciliated structure important for central nervous system development. To test if AHI1 and CEP290 may have co-evolved, we carried out a genomic survey of a large group of organisms across eukaryotic evolution. We found that, in animals, ahi1 and cep290 are almost always found together; however in other organisms either one may be found independent of the other. Finally, we tested in murine epithelial cells if Ahi1 was required for recruitment of Cep290 to the centrosome. We found no obvious differences in Cep290 localisation in the presence or absence of Ahi1, suggesting that, while Ahi1 and Cep290 may function together in the whole organism, they are not interdependent for localisation within a single cell. Taken together these data support a role for AHI1 and CEP290 in multiple organs throughout development and we suggest that this accounts for the wide phenotypic spectrum of AHI1 and CEP290 mutations in man

Lessons from Expert Focus Groups on how to Better Support Adults with Mild Intellectual Disabilities to Engage in Co-Design

Co-design techniques generally rely upon higher-order cognitive skills, such as abstraction and creativity, meaning they may be inaccessible to people with intellectual disabilities (ID). Consequently, investigators must adjust the methods employed throughout their studies to ensure the complex needs of people with ID are appropriately catered to. Yet, there are a lack of guidelines to support researchers in this process, with previous literature often neglecting to discuss the decisions made during the development of their study protocols. We propose a new procedure to overcome this lack of support, by utilizing the knowledge of “experts” in ID to design a more accessible workshop for the target population. 12 experts across two focus groups were successful in identifying accessibility barriers throughout a set of typical early co-design activities. Recommendations to overcome these barriers are discussed along with lessons on how to better support people with ID to engage in co-design

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Optimizing Radiant Systems for Energy Efficiency and Comfort

Radiant cooling and heating systems provide an opportunity to achieve significant energy savings, peak demand reduction, load shifting, and thermal comfort improvements compared to conventional all-air systems. As a result, application of these systems has increased in recent years, particularly in zero-net-energy (ZNE) and other advanced low-energy buildings. Despite this growth, completed installations to date have demonstrated that controls and operation of radiant systems can be challenging due to a lack of familiarity within the heating, ventilation, and air-conditioning (HVAC) design and operations professions, often involving new concepts (particularly related to the slow response in high thermal mass radiant systems). To achieve the significant reductions in building energy use proposed by California Public Utilities Commission’s (CPUC’s) Energy Efficiency Strategic Plan that all new non-residential buildings be ZNE by 2030, it is critical that new technologies that will play a major role in reaching this goal be applied in an effective manner. This final report describes the results of a comprehensive multi-faceted research project that was undertaken to address these needed enhancements to radiant technology by developing the following: (1) sizing and operation tools (currently unavailable on the market) to provide reliable methods to take full advantage of the radiant systems to provide improved energy performance while maintaining comfortable conditions, (2) energy, cost, and occupant comfort data to provide real world examples of energy efficient, affordable, and comfortable buildings using radiant systems, and (3) Title-24 and ASHRAE Standards advancements to enhance the building industry’s ability to achieve significant energy efficiency goals in California with radiant systems. The research team used a combination of full-scale fundamental laboratory experiments, whole-building energy simulations and simplified tool development, and detailed field studies and control demonstrations to assemble the new information, guidance and tools necessary to help the building industry achieve significant energy efficiency goals for radiant systems in California