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  • Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): Protocol for a pilot cluster randomised trial

    Sampson, E.L.; Feast, A.; Blighe, Alan J.; Froggatt, K.; Hunter, R.; Marston, L.; McCormack, B.; Nurock, S.; Panca, M.; Powell, Catherine; et al. (2019-05)
    Introduction: Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care. Methods and analysis: Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates).
  • The public health end-of-life care movement: History, principles, and styles of practice

    Karapliagou, Aliki; Kellehear, Allan; Wegleitner, K. (Oxford University Press, 2018)
  • Video rasterstereography of the spine and pelvis in eight erect positions: A reliability study

    Alzyoud, K.; Hogg, P.; Snaith, Beverly; Preece, S.; England, A. (2019)
    Introduction: To investigate the reliability and variability of Video Rasterstereography (VR) measurements of the spine and pelvis, for eight proposed standing postures, in order to help define an optimal standing position for erect pelvis radiography. Methods: Surface topography data were collected using the formetic 4D dynamic modelling (Diers) system. 61 healthy participants were recruited; each participant performed eight different standing positions. Four positions were performed with the feet shoulder width apart and parallel, and four positions were performed with the feet shoulder width apart and internally rotated. For the upper extremity, each of the (two sets of) four positions were performed with different arm positions (arms by the sides, arms crossed over the chest, arms 30° flexed and touching the medial end of the clavicle, arms 30° flexed with the hands holding a support). Three sets of surface topography were collected in the eight positions (n = 24). The variability was assessed by calculating standard error of the measurement (SEm) and the coefficient of variation (CV). Reliability was assessed using intra-class correlation coefficients (ICC ± 95% CI). Results: No significant differences in the SEm were found between the three paired measurements for all standing positions (P > 0.05). ICC values demonstrated excellent reliability for all measurements across the eight standing positions (range 0.879–1.00 [95% CI 0.813–1.00]). Conclusion: Evaluating eight standing positions radiographically would be unethical as it would involve repeat radiation exposures. Using the formetic 4D dynamic modelling (Diers) system, provides an alternative and has shown that there was only a minimal, non-statistically significant, differences between the eight different standing positions.
  • Variation in pelvic radiography practice: Why can we not standardise image acquisition techniques?

    Snaith, Beverly; Field, L.; Lewis, E.F.; Flintham, K. (2019)
    Introduction: Pelvic radiographs remain an essential investigation in orthopaedic practice. Although it is recognised that acquisition techniques can affect image appearances and measurement accuracy, it remains unclear what variation in practice exists and what impact this could have on decision making. Method: This was a cross sectional survey of UK radiology departments utilising an electronic tool. An introductory letter and link was distributed. Responses were received from 69 unique hospital sites within the specified timeframe, a response rate of 37.9%. Results: There was no consistent technique for the positioning of patients for pelvic radiographs. The distance varied between 90 and 115 cm and 10 different centering points were described. In relation to leg position, the feet are usually internally rotated (65 of 69 [94.2%]). Only 1 teaching hospital (1 of 69 [1.4%]) uses a weight-bearing position as standard. Orthopaedic calibration devices were not in routine use, with only 21 using on pelvic x-rays (30.4%). Further, the type of device and application criteria were inconsistent. Conclusions: To our knowledge this is the first study to directly compare radiographic positioning across hospital sites. Our data demonstrated marked variation in technique for pelvis radiographs with associated implications for clinical decision making. Research is required to determine the standard technique and quality outcome measures to provide confidence in diagnostic interpretation particularly for serial radiographs.
  • Expanding training capacity for radiographer reporting using simulation: Evaluation of a pilot academy project

    Harcus, J.W.; Snaith, Beverly (2019)
    Introduction: Whilst there is increasing demand on radiology services in the UK, pressures are restricting the expansion of the multi-professional workforce. A pilot academy for radiography reporting was established to augment the traditional university and clinical education in a simulated environment using focussed teaching and real image worklists in a dedicated environment away from departments. Methods: Located at a facility to replicate the clinical reporting environment, the emphasis of the nine-month pilot was to provide extensive ‘hands-on’ training to eight trainees. Evaluation of the academy was undertaken through focus groups, telephone interviews, and online surveys to consider the experiences of the trainees and their managers and mentors. Results: There was overwhelming support for the academy from trainees, mentors, and managers. Key benefits included relieving pressures on department and mentors; providing an intense, structured, and safe environment to learn; and, perhaps most importantly, an extensive and cohesive peer-support network. Issues identified included conflict within departments due to differences in reporting style and the need for greater collaboration between the university, academy, and departments. Conclusion: The use of simulation in education is widely researched, however, there are a number of key factors that need to be considered when implementing it into practise. Peer-support and reflection is seen as essential for its success. Extensive dedicated time to focus on reporting alongside peers can support the development of these skills away from the clinical environment and as such can reduce pressure on service delivery and positively influence learner outcomes.
  • Radiographer reporting: A literature review to support cancer workforce planning in England

    Culpan, Gary; Culpan, A.-M.; Docherty, P.; Denton, E. (2019)
    Objective: Clinical Imaging contributes to screening, diagnosis, planning and monitoring of treatment and surveillance in cancer care. This literature review summarises evidence about radiographer reporting to help imaging service providers respond to Health Education England's 2017 Cancer Workforce Plan project to expand radiographer reporting in clinical service provision. Key findings: Papers published between 1992 and 2018 were reviewed (n ¼ 148). Evidence related to dynamic examinations (fluoroscopy, ultrasound) and mammography was excluded. Content was analysed and summarised using the following headings: clinical scope of practice, responsibilities, training, assessment, impact in practice and barriers to expansion. Radiographer reporting is well established in the United Kingdom. Scope of practice varies individually and geographically. Deployment of appropriately trained reporting radiographers is helping the NHS maintain high quality clinical imaging service provision and deliver a cost-effective increase in diagnostic capacity. Conclusion: Working within multiprofessional clinical imaging teams, within a defined scope of practice and with access to medical input when required, reporting radiographers augment capacity in diagnostic pathways and release radiologist time for other complex clinical imaging responsibilities.
  • Letter re: Comparison of acetabular and femoral morphologies on hip, pelvic, and lumbar radiographs (Yun et al.)

    Snaith, Beverly; Flintham, K. (2018)
    We read with interest the recent article by Yun et al. [1] comparing acetabular and hip measurements across pelvis, hip and lumbar spine radiographs. The authors assert that lumbar radiographs can be utilised in place of routine pelvis radiographs for these measurements. The example lumbar spine radiograph (figure 2) appears to be an abdominal image, with a contrast urogram. Indeed, standard texts [2,3] confirm that the anteroposterior lumbar spine radiograph should not include any coverage of the hips as appropriate collimation should limit the anatomy to T12 superiorly, lower sacrum inferiorly and the sacroiliac joints laterally, which would exclude the hip joints. Thus assessing any hip measurements on an appropriately collimated lumbar spine radiograph should not be possible. This is further compounded by the description of the centring point within their study (iliac crest), which varies from the internationally recognised standard of lower costal margin/L3 [2,3].
  • The impact of relationship quality on life satisfaction and well-being in dementia caregiving dyads: findings from the IDEAL study

    Rippon, I.; Quinn, Catherine; Martyr, A.; Morris, R.; Nelis, S.M.; Jones, I.R.; Victor, C.R.; Clare, L. (2019)
    Objectives: The quality of the relationship between people with dementia and their informal caregiver maybe an important determinant of life satisfaction and well-being for both members of the dyad. Taking a dyadic perspective, the aim of this study was to examine whether self- and partner- rated relationship quality influences life satisfaction and well-being for both people with dementia and their caregivers. Design and methods: Using data from 1283 dyads in the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) cohort, we examined the impact of current relationship quality on life satisfaction and well-being in dementia caregiving dyads. Data were analysed using the Actor–Partner Interdependence Model (APIM) framework. Results: Self-rated relationship quality was associated with own life satisfaction and well-being for both people with dementia and caregivers. Partner-rated relationship quality did not influence own life satisfaction or well-being for either member of the dyad. Conclusion: This study is the first to use the APIM framework to explore the dyadic associations between relationship quality and life satisfaction and well-being in a large cohort of dementia caregiving dyads. The obtained findings suggest that the individual perception of the quality of the caregiving relationship held by each member of the caregiving dyad is an important factor for that member’s life satisfaction and well-being, while the partner’s perception of relationship quality is not. The findings highlight the importance of considering the individual perspective of both the person with dementia and the caregiver and enabling each to maintain positive perceptions of relationship quality.
  • Medication-related risk factors and its association with repeated hospital admissions in frail elderly: A case control study

    Cheong, V-Lin; Sowter, J.; Scally, Andy J.; Hamilton, N.; Ali, A.; Silcock, Jonathan (2019)
    Repeated hospital admissions are prevalent in older people. The role of medication in repeated hospital admissions has not been widely studied. The hypothesis that medication-related risk factors for initial hospital admissions were also associated with repeated hospital admissions was generated. To examine the association between medication-related risk factors and repeated hospital admissions in older people living with frailty. A retrospective case-control study was carried out with 200 patients aged ≥75 years with unplanned medical admissions into a large teaching hospital in England between January and December 2015. Demographic, clinical, and medication-related data were obtained from review of discharge summaries. Statistical comparisons were made between patients with 3 or more hospital admissions during the study period (cases) and those with 2 or fewer admissions (controls). Regressions were performed to establish independent predictors of repeated hospital admissions. Participants had a mean age of 83.8 years (SD 5.68) and 65.5% were female. There were 561 admission episodes across the sample, with the main reasons for admissions recorded as respiratory problems (25%) and falls (17%). Univariate logistic regression revealed five medication-related risks to be associated with repeated hospital admissions: Hyper-polypharmacy (defined as taking ≥10 medications) (OR 2.50, p < 0.005); prescription of potentially inappropriate medications (PIMs) (OR 1.89; p < 0.05); prescription of a diuretic (OR 1.87; p < 0.05); number of high risk medication (OR 1.29; p < 0.05) and the number of 'when required' medication (OR 1.20; p < 0.05). However, the effects of these risk factors became insignificant when comorbid disease was adjusted for in a multivariable model. Medication-related risk factors may play an important role in future repeated admission risk prediction models. The modifiable nature of medication-related risks factors highlights a real opportunity to improve health outcomes.
  • Caregiver influences on 'living well' for people with dementia: Findings from the IDEAL study.

    Quinn, Catherine; Nelis, S.M.; Martyr, A.; Morris, R.G.; Victor, C.; Clare, L. (2019-05)
    Objectives: The capability to ‘live well’ in people with dementia can be influenced by many factors, including those related to the experiences of their informal caregiver. How caregivers experience their own role can affect not only their well-being but also the way they provide care and hence the experience of the person with dementia. The aim of this study is to identify the potential impact of the caregiver’s perception of the caregiving experience on how people with mild to moderate dementia self-rate their QoL, well-being and satisfaction with life. Method: This study utilised time-point 1 data from 1283 informal caregiver and the 1283 people with dementia whom they provide care from the IDEAL cohort study. Multivariate modelling was used to investigate the associations between measures related to the caregiver’s perception of the caregiving experience (caregiving stress, perceived social restrictions, caregiving competence, positive aspects of caregiving, and coping) and the self-ratings of QoL, satisfaction with life, and well-being by the person with dementia. Results: Lower QoL ratings by the person with dementia were associated with high caregiver stress (−1.98; 95% CI: −2.89, −1.07), high perceived social restrictions (−2.04; 95% CI: −2.94, −1.14) and low caregiving competence (−2.01; 95% CI: −2.95, −1.06). Similar associations were found for satisfaction with life and wellbeing. Positive aspects of caregiving and coping were not associated with outcomes for the person with dementia. Conclusion: The findings indicate that how the caregiver experiences caregiving can affect the person with dementia. This finding reinforces the importance of providing support to caregivers.
  • The relationship between perceived functional difficulties and the ability to live well with mild-to-moderate dementia: Findings from the IDEAL programme.

    Martyr, A.; Nelis, S.M.; Quinn, Catherine; Rusted, J.M.; Morris, R.G.; Clare, L. (2019)
    Objectives: The objectives of the study are to investigate how different levels of functional ability relate to quality of life, well‐being, and satisfaction with life, conceptualised as reflecting capability to “live well” in people with dementia. Methods/design: Participants were 1496 people with mild‐to‐moderate dementia and 1188 informants who completed baseline assessments in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study. Total selfrated and informant‐rated scores on the Functional Activities Questionnaire were split into six ability levels to monitor how poorer functioning impacts the ability to live well. We also investigated the potential influence of sociodemographic and diagnostic variables, depression, cognition, and carer stress. Results: Multivariate multiple regression models found that people with dementia who had the greatest functional impairment according to self‐ratings and informant ratings had poorer living well scores than those with the least functional impairment. Sociodemographic and diagnostic factors and cognition had little impact on effect sizes. For self‐ratings, depression attenuated the relationship between functional ability and living well, whereas carer stress attenuated informant ratings. Conclusions: People with dementia with the least functional impairments had greater capability to live well than those with the most functional impairment. Even subtle perceived difficulties in functional ability had a detrimental effect on the ability of people with dementia to live well. Depression in people with dementia and carer stress in informants influenced these associations, and therefore, these factors should be routinely included in future research studies and clinical assessments.
  • Compassionate communities: design and preliminary results of the experience of Vic (Barcelona, Spain) caring city

    Gómez-Batiste, X.; Mateu, S.; Serra-Jofre, S.; Molas, M.; Mir-Roca, S.; Amblàs, J.; Costa, X.; Lasmarías, C.; Serrarols, M.; Solà-Serrabou, A.; et al. (2018)
    Background: A program of Compassionate City or Community (CC) has been designed and developed in the City of Vic (43,964 habitants, Barcelona, Spain), based on The Compassionate City Charter and other public health literature and experiments, with the joint leadership of the City Council and the Chair of Palliative Care at the University of Vic, and as an expansion of a comprehensive and integrated system of palliative care. Methods: The program started with an assessment of needs of the city as identified by 48 social organizations with a foundational workshop and a semi-structured survey. After this assessment, the mission, vision, values and aims were agreed. The main aims consisted in promoting changes in social and cultural attitudes toward the end of life (EoL) and providing integrated care for people with advanced chronic conditions and social needs such as loneliness, poverty, low access to services at home, or conflict. The selected slogan was “Living with meaning, dignity, and support the end of life”. Results: The program for the first year has included 19 activities (cultural, training, informative, and mixed) and followed by 1,260 attendants, and the training activities were followed by 147 people. Local and regional sponsors are funding the initiative. After a year, a quantitative and qualitative evaluation was performed, showing high participation and satisfaction of the attendants and organizations. In the second year, the care for particular vulnerable people defined as targets (EoL and social factors described before) will start with volunteers with more organizations to join the project. Conclusions: The key identified factors for the initial success are: the strong joint leadership between social department of the Council and the University; clear aims and targets; high participation rates; the limited size of the geographical context; which allowed high participation and recognition; and the commitment to evaluate results.
  • Assessing community readiness for early intervention programmes to promote social and emotional health in children

    Islam, Shahid; Small, Neil A.; Bryant, M.; Bridges, S.; Hancock, N.; Dickerson, J. (2019-06)
    Evidence for early intervention and prevention-based approaches for im-proving social and emotional health in young children is robust. However, rates of participation in programmes are low. We explored the dynamics which affect levels of community readiness to address the issues of social and emotional health for preg-nant women, young children (0-4 years) and their mothers.Setting:A deprived inner‐city housing estate in the north of England. The estate falls within the catchment area of a project that has been awarded long-term funding to address social and emotional health during pregnancy and early childhood.Methods:We interviewed key respondents using the Community Readiness Model. This approach applies a mixed methodology, incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling the placement of the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework approach to generate con-textual information to augment the numerical scores.Results:An overall score consistent with vague awareness was achieved, indicating a low level of community readiness for social and emotional health interventions. This score suggests that there will be a low likelihood of participation in programmes that address these issues.Conclusion:Gauging community readiness offers a way of predicting how willing and prepared a community is to address an issue. Modifying implementation plans so that they first address community readiness may improve participation rates.
  • Diet and physical activity in pregnancy: a study exploring women's beliefs and behaviours

    Chana, R.; Haith-Cooper, Melanie (2019-05-02)
    Being obese or gaining excessive weight during pregnancy can increase health risks for mother and baby. Adopting a healthy diet and increasing physical activity reduces these risks and has long-term health benefits for women. Despite this, women do not always maintain a healthy lifestyle during pregnancy. Aim To explore the factors that encouraged and prevented a diverse group of women to maintain a healthy lifestyle during pregnancy. Methods A total of 12 women participated in semi-structured qualitative interviews, underpinned by the theory of planned behaviour. Interviews were audio recorded, transcribed verbatim then subject to deductive thematic analysis. Findings Four themes emerged: women's knowledge of a healthy lifestyle, sociocultural influences, physical health and health professional support. These influenced women's intentions and actual behaviours during pregnancy. Conclusions Enhanced health professional advice may motivate women to adopt a healthy lifestyle during pregnancy. This could be through new means such as health technology.
  • Caregivers' beliefs about dementia: findings from the IDEAL study

    Quinn, Catherine; Jones, I.R.; Martyr, A.; Nelis, S.M.; Morris, R.G.; Clare, L.; IDEAL Study Team (2019)
    Objective: Informal caregivers of people with dementia develop their own beliefs about the condition, referred to as Dementia Representations (DRs), as they try to make sense of the changes they are observing. The first aim of this study was to provide a profile of the types of DRs held by caregivers. The second aim was to examine the impact of caregivers’ DRs on their well-being, satisfaction with life (SwL) and caregiving stress. Methods: Participants were 1264 informal caregivers of people in the mild-to-moderate stages of dementia from time-point 1 of the IDEAL cohort study. Measures: DRs were measured using questionnaire items covering: Identity, Cause, Control, and Timeline. Results: Almost half (49.2%) of caregivers used a diagnostic term to describe the person’s condition, although 93.4% of caregivers stated they were aware of the diagnosis. Higher well-being, SwL, and lower caregiving stress were associated with the use of an identity term relating to specific symptoms of dementia, attributing the cause to ageing or not knowing the cause, and believing the condition would stay the same. Lower well-being, SwL, and higher caregiving stress were associated with believing there was little that could be done to control the effects of the condition. Conclusion: Healthcare professionals should assess and gain an understanding of caregivers’ DRs in order to provide more tailored information and support.
  • The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals

    Mohammad, Mohammad A.; Faisal, Muhammad; Richardson, D.; Scally, Andy J.; Howes, R.; Beatson, K.; Irwin, S.; Speed, K. (2019-03-01)
    Background The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.
  • Development and validation of a novel computer-aided score to predict the risk of in-hospital mortality for acutely ill medical admissions in two acute hospitals using their first electronically recorded blood test results and vital signs: a cross-sectional study

    Faisal, Muhammad; Scally, Andy J.; Jackson, N.; Richardson, D.; Beatson, K.; Howes, R.; Speed, K.; Menon, M.; Daws, J.; Dyson, J.; et al. (2018-12)
    Objectives There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. Design Logistic regression model development and external validation study. Setting Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)—model development data; York Hospital (YH)—external validation data). Participants Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission. Results The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00). Conclusions We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
  • Understanding and applying practitioner and patient views on the implementation of a novel automated Computer-Aided Risk Score (CARS) predicting the risk of death following emergency medical admission to hospital: qualitative study

    Dyson, J.; Marsh, C.; Jackson, N.; Richardson, D.; Faisal, Muhammad; Scally, Andy J.; Mohammad, Mohammad A. (2019-04)
    Objectives The Computer-Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of healthcare practitioners (staff) and service users and carers (SU/C) on (1) the potential value, unintended consequences and concerns associated with CARS and practitioner views on (2) the issues to consider before embedding CARS into routine practice. Setting This study was conducted in two National Health Service (NHS) hospital trusts in the North of England. Both had in-house information technology (IT) development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital trusts. Participants We conducted eight focus groups with 45 healthcare practitioners and two with 11 SU/Cs in two NHS acute hospitals. Results Staff and SU/Cs recognised the potential of CARS but were clear that the score should not replace or undermine clinical judgments. Staff recognised that CARS could enhance clinical decision-making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests. Conclusion Risk scores are widely used in healthcare, but their development and implementation do not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice.
  • Computer-aided National Early Warning Score to predict the risk of sepsis following emergency medical admission to hospital: a model development and external validation study

    Faisal, Muhammad; Richardson, D.; Scally, Andy J.; Howes, R.; Beatson, K.; Speed, K.; Mohammad, Mohammad A. (2019-04-08)
    Background: In English hospitals, the patient’s vital signs are monitored and summarised into a National Early Warning Score (NEWS). NEWS is more accurate than the quick sepsis related organ failure assessment (qSOFA) score at identifying patients with sepsis. We investigate the extent to which the accuracy of the NEWS is enhanced by developing computer-aided NEWS (cNEWS) models. We compared three cNEWS models (M0=NEWS alone; M1=M0 + age + sex; M2=M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis. Methods: All adult emergency medical admissions discharged over 24-months from two acute hospitals (YH–York Hospital for model development; NH–Northern Lincolnshire and Goole Hospital for external model validation). We used a validated Canadian method for defining sepsis from administrative hospital data. Findings: The prevalence of sepsis was lower in YH (4.5%=1596/35807) than NH (8.5%=2983/35161). The c-statistic increased across models (YH: M0: 0.705, M1:0.763, M2:0.777; NH:M0: 0.708, M1:0.777, M2:0.791). At NEWS 5+, sensitivity increased (YH: 47.24% vs 50.56% vs 52.69%; NH: 37.91% vs 43.35% vs 48.07%)., the positive likelihood ratio increased (YH: 2.77 vs 2.99 vs 3.06; NH: 3.18 vs 3.32 vs 3.45) and the positive predictive value increased (YH: 11.44% vs 12.24% vs 12.49%; NH: 22.75% vs 23.55% vs 24.21%). Interpretation: From the three cNEWS models, Model M2 is the most accurate. Since it places no additional data collection burden on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
  • How much image noise can be added in cardiac x-ray imaging without loss in perceived image quality?

    Gislason-Lee, Amber J.; Kumcu, A.; Kengyelics, S.M.; Brettle, D.S.; Treadgold, L.A.; Sivananthan, M.; Davies, A.G. (2015-10)
    Cardiologists use x-ray image sequences of the moving heart acquired in real-time to diagnose and treat cardiac patients. The amount of radiation used is proportional to image quality; however, exposure to radiation is damaging to patients and personnel. The amount by which radiation dose can be reduced without compromising patient care was determined. For five patient image sequences, increments of computer-generated quantum noise (white + colored) were added to the images, frame by frame using pixel-to-pixel addition, to simulate corresponding increments of dose reduction. The noise adding software was calibrated for settings used in cardiac procedures, and validated using standard objective and subjective image quality measurements. The degraded images were viewed next to corresponding original (not degraded) images in a two-alternativeforced- choice staircase psychophysics experiment. Seven cardiologists and five radiographers selected their preferred image based on visualization of the coronary arteries. The point of subjective equality, i.e., level of degradation where the observer could not perceive a difference between the original and degraded images, was calculated; for all patients the median was 33% 15% dose reduction. This demonstrates that a 33% 15% increase in image noise is feasible without being perceived, indicating potential for 33% 15% dose reduction without compromising patient care.

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