197 research outputs found
Enhancing informed consent in oncological surgery through digital platforms and artificial intelligence
No full textInformed consent is a cornerstone of ethical medical practice, particularly in high-stakes oncological surgery where treatment options are complex and risks are significant. This paper explores the potential of digital platforms and artificial intelligence (AI) to enhance the informed consent process. The traditional consent process, reliant on face-to-face interactions and paper-based documentation, is increasingly being supplemented by digital solutions that offer remote consultations, personalized patient information, and electronic consent forms. These digital pathways not only improve accessibility and patient comprehension but also streamline documentation, reducing errors and administrative burdens. AI technologies, including ambient digital scribes and large language models (LLMs), could further augment this process by generating personalized risk assessments, simplifying complex medical information, and facilitating multilingual communication. However, success will also depend on addressing ethical concerns, ensuring equitable access, and preserving the irreplaceable human connection between patients and clinicians. By augmenting rather than replacing clinician expertise, digital platforms and AI can empower patients to make truly informed decisions in oncological care
Protocol for developing quality assurance measures to use in surgical trials: an example from the ROMIO study
No full textIntroduction: Randomised controlled trials (RCTs) in surgery are frequently criticised because surgeon expertise and standards of surgery are not considered or accounted for during study design. This is particularly true in pragmatic trials (which typically involve multiple centres and surgeons and are based in 'real world' settings), compared with explanatory trials (which are smaller and more tightly controlled).Objective: This protocol describes a process to develop and test quality assurance (QA) measures for use within a predominantly pragmatic surgical RCT comparing minimally invasive and open techniques for oesophageal cancer (the NIHR ROMIO study). It builds on methods initiated in the ROMIO pilot RCT.Methodsamd analysis: We have identified three distinct types of QA measure: (i) entry criteria for surgeons, through assessment of operative videos, (ii) standardisation of operative techniques (by establishing minimum key procedural phases) and (iii) monitoring of surgeons during the trial, using intraoperative photography to document key procedural phases and standardising the pathological assessment of specimens. The QA measures will be adapted from the pilot study and tested iteratively, and the video and photo assessment tools will be tested for reliability and validity.Ethics and dissemination: Ethics approval was obtained (NRES Committee South West-Frenchay, 25 April 2016, ref: 16/SW/0098). Results of the QA development study will be submitted for publication in a peer-reviewed journal. Trial registration number: ISRCTN59036820, ISRCTN10386621
Efficiency of small constructed wetlands for subsurface treatment of single family domestic effluent
No full textPeer reviewedWetlandsWastewaterPollution treatmentDomestic wastewaterSeasonalityLoad reductionSingle-family constructed wetland systems in Ohio, USA, are studied to evaluate their effectiveness in improving water quality. Twenty-one, three-cell systems (septic tank with two wetlands) are found to meet US Environmental Protection Agency (EPA) effluent load guidelines in 68% of the quarterly water quality samples collected from 1994 to 2001. These wetlands most frequently meet EPA standards for mitigation of biochemical oxygen demand (89% below30 mg/l); total suspended solids (79% below 30 mg/l); and fecal coliform (74% below 1000 counts/100 ml). Phosphorus and ammonia discharge meet the guidelines less often (50% at 1 mg/l and 16% at 1.5 mg/l, respectively). These data also indicate that domestic treatment wetlands can reduce output of fecal coliform 88 +/- 27%, total suspended solids 56 +/- 53%, biochemical oxygen demand 70 +/- 48%, ammonia 56 +/- 31% and phosphorus 80 +/- 20%. Analysis of variance for these systems indicates that biochemical oxygen demand reduction is ~10% less efficiently reduced during winter and ammonia was reduced ~20% more efficiently in fall when compared with the other seasons. Phosphorus reductions display complex seasonal variations that imply that the least efficient phosphorus reduction occurs in winter and the most efficient reduction occurs in fall. © 2002 Elsevier Science B.V. All rights reserved
Seminal plasma and prostaglandin E2 up-regulate fibroblast growth factor 2 expression in endometrial adenocarcinoma cells via E-series prostanoid-2 receptor-mediated transactivation of the epidermal growth factor receptor and extracellular signal-regulated kinase pathway
No full textProstaglandin E(2) (PGE(2)) has been shown to modulate angiogenesis and tumour progression via the E-series prostanoid-2 (EP2) receptor. Endometrial adenocarcinomas may be exposed to endogenous PGE(2) and exogenous PGE(2), present at high concentration in seminal plasma
Defence spending and the north-south divide
No full textGovernment spending on defence equipment in the UK is currently 6% of public expenditure. It is a major generator of employment and is concentrated in the high-tech electronics and aerospace sectors. Over half of this expenditure is in the southeast. A comparison with regional assistance programmes underlines the imbalance of public expenditure. The author proposes an annual regional audit of public expenditure programmes and an exploration of the rationale for a geography of public expenditure. -after Autho
The geography of military industry in Britain
No full textIn this paper new data on military industrial activity at regional levels in Britain are presented. It is argued that such activity is an important element of wider spatial changes in the 1980s. -Author
How can communication to GPs at hospital discharge be improved? A Systems Approach
No full textAbstract
Background Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to improvement after decades of work.
Aim To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement.
Design, Setting A qualitative exploration of the secondary-to-primary care communication system surrounding a UK tertiary hospital
Method A ‘systems approach’, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n=18) of clinical and administrative staff from both sides of the primary-secondary care interface and a subsequent focus group.
Results The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance and quality of care. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance in relation to using standardised communication templates.
Conclusion Facilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance, such as patient complexity
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