192815 research outputs found
Sort by
E‐Professionalism's impact on dental professionalism: a rapid scoping review
Get PDFBackground: Dental regulators and educational institutions are increasingly concerned about the influence of digital platforms used by the profession for social, business, digital interaction with the public/patients and its impact on the professionalism in practice now and going forward. However, academic knowledge and research within dentistry are relevant to e‐professionalism at a level of engagement and approach in delivering guidance to students through the current dental curriculum. The question therefore asked was what breadth of academic material, research, debate and discourse is available to inform our understanding, guidance and teaching on this ever‐evolving topic. Aim: To map how e‐professionalism has developed in academic dental literature as a topic within the study of professionalism in practice. Method: A rapid scoping review was conducted to identify published research that describes and tests the topic of professionalism from 2016 to 2023. Studies were synthesised narratively using thematic analysis to inform the understanding of what has been already researched in the field. Results: Thirteen articles were included in the review. After undertaking a thematic analysis, five themes were constructed. These included: curriculum, opportunities and safe professional use, reflections, personal and professional identity issues, and students as co‐creators. Conclusions: Within dental research there is consensus that e‐professionalism could present a tangible threat to the identity of dental professionals their clinical practice and interaction with patients/public however, less is known about what educational strategies are most effective when teaching e‐professionalism
The review and development of professional standards through the lens of Democratic Anchorage points
Get PDFThe recent review of the Scottish professional standards for teachers, led by the General Teaching Council for Scotland, offered a unique perspective to interrogate participative approaches in policy‐making in the Scottish education context and to provide insights and implications for future policy‐making. Using one of the authors’ experiences as a General Teaching Council Scotland Officer during the review of the professional standards, this paper conceptualises the consultation process as a form of democratic governance, using Sørensen and Torfing's framing of the four anchorage points that enable democratic legitimacy in governance networks. This perspective places policy‐making within a governance structure that is created by networks that interact, overlap and are entangled with each other, implying a decentralised form of governance. An analysis of the stages of the review process demonstrated that it was participatory. However, there was an over‐reliance on the established policy‐making community. In addition, authentic participation was restricted as choices were limited by the metagovernor. We argue that Sørensen and Torfing's anchorage points for democratic legitimacy allow an interrogation of the extent to which policy‐making in Scottish education is authentically democratic and conclude by offering a framework of critical questions for more transparent democratic participation in future iterations of similar professional standards reviews
Visit‐to‐visit changes in heart rate in heart failure: A pooled participant‐level analysis of the PARADIGM‐HF and PARAGON‐HF trials
Get PDFAims:
Resting heart rate (HR) is a strong risk marker in patients with heart failure (HF), but the clinical implications of visit-to-visit changes in HR (ΔHR) are less well established. We aimed to explore the association between ΔHR and subsequent outcomes in a pooled dataset of two well-characterized cohorts of patients with HF across the full range of left ventricular ejection fraction (LVEF).
Methods and results:
PARADIGM-HF and PARAGON-HF were randomized trials testing sacubitril/valsartan versus enalapril or valsartan, respectively, in patients with HF and LVEF ≤40% (PARADIGM-HF) or LVEF ≥45% (PARAGON-HF). We analysed the association between ΔHR from the preceding visit with the primary endpoint of HF hospitalization (HFH) or cardiovascular death using covariate-adjusted Cox proportional hazards models. A total of 13 194 patients (mean age 67 ± 11 years, 67% men, mean LVEF 40 ± 15%) were included. Over a median follow-up of 2.5 years, 3114 patients experienced a first HFH or cardiovascular death event (10.4 events per 100 patient-years). An increase in HR from the preceding visit, compared with no change, was associated with a higher risk (hazard ratio 1.12; 95% confidence interval [CI] 1.10–1.15; p < 0.001 per 5 bpm increase). Conversely, a drop in HR was associated with a lower risk (hazard ratio 0.97; 95% CI 0.94–1.00; p = 0.044 per 5 bpm drop). The prognostic implications of ΔHR were consistent across the range of LVEF and observed regardless of β-blocker use or presence of a permanent pacemaker. Visit-to-visit increases in HR were especially prognostic in patients without atrial fibrillation (pinteraction = 0.006).
Conclusion:
Across a broad spectrum of patients with chronic HF, increases in HR from a preceding visit independently predicted clinical outcomes. The detection of notable increases in HR between outpatient visits may help identify patients at heightened risk of adverse events.
Clinical Trial Registration; ClinicalTrials.gov NCT01035255 (PARADIGM-HF), NCT01920711 (PARAGON-HF)
Differentially Private Integrated Decision Gradients (IDG-DP) for Radar-based Human Activity Recognition
Get PDFHuman motion analysis offers significant potential for healthcare monitoring and early detection of diseases. The advent of radar-based sensing systems has captured the spotlight for they are able to operate without physical contact and they can integrate with pre-existing Wi-Fi networks. They are also seen as less privacy-invasive compared to camera-based systems. However, recent research has shown high accuracy in recognizing subjects or gender from radar gait patterns, raising privacy concerns. This study addresses these issues by investigating privacy vulnerabilities in radar-based Human Activity Recognition (HAR) systems and proposing a novel method for privacy preservation using Differential Privacy (DP) driven by attributions derived with Integrated Decision Gradient (IDG) algorithm. We investigate Black-box Membership Inference Attack (MIA) Models in HAR settings across various levels of attacker-accessible information. We extensively evaluated the effectiveness of the proposed IDG-DP method by designing a CNN-based HAR model and rigorously assessing its resilience against MIAs. Experimental results demonstrate the potential of IDG-DP in mitigating privacy attacks while maintaining utility across all settings, particularly excelling against label-only and shadow model blackbox MIA attacks. This work represents a crucial step towards balancing the need for effective radar-based HAR with robust privacy protection in healthcare environments
We match! Building online brand engagement behaviours through emotional and rational processes
Get PDFStrong influencers generate attention and engagement for specific brands they endorse and present, but still little is known on how their intrinsic characteristics may contribute to their ability to generate content engagement intentions for any posted content. This study uses the dual-process theory and data collected from 1012 followers of an Instagram micro-influencer to examine how perceived consumer micro-influencers drive behavioural engagement with any shared branded content through emotional and rational processing. The results indicate that follower-influencer similarity exerts a positive and direct influence on all three engagement behaviours, and it indirectly affects content consumption and contribution behaviours through parasocial relationships (emotional route) and credibility (rational route). The findings also reveal that parasocial relationships enhance the influencer's credibility, underscoring the significant mediating role of these relationships. Notably, the indirect effect of similarity on credibility, mediated by parasocial relationships, is proven more substantial than the direct effect
Psychological, physical, and professional impact on second victims in veterinary anaesthesia: a cross-sectional international survey - Part 1
Get PDFObjectives:
To investigate the psychological, physical, and professional impact of veterinary patient safety incidents (PSIs) on veterinary anaesthesia professionals.
Study design:
We conducted an observational cross-sectional survey, inviting veterinary anaesthesiologists, anaesthesiologists in training, and veterinary nurses/technicians through social media platforms from 2nd June–20th of September 2023. The questionnaire was based on the Second Victim Experience and Support Survey (SVEST) and analysed using descriptive statistics and subscale scoring to assess psychological, physical, and professional impacts.
Results:
A total of 303 participants from 31 countries responded, including North (24%), Central (13.5%), and South America (25%), Europe (13.2%), UK (12.5%), Australia/New Zealand (8.1%) and Asia/Middle East (3.3%). A participation rate cannot be estimated. All respondents described themselves as second victims, with 70% encountering a PSI in the past 6 months. Of the 303 participants, 75% had direct involvement with the incident. Common post-incident challenges included: an increased awareness for PSIs (67.1%), fear of new PSIs (62.7%), diminished confidence (56.1%), more defensive medicine practice (46.7%), and sleep disorders (43.3%). Additionally, 62.7% agreed or strongly agreed that they experienced embarrassment post-incident. Following a PSI, approximately 69% of the participants reported feeling inadequate in their animal care abilities, and a similar percentage questioned their professional competence. Over half of the respondents (54.6%) became fearful of undertaking high-risk procedures. Approximately 38% of respondents considered leaving the field of anaesthesia, while over 56% harboured thoughts of leaving their job due to the stress from PSIs. Additionally, a significant proportion, 69.8%, reported not taking time off work following PSIs.
Conclusion:
The study identifies a significant psychological, physical, and professional impact on veterinary anaesthesia professionals, with notable effects on their emotional well-being and professional self-efficacy. The findings emphasize the need for supportive measures and interventions to mitigate the adverse effects experienced by these individuals
Adding traditional and emerging biomarkers for risk assessment in secondary prevention: a prospective cohort study of 20,656 patients with cardiovascular disease
Get PDFBackground:
This study aims to explore whether conventional and emerging biomarkers could improve risk discrimination and calibration in secondary prevention of recurrent atherosclerotic cardiovascular disease (ASCVD), based on a model using predictors from SMART2.
Methods:
In a cohort of 20,658 UK Biobank participants with medical history of ASCVD, we analysed any improvement in C indices and net reclassification index (NRI) for future ASCVD events, following addition of LP-a, ApoB, cystatin C, HbA1c, GGT, AST, ALT, and ALP, to a model with predictors used in SMART2 for the outcome of recurrent major cardiovascular event. We also examined any improvement in C indices and NRIs replacing creatinine based estimated glomerular filtration rate (eGFR) with cystatin C based estimates. Calibration plots between different models were also compared.
Results:
Compared with the baseline model (C index=0.663), modest increment in C indices were observed when adding HbA1c (ΔC=0.0064, p<0.001), cystatin C (ΔC=0.0037, p<0.001), GGT (ΔC=0.0023, p<0.001), AST (ΔC= 0.0007, p<0.005) or ALP (ΔC=0.0010, p<0.001) or replacing eGFRCr with eGFRCysC (ΔC=0.0036, p<0.001) or eGFRCr-CysC (ΔC=0.00336, p<0.001). Similarly, the strongest improvements in NRI were observed with the addition of HbA1c (NRI=0.014), or cystatin C (NRI= 0.006) or replacing eGFRCr with eGFRCr-CysC (NRI=0.001) or eGFRCysC (NRI=0.002). There was no evidence that adding biomarkers modify calibration.
Conclusions:
Adding several biomarkers, most notably cystatin C and HbA1c, but not LP-a, in a model using SMART2 predictors modestly improved discrimination
Quality assurance in surgical trials of arteriovenous grafts for haemodialysis: a systematic review, a narrative exploration and expert recommendations
No full textBackground:
Introducing new procedures and challenging established paradigms requires well-designed randomised controlled trials (RCT). However, RCT in surgery present unique challenges with much of treatment tailored to the individual patient circumstances, refined by experience and limited by organisational factors. There has been considerable debate over the outcomes of arteriovenous grafts (AVG) compared to AVF, but any differences may reflect differing practice and potential variability. It is essential, therefore, when considering an RCT of a novel surgical procedure or device that quality assurance (QA) is defined for both the new approach and the comparator. The aim of this systematic review was to evaluate the QA standards performed in RCT of AVG using a multi-national, multi-disciplinary approach and propose an approach for future RCT.
Method:
The methods of this have been previously registered (PROSPERO: CRD420234284280) and published. In summary, a four-stage review was performed: identification of RCT of AVG, initial review, multidisciplinary appraisal of QA methods and reconciliation. QA measures were sought in four areas – generic, credentialing, standardisation and monitoring, with data abstracted by a multi-national, multi-speciality review body.
Results:
QA in RCT involving AVG in all four domains is highly variable, often sub-optimally described and has not improved over the past three decades. Few RCT established or defined a pre-RCT level of experience, none documented a pre-trial education programme, or had minimal standards of peri-operative management, no study had a defined pre-trial monitoring programme, and none assessed technical performance.
Conclusion:
QA in RCT is a relatively new area that is expanding to ensure evidence is reliable and reproducible. This review demonstrates that QA has not previously been detailed, but can be measured in surgical RCT of vascular access, and that a four-domain approach can easily be implemented into future RCT
Science fiction studies and the medical humanities: interdisciplinary futures
No full textNo abstract available
Coming to terms with climate change: a glossary for climate change impacts on mental health and well-being
Get PDFClimate change is a major threat to global health. Its effects on physical health are increasingly recognised, but mental health impacts have received less attention. The mental health effects of climate change can be direct (resulting from personal exposure to acute and chronic climatic changes), indirect (via the impact on various socioeconomic, political and environmental determinants of mental health) and overarching (via knowledge, education and awareness of climate change). These impacts are unequally distributed according to long-standing structural inequities which are exacerbated by climate change. We outline key concepts and pathways through which climate change may affect mental health and explore the responses to climate change at different levels, from emotions to politics, to highlight the need for multilevel action. We provide a broad reference to help guide researchers, practitioners and policy-makers in the use and understanding of different terms in this rapidly growing interdisciplinary field
Data sources:
Access Repository Dashboard
Do you manage Open Research Online? Become a CORE Member to access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard! 👇