Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing (Br J Surg 2007; 94: 966-969)

No abstract available

Guidelines in the era of realistic medicine

No abstract available

Evaluation of the HSCVF Bursary Scheme

The ‘Building Sustainability: Extended Support Package’ aimed to increase the capacity and sustainability of 94 local projects - all were Voluntary, Community and Social Enterprise (VCSE) organisations funded by the Health and Social Care Volunteering Fund (HSCVF). The bursary scheme, as it became known, was managed by Ecorys as the lead partner alongside Eastside Primetimers, CSV and Attend as the three delivery partners. Projects chose from a menu of over 50 offers including mentoring, coaching, on-site support, training and ‘other’. A Support Consultant, allocated to each project, helped them assess their needs, choose the most appropriate offers and submit the application. The scheme was introduced in 2012 with all offers utilised by May 2013. It was funded by the Department of Health. This report presents the findings from an evaluation undertaken by the Institute for Health & Wellbeing at Leeds Metropolitan University

Evaluation of the Altogether Better Asset Mapping in Sharrow and Firth Park, Sheffield

‘I am My Community’ is an asset mapping exercise led by Altogether Better that has explored a model by which trained Community Health Champions (CHCs) are used to undertake an inventory of the physical and social assets linked to the health and well-being of their communities and neighbourhoods. The project, which started in 2011 and was completed in April 2012, was undertaken in two communities in Sheffield, Sharrow and Firth Park, by two delivery organisations, ShipShape and SOAR. A steering group including Altogether Better, the Department of Health, Sheffield Well-Being Consortium, Sheffield City Council, ShipShape staff and CHCs, SOAR staff and CHCs, and South Yorkshire Police has overseen the delivery and development of the project and work. This report presents findings from an evaluation of the ‘I am My Community’ asset mapping, conducted by the Centre for Health Promotion Research, Institute for Health and Wellbeing at Leeds Metropolitan University. It presents evidence about the engagement of CHCs in asset mapping and offers recommendations regarding their involvement in future projects

Labour pain: the hidden influences of anxiety and social deprivation

No abstract available

Uplift Quadratic Program in Irish Electricity Price Setting

Bord Gis required a deeper insight into the dynamics of Uplift prices. The aim of the group was to apply a variety of analytical tools to the problem in order to satisfy Bord Gis requirements. The group conducted a KKT Optimality Analysis of the quadratic program used to determine the Uplift prices, performed statistical analysis to identify the binding constraints and their sensitives to the Uplift prices, simulated a synthetic stochastic process that is consistent with the Uplift pricing series and investigated alternative objective functions for the quadratic program

The Leeds Winter Warmth Campaign: Stakeholder Evaluation

The winter of 2012/13 was longer and colder than usual; whilst temperatures were average in December, it was colder than usual from January through to May. March was the coldest it has been for 50 years (Met Office, 2013). This evaluation focuses on the organisations funded by the Winter Warmth campaign to deliver services to Leeds residents. The overriding aim of the evaluation was to inform the operation of possible future schemes, with good practices and any issues identified. The views of organisations on the need for the funds and how the campaign was organised were ascertained. How they delivered the services, reached clients and worked with other stakeholders is explored and their suggestions for improvements described. This report should be read alongside the overall campaign report, by Leeds City Council, and the beneficiary report

Physical outcome measure for critical care patients following intensive care discharge

Introduction: The aim of this study was to evaluate the most suitable physical outcome measures to be used with critical care patients following discharge. ICU survivors experience physical problems such as reduced exercise capacity and intensive care acquired weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends the use of outcome measures however does not provide any specific guidance. A recent Cochrane review noted wide variability in measures used following ICU discharge (2). Methods: Discharged ICU patients attended a five week multidisciplinary programme. Patients’ physical function was assessed during the programme, at 6 months and 12 months post discharge. Three outcome measures were included in the initial two cohorts. The Six Minute Walk Test (6MWT) and the Incremental Shuttle Walk test (ISWT) were chosen as they have been used within the critical care follow up setting (2). The Chester Step Test (CST) is widely thought to be a good indicator of ability to return to work (one of the programmes primary aims). Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected for the initial patients attending the programme (n = 13), median age was 52 (IQR = 38-72), median ICU LOS was 19 days (IQR = 4-91), median APACHE II was 23 (IQR = 19-41) and 11 were men. One patient was so physically debilitated that the CST or ISWT could not be completed however a score was achieved using the 6MWT. Another patient almost failed to achieve level 1 of the ISWT. Subsequent patients for this project (total n = 47) have all therefore been tested using the 6MWT. Good inter-rater and intrarater reliability and validity have been reported for the 6MWT (3). Conclusions: Exercise capacity measurement is not achievable for some patients with either the ISWT or the CST due to the severity of their physical debilitation. Anxiety, post-traumatic stress disorder and depression are common psychological problems post discharge (4), therefore using a test with a bleep is not appropriate. Therefore, the 6MWT is the most appropriate physical outcome measure to be used with critical care patients post discharge

Classification of pain and its treatment at an intensive care rehabilitation clinic

Introduction Treatment in an Intensive Care Unit (ICU) often necessitates uncomfortable and painful procedures for patients throughout their admission. There is growing evidence to suggest that chronic pain is becoming increasingly recognised as a long term problem for patients following an ICU admission [1]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU discharge at Glasgow Royal Infirmary. This study investigated the incidence and location of chronic pain in patients discharged from ICU and classified the analgesics prescribed according to the World Health Organization analgesic Methods The InS:PIRE programme involved individual sessions for patients and their caregivers with a physiotherapist and a pharmacist along with interventions from medical, nursing, psychology and community services. The physiotherapist documented the incidence and pain location during the assessment. The pharmacist recorded all analgesic medications prescribed prior to admission and at their clinic visit. The patient’s analgesic medication was classified according to the WHO pain ladder from zero to three, zero being no pain medication and three being treatment with a strong opioid. Data collected was part of an evaluation of a quality improvement initiative, therefore ethics approval was waived. Results Data was collected from 47 of the 48 patients who attended the rehabilitation clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67 %)). Prior to admission to ICU 43 % of patients were taking analgesics and this increased to 81 % at the time of their clinic visit. The number of patients at step two and above on the WHO pain ladder also increased from 34 % to 56 %. Conclusions Of the patients seen at the InS:PIRE clinic two-thirds stated that they had new pain since their ICU admission. Despite the increase in the number and strength of analgesics prescribed, almost a quarter of patients still complained of pain at their clinic visit. These results confirm that pain continues to be a significant problem in this patient group. Raising awareness in primary care of the incidence of chronic pain and improving its management is essential to the recovery process following an ICU admission

A retrospective study on the effects of illness severity and atrial fibrillation on outcomes in the intensive care unit

Introduction: Atrial fibrillation (AF) is common in patients in the intensive care unit (ICU) and has been associated with worse outcomes. However, it is unclear whether AF itself adds to the risk of death or is merely a marker of illness severity. We aimed to record the incidence and outcomes of all patients with different categories of AF and determine whether AF was an independent predictor of death.<p></p> Methods: This retrospective cohort study was undertaken in the ICU of a tertiary-referral university hospital. Category of AF, sex, C-reactive protein (CRP) level, APACHE II score, predicted hospital mortality and survival outcomes were analysed from 1084 records. Percentages, medians and interquartile ranges were used to describe the sample. Chi-square test and the non-parametric Mann–Whitney U test were used, as appropriate, for statistical analysis. Logistic regression analyses were performed to evaluate the association of AF with death in the ICU adjusting for age, sex, CRP level and APACHE II score.<p></p> Results: Overall, 13.6% of patients developed new-onset AF during their critical illness, while 4.3% had a pre-existing history. The hospital mortality rate was higher in those with AF compared with those without (47.9% vs. 30.9%, p<0.001) and higher in those with newly diagnosed AF compared with those with a prior history (53.1% vs. 31.9%, p=0.012). CRP levels were higher in those with AF (p<0.001) compared with those without and higher in those with newly diagnosed AF compared with those with a prior history (p=0.012). On multivariate logistic regression analysis, only the APACHE II score was found to be an independent predictor of death.<p></p> Conclusion: Despite the higher mortality rate in patients with AF, the APACHE II score was the only independent predictor of death within the ICU. Prospective studies are required to explore the apparently reduced risk of dying among those with a prior history of AF.<p></p&gt