2821 research outputs found
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Effectiveness and cost effectiveness of pharmacological thromboprophylaxis for medical inpatients: decision analysis modelling study
Full text linkObjective To determine the balance of costs, risks, and benefits for different thromboprophylaxis strategies for medical patients during hospital admission.
Design Decision analysis modelling study.
Setting NHS hospitals in England.
Population Eligible adult medical inpatients, excluding patients in critical care and pregnant women.
Interventions Pharmacological thromboprophylaxis (low molecular weight heparin) for all medical inpatients, thromboprophylaxis for none, and thromboprophylaxis given to higher risk inpatients according to risk assessment models (Padua, Caprini, IMPROVE, Intermountain, Kucher, Geneva, and Rothberg) previously validated in medical cohorts.
Main outcome measures Lifetime costs and quality adjusted life years (QALYs). Costs were assessed from the perspective of the NHS and Personal Social Services in England. Other outcomes assessed were incidence and treatment of venous thromboembolism, major bleeds including intracranial haemorrhage, chronic thromboembolic complications, and overall survival.
Results Offering thromboprophylaxis to all medical inpatients had a high probability (>99%) of being the most cost effective strategy (at a threshold of £20 000 (€23 440; $25 270) per QALY) in the probabilistic sensitivity analysis, when applying performance data from the Padua risk assessment model, which was typical of that observed across several risk assessment models in a medical inpatient cohort. Thromboprophylaxis for all medical inpatients was estimated to result in 0.0552 additional QALYs (95% credible interval 0.0209 to 0.1111) while generating cost savings of £28.44 (−£47 to £105) compared with thromboprophylaxis for none. No other risk assessment model was more cost effective than thromboprophylaxis for all medical inpatients when assessed in deterministic analysis. Risk based thromboprophylaxis was found to have a high (76.6%) probability of being the most cost effective strategy only when assuming a risk assessment model with very high sensitivity is available (sensitivity 99.9% and specificity 23.7% v base case sensitivity 49.3% and specificity 73.0%).
Conclusions Offering pharmacological thromboprophylaxis to all eligible medical inpatients appears to be the most cost effective strategy. To be cost effective, any risk assessment model would need to have a very high sensitivity resulting in widespread thromboprophylaxis in all patients except those at the very lowest risk, who could potentially avoid prophylactic anticoagulation during their hospital stay
Can acutely ill patients predict their outcomes? A scoping review.
Full text linkThe full impact of an acute illness on subsequent health is seldom explicitly discussed with patients. Patients' estimates of their likely prognosis have been explored in chronic care settings and can contribute to the improvement of clinical outcomes and patient satisfaction. This scoping review aimed to identify studies of acutely ill patients' estimates of their outcomes and potential benefits for their care. A search was conducted in PubMed, Embase, Web of Science and Google Scholar, using terms related to prognostication and acute care. After removal of duplicates, all articles were assessed for relevance by six investigator pairs; disagreements were resolved by a third investigator. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Our search identified 3265 articles, of which 10 were included. The methods of assessing self-prognostication were very heterogeneous. Patients seem to be able to predict their need for hospital admission in certain settings, but not their length of stay. The severity of their symptoms and the burden of their disease are often overestimated or underestimated by patients. Patients with severe health conditions and their relatives tend to be overoptimistic about the likely outcome. The understanding of acutely ill patients of their likely outcomes and benefits of treatment has not been adequately studied and is a major knowledge gap. Limited published literature suggests patients may be able to predict their need for hospital admission. Illness perception may influence help-seeking behaviour, speed of recovery and subsequent quality of life. Knowledge of patients' self-prognosis may enhance communication between patients and their physicians, which improves patient-centred care
Improved corrosion and cavitation erosion resistance of laser-based powder bed fusion produced Ti-6Al-4V alloy by pulsed magnetic field treatment
Full text linkThe application of pulsed magnetic field (PMF) treatment demonstrated enhanced corrosion resistance in saline
solution and prolonged resistance to cavitation erosion in deionised water for Ti-6AI-4V alloy manufactured by
laser-based powder bed fusion (LPBF) and conventional wrought processing methods. The observed outcomes
were attributed to the formation of a denser protective surface oxide layer and microstructural changes, resulting
in a reduction of the α’ phase by 0.13% and an increase in the presence of dislocations at the surface. Consequently,
this led to an increase in the compressive residual stresses. Additionally, the application of this treatment
resulted in the formation of highly refined and uniform precipitates, leading to a notable enhancement in
microhardness by 5.73% and 5.85% for the conventionally manufactured (CM) and LPBF samples, respectively
Covid-19: the impact of the pandemic and resulting support needs of children and young people
Full text linkCapacity for death awareness and death anxiety in children and young people has been previously documented but the impact of Covid-19 and subsequent support needs are not currently known. Therefore, the aim of this study was to explore children’s and young people’s experiences and responses to the Covid-19 pandemic and to identify resulting support needs, which are long-lasting or ongoing. Qualitative data was collected from thirteen children aged 9–10 years old in a primary school in Northwest England and from over a hundred young people, including nine interviews, across the United Kingdom. Children were asked to draw their thoughts and feelings about the pandemic and write a short narration to accompany the drawing. A questionnaire and semi-structured interviews were used with young people aged 12-16. Thematic analysis identified four themes in the data: death anxiety; mental health; positive experiences of the pandemic; and support needs. Findings indicate the need for appropriate support and interventions with children and young people to facilitate safe spaces to express their emotions and share feelings around death, dying, and bereavement confidently in a non-judgemental setting
Coming of age: the assistant practitioner role 21 years on
No full textIn 2023, a milestone was reached, marking 21 years of education, training and development of the assistant practitioner (AP) role at the University of Bolton. This is the first of two articles looking at the development of the assistant practitioner (AP) role in the north-west of England and the involvement of the University of Bolton in it over the past 21 years. It looks at the history and background of the programme at Bolton, from the first cohort in 2002 to the present apprenticeship programme for assistant practitioners in health
Impact of gamification on student learning: an empirical evidence
No full textLearner diversity is a matter for universities enrolling international students. Learner engagement then becomes a major concern for instructors. This
study uses gamification techniques to determine its impact on engagement and
learning when it comes to diverse cohort of learners. A survey questionnaire
method was used to identify the effect of gamification on engagement, motivation, performance, and learning. This empirical study revealed that quizzes supported by gamification enhanced engagement, performance and learning but did
not motivate learners to study outside the lecture theater. This paper also summarizes the issues while using gamified quizzes in the classroom settings and provides potential solutions
An ICT-based framework for innovative integration between BIM and lean practices obtaining smart sustainable cities
No full textSmart sustainable cities rely on the latest technologies and apply recent knowledge like Information and
Communication Technologies (ICT), BIM, and lean construction to expand people's eminence of life, smooth urban
maneuvers and facilities more competent, and develop their competitiveness while confirming that they achieve the
economic, social, environmental, and cultural demands of current and forthcoming generations. This paper explores
the synergies between Building Information Modelling (BIM) visualisation and Lean construction practices to
enhance Architecture, Engineering, and Construction (AEC) industry performance. A structured questionnaire was
distributed among BIM and lean experts and analysed by SPSS. The study uses descriptive and correlation analyses
to assess ten key lean practices, revealing high industry adoption and favorable mean scores. Notably, BIM-enhanced
clash detection and coordination lead with a score of 4.4 out of 5. Correlation analysis establishes significant positive
associations between BIM visualisation and practices such as just-in-time production, value stream mapping, lean
pull systems, work sequencing, standardised work, and continuous improvement. The findings accentuate the pivotal
role of BIM in optimising lean practices, offering valuable insights for practitioners seeking to elevate AEC industry
performance through strategic integration. Future studies endeavors are recommended to investigate several
alternative avenues to enhance the integration between BIM and Lean practices in the AEC industry. Furthermore,
the forthcoming researchers are advised to validate the proposed framewor
Gamifying simulated nursing education: a digital technology approach to enhancing pedagogy and student experience
No full textHigher educational institutions have responded to a shortage of clinical
placements for students by adopting innovative approaches, such as the
use of simulated learning environments. The integration of gamification
in simulated placements presents a promising opportunity to enrich and
diversify the learning experience. A series of game-based resources to
support simulated practice learning was developed by the academic team
at the University of Bolton. This study involved evaluating the experiences of
students who engaged in these interactive scenarios to assess the potential
impact of these digital interventions on learning. The findings indicate that
the approach had a significant impact on student learning, improving both
their knowledge and their confidence in applying procedures in practice.
These findings are of particular significance since it is commonly considered
that students in fields such as nursing, which are known for their emphasis
on human-centred care, place less value on digital learning technologie
CIA security for Internet of Vehicles and blockchain-AI integration
No full textThe lack of data security and the hazardous nature of the Internet of Vehicles
(IoV), in the absence of networking settings, have prevented the openness and
self-organization of the vehicle networks of IoV cars. The lapses originating
in the areas of Confidentiality, Integrity, and Authenticity (CIA) have also increased the possibility of malicious attacks. To overcome these challenges,
this paper proposes an updated Games-based CIA security mechanism to secure IoVs using Blockchain and Artificial Intelligence (AI) technology. The
proposed framework consists of a trustworthy authorization solution with
three layers, including the authentication of vehicles using Physical Unclonable Functions (PUFs), a flexible Proof-of-Work (dPOW) consensus framework, and AI-enhanced duel gaming. The credibility of the framework is
validated by different security analyses, showcasing its superiority over existing systems in terms of security, functionality, computation, and transaction
overhead. Additionally, the proposed solution effectively handles challenges
like side channel and physical cloning attacks, which many existing frameworks fail to address. The implementation of this mechanism involves the use
of a reduced encumbered blockchain, coupled with AI-based authentication
through duel gaming, showcasing its efficiency and physical-level support, a
feature not present in most existing blockchain-based IoV verification frameworks
DSPHR: A dynamic SDN-based Port Hopping Routing technique for mitigating SD-WSN attacks
No full textThis study introduces a Dynamic SDN-based Port Hopping Routing (DSPHR)
technique to enhance the practical security defense of Software-Defined Wireless Sensor Networks (SD-WSNs) in wireless networks. DSPHR aims to thwart
network probe and packet intersection attacks by formulating route hopping
as a limitation resolution problem. The technique integrates the Compliance
Quotient Theory (CQT) solver to establish constraints for achieving multiple
routes, addressing capacity and overlap constraints. The SDN controller of the
WSN, following a route hopping strategy and designated hopping slots, configures flow entries in OpenFlow switches along each transmission route. These
entries enable the proper forwarding of secured communication flows. Simultaneously, the information regarding ports and addresses undergoes random
alterations, ensuring not only random route hopping but also concealing original
communication entity details. Theoretical analysis and experimental simulations
validate DSPHR’s efficacy, demonstrating seamless and optimal route hopping
with minimal communication latency. The technique significantly bolsters practical security measures, providing robust defense against interception and probe
attacks in SDN-based wireless networks