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Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation
No full textNoFalls are the most common safety incident reported by acute hospitals. NICE recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable.
Determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute NHS hospitals in England.
Design: Realist review and multi-site case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (N=50), patient and carer interviews (N=31), and record review (N=60).
Setting: Three Trusts, one orthopaedic and one older person ward in each.
Results: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored: (1) Leadership: Wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared Responsibility: A key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: Assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient Participation: Nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling.
Limitations: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted.
Conclusions: (1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) Shared Responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) Facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) Patient Participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling.
Future work: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) Mixed method and economic evaluations of patient supervision; (3) Evaluation of engagement support workers, volunteers, and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English.This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in the Health and Social Care Delivery Research Journal
Venous blood point-of-care testing (POCT) for paramedics in urgent and emergency care: protocol for a single-site feasibility study (POCTPara)
Get PDFYesThe COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase ‘see and treat’ opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making. In terms of POCT of blood samples obtained from patients in the pre-hospital setting, there is a paucity of evidence beyond its utility for measuring lactate and troponin in acute presentations such as sepsis, trauma and myocardial infarction, although potential exists for the analysis of a much wider panel of analytes beyond these isolated biomarkers. In addition, there is a relative dearth of evidence in respect of the practicalities of using POCT analysers in the pre-hospital setting.
This single-site feasibility study aims to understand whether it is practical to use POCT for the analysis of patients’ blood samples in the urgent and emergency care pre-hospital setting, through descriptive data of POCT application and through qualitative focus group interviews of advanced practitioners (specialist paramedics) to inform the feasibility and design of a larger study.
The primary outcome measure is focus group data measuring the experiences and perceived self-reported impact by specialist paramedics. Secondary outcome measures are number and type of cartridges used, number of successful and unsuccessful attempts in using the POCT analyser, length of time on scene, specialist paramedic recruitment and retention, number of patients who receive POCT, descriptive data of safe conveyance, patient demographics and presentations where POCT is applied and data quality.
The study results will inform the design of a main trial if indicated.The full-text of this article will be released for public view at the end of the publisher embargo on 1 Jun 2024
Review of substitutive assistive tools and technologies for people with visual impairments: recent advancements and prospects
Get PDFYesThe development of many tools and technologies for people with visual impairment has become a major priority in the
field of assistive technology research. However, many of these technology advancements have limitations in terms of the
human aspects of the user experience (e.g., usability, learnability, and time to user adaptation) as well as difficulties in
translating research prototypes into production. Also, there was no clear distinction between the assistive aids of adults
and children, as well as between “partial impairment” and “total blindness”. As a result of these limitations, the produced
aids have not gained much popularity and the intended users are still hesitant to utilise them. This paper presents a comprehensive review of substitutive interventions that aid in adapting to vision loss, centred on laboratory research studies
to assess user-system interaction and system validation. Depending on the primary cueing feedback signal offered to the
user, these technology aids are categorized as visual, haptics, or auditory-based aids. The context of use, cueing feedback
signals, and participation of visually impaired people in the evaluation are all considered while discussing these aids.
Based on the findings, a set of recommendations is suggested to assist the scientific community in addressing persisting
challenges and restrictions faced by both the totally blind and partially sighted people
Randomised, placebo-controlled, phase 3 trial of the effect of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on colorectal cancer recurrence and survival after surgery for resectable liver metastases: EPA for Metastasis Trial 2 (EMT2) study protocol
Get PDFYesThere remains an unmet need for safe and cost-effective adjunctive treatment of advanced colorectal
cancer (CRC). The omega-3 polyunsaturated fatty acid
eicosapentaenoic acid (EPA) is safe, well-tolerated and
has anti-inflammatory as well as antineoplastic properties.
A phase 2 randomised trial of preoperative EPA free fatty
acid 2 g daily in patients undergoing surgery for CRC liver
metastasis showed no difference in the primary endpoint
(histological tumour proliferation index) compared with
placebo. However, the trial demonstrated possible benefit
for the prespecified exploratory endpoint of postoperative
disease-free survival. Therefore, we tested the hypothesis
that EPA treatment, started before liver resection surgery
(and continued postoperatively), improves CRC outcomes
in patients with CRC liver metastasis.
Methods and analysis: The EPA for Metastasis Trial 2 trial
is a randomised, double-blind, placebo-controlled, phase 3
trial of 4 g EPA ethyl ester (icosapent ethyl (IPE; Vascepa))
daily in patients undergoing liver resection surgery for
CRC liver metastasis with curative intent. Trial treatment
continues for a minimum of 2 years and maximum of
4 years, with 6monthly assessments, including quality
of life outcomes, as well as annual clinical record review
after the trial intervention. The primary endpoint is CRC
progression-free survival. Key secondary endpoints are
overall survival, as well as the safety and tolerability of IPE.
A minimum 388 participants are estimated to provide 247
CRC progression events during minimum 2-year follow-up,
allowing detection of an HR of 0.7 in favour of IPE, with a
power of 80% at the 5% (two sided) level of significance,
assuming drop-out of 15%.
Ethics and dissemination: Ethical and health research
authority approval was obtained in January 2018. All data
will be collected by 2025. Full trial results will be published
in 2026. Secondary analyses of health economic data,
biomarker studies and other translational work will be
published subsequently.
Trial registration number NCT03428477.The EMT2 trial is funded by Yorkshire Cancer Research (L387) and is sponsored by the University of Leeds. The EMT2 biospecimen collection is funded by the National Institutes of Health (1R01CA243454-01A1) and is sponsored by the University of Leeds ( governance-ethics@ leeds. ac. uk). Both studies have been adopted to the NIHR Clinical Research Network (CRN) Portfolio (CPMS ID 34700 and 47372, respectively) and have benefited from CRN research staff support
Qualitative Failure Analysis of IoT-enabled Industrial Fire Detection and Prevention System
No full textYesThe Internet of Things (IoT) has improved our lives through various applications such as home automation, smart city monitoring, environmental monitoring, intelligent farming, and a host of others. IoT is increasingly being used for environmental monitoring to prevent fire incidents and other environmental hazards. However, for IoT systems to function effectively in preventing fire incidents, they must operate in a safe, reliable, and dependable manner. The intelligent sensors and devices that constitute the system are prone to different types of failures, which can lead to unsafe or dangerous conditions. Failure of a fire prevention system can pose significant risks to Health, Safety, and the Environment (HSE). To address these concerns, it is essential to understand how component failures can contribute to the overall system failure. This paper adopts Fault Tree Analysis, a widely used framework for failure behaviour analysis in other safety-critical domains, to qualitatively analyse an intelligent fire detection system in an industrial setting. The analysis outlines the ways in which the system can fail and the necessary prevention mechanism to guard against undesired system failure
Synthesis and biological evaluation of cyclobutane-based β3 integrin antagonists: A novel approach to targeting integrins for cancer therapy
Get PDFYesThe Arg-Gly-Asp (RGD)-binding family of integrin receptors, and notably the β3 subfamily, are key to multiple physiological processes involved in tissue development, cancer proliferation, and metastatic dissemination. While there is compelling preclinical evidence that both αvβ3 and αIIbβ3 are important anticancer targets, most integrin antagonists developed to target the β3 integrins are highly selective for αvβ3 or αIIbβ3. We report the design, synthesis, and biological evaluation of a new structural class of ligand-mimetic β3 integrin antagonist. These new antagonists combine a high activity against αvβ3 with a moderate affinity for αIIbβ3, providing the first evidence for a new approach to integrin targeting in cancer.This work was supported by the EPSRC (RCUK Academic Fellowship and Grant EP/H002626/1 to H.M.S.) and Prostate Cancer UK (Pilot Grant PA10-01). F.O.F.O.A-S.. was funded by the Public Authority for Applied Education and Training, Kuwait (PhD studentship)
Cherries with different geographical origins regulate neuroprotection in a photoperiod-dependent manner in F344 rats
Get PDFYesThe photoperiod is the main environmental cue that drives seasonal adaptive responses in reproduction, behavior, and metabolism in seasonal animals. Increasing evidence suggests that (poly)phenols contained in fruits can also modulate seasonal rhythms. (Poly)phenol-rich diets are associated with an improvement in cognitive function and neuroprotection due to their anti-inflammatory and antioxidative properties. However, it is unknown whether cherries affect neuroprotection in a photoperiod-dependent manner. To test this, F344 rats were exposed to L6 (6 h light/day), L12 (12 h light/day) and L18 (18 h light/day) photoperiods and fed a standard chow diet supplemented with either a control, lyophilized cherry 1 or cherry 2 with distinctive phenolic hallmarks. Physiological parameters (body weight, eating pattern index (EPI), testosterone, T4/T3) and hypothalamic key genes (Dio2, Dio3, Raldh1 and Ghrh) were strongly regulated by the photoperiod and/or fruit consumption. Importantly, we show for the first time that neurotrophs (Bdnf, Sod1 and Gpx1) in the hippocampus are also regulated by the photoperiod. Furthermore, the consumption of cherry 2, which was richer in total flavonols, but not cherry 1, which was richer in total anthocyanins and flavanols, enhanced neuroprotection in the hippocampus. Our results show that the seasonal consumption of cherry with a specific phenolic composition plays an important role in the hippocampal activation of neuroprotection in a photoperiod-dependent manner.This work was supported by grant number PID2020-113739RB-I00 funded by MCIN/AEI/10.13039/501100011033 and by Pect-Nutrisalt funded by the European Regional Development Fund of the European Commission through the Operative Program Erdf of Catalonia 2014–2020. The authors thank the British Society for Neuroendocrinology (BSN) for providing a research visit Grant to F.M (Grant number: BSN-2022-1452). F.M. is the recipient of a predoctoral fellowship from Universitat Rovira i Virgili—Martí i Franquès (Grant number: 2019PMF-PIPF-19)
Ethical and quality of care-related challenges of digital health twins in older care settings: Protocol for a scoping review
Get PDFYesDigital health twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. DHTs have already contributed to improving the quality of dementia and trauma care, cardiac treatment, and health care services for older individuals. Despite its many benefits, the optimum implementation of DHTs has faced several challenges associated with ethical issues, quality of care, management and leadership, and design considerations in older care settings. Since the need for such care is continuously rising and there is evident potential for DHTs to meet those needs, this review aims to map key concepts to address the gaps in the research knowledge to improve DHT implementation.
The review aims to compile and synthesize the best available evidence regarding the problems encountered by older adults and care providers associated with the application of DHTs. The synthesis will collate the evidence of the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings.
The review will follow the Joanna Briggs Institute (JBI) methodology. The published studies will be searched through CINAHL, MEDLINE, JBI, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2002 will be considered. This review will include studies of older individuals (aged 65 years or older) undergoing care delivery associated with DHTs and their respective care providers. The concept will include the application of the technology, and the context will involve studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text and opinion studies, will be considered. A total of 2 independent reviewers will screen the titles and s and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study.
The results will be presented in a PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews) flow diagram. A draft charting table will be developed as a data extraction tool. The results will be presented as a "map" of the data in a logical, diagrammatic, or tabular form in a descriptive format.
The evidence synthesis is expected to uncover the shreds of evidence required to address the ethical and care quality-related challenges associated with applying DHTs. A synthesis of various strategies used to overcome identified challenges will provide more prospects for adopting them elsewhere and create a resource allocation model for older individuals.
DERR1-10.2196/51153.A publishing grant has been received from Linnaeus University as part of the University Library’s research support
An evaluation of CT radiation doses within the Yorkshire Lung Screening Trial
Get PDFYesObjectives;
To evaluate radiation doses for all low-dose CT scans performed during the first year of a lung screening trial.
Methods;
For all lung screening scans that were performed using a CT protocol that delivered image quality meeting the RSNA QIBA criteria, , radiation dose metrics, participant height, weight, gender and age were recorded. Values of CTDIvol and DLP were evaluated as a function of weight in order to assess the performance of the scan protocol across the participant cohort. Calculated effective doses were used to establish the additional lifetime attributable cancer risks arising from trial scans.
Results;
Median values of CTDIvol, DLP and effective dose (IQR) from the 3521 scans were 1.1mGy (0.70), 42.4mGycm (24.9) and 1.15mSv (0.67), whilst for 60-80kg participants the values were 1.0mGy (0.30), 35.8mGycm (11.4) and 0.97mSv (0.31). A statistically significant correlation between CTDIvol and weight was identified for males (r=0.9123, p<0.001) and females (r=0.9052, p<0.001), however the effect of gender on CTDIvol was not statistically significant (p=0.2328) despite notable differences existing at the extremes of the weight range. The additional lifetime attributable cancer risks from a single scan were in the range 0.001-0.006%.
Conclusions;
Low radiation doses can be achieved across a typical lung screening cohort using scan protocols that have been shown to deliver high levels of image quality. The observed dose levels may be considered as typical values for lung screening scans on similar types of scanner for an equivalent participant cohort.
Advances in Knowledge;
Presentation of typical radiation dose levels for CT lung screening examinations in a large UK trial.
Effective radiation doses can be of the order of 1mSv for standard sized participants.
Lifetime attributable cancer risks resulting from a single LDCT scan did not exceed 0.006%.The Yorkshire Lung Screening Trial is funded by Yorkshire Cancer Research (award reference L403)
A State-of-the-Art Artificial intelligence model for Infectious Disease Outbreak Prediction. Infectious disease outbreak have been predicted in England and Wales using Artificial Intelligence, Machine learning, and Fast Fourier Transform for COVID-19.
No full textThe pandemic produced by the COVID-19 virus has resulted in an estimated 6.4 million deaths worldwide and a rise in unemployment rates, notably in the UK. Healthcare monitoring systems encounter several obstacles when regulating and anticipating epidemics. The study aims to present the AF-HIDOP model, an artificial neural network Fast Fourier Transform hybrid technique, for the early identification and prediction of the risk of Covid-19 spreading within a specific time and region. The model consists of the following five stages: 1) Data collection and preprocessing from reliable sources; 2) Optimal machine learning algorithm selection, with the Random Forest tree (RF) classifier achieving 94.4% accuracy; 3) Dimensionality reduction utilising principal components analysis (PCA) to optimise the impact of the data volume; 4) Predicting case numbers utilising an artificial neural network model, with 52% accuracy; 5) Enhancing accuracy by incorporating Fast Fourier Transform (FFT) feature extraction and ANN, resulting in 91% accuracy for multi-level spread risk classification. The AF-HIDOP model provides prediction accuracy ranging from moderate to high, addressing issues in healthcare-based datasets and costs of computing, and may have potential uses in monitoring and managing infectious disease epidemics