1,720,971 research outputs found
A mixed methods study of the impact of consultant overnight working in an English Emergency Department
No full textBackground There is a growing expectation that consultant-level doctors should be present within an ED overnight. However, there is a lack of robust evidence substantiating the impact on patient waiting times, safety or the workforce.Objectives To evaluate the impact of consultant-level doctors overnight working in ED in a large university hospital.Methods We conducted a controlled interrupted time series analysis to study ED waiting times before and after the introduction of consultant night working. Adverse event reports (AER) were used as a surrogate for patient safety. We conducted interviews with medical and nursing staff to explore attitudes to night work.Results The reduction seen in average time in department relative to the day, following the introduction of consultant was non-significant (−12 min; 95% CI −28 to 4, p=0.148). Analysis of hourly arrivals and departures indicated that overnight work was inherited from the day. There were three (0.9%) moderate and 0 severe AERs in 1 year. The workforce reported that night working had a negative impact on sleep patterns, performance and well-being and there were mixed views about the benefits of consultant night presence. Additional time off during the day acted as compensation for night work but resulted in reduced contact with ED teams.Conclusions Our single-site study was unable to demonstrate a clinically important impact of consultant night working on total time patients spend in the department. Our analysis suggests there may be more potential to reduce total time in department during the day, at our study site. Negative impacts on well-being, and likely resistance to consultant night working should not be ignored. Further studies of night working are recommended to substantiate our results
Here’s something we prepared earlier: development, use and reuse of a configurable, inter-disciplinary approach for tackling overcrowding in NHS hospitals
No full textOvercrowding affects hospital emergency departments (ED) worldwide. Most OR studies addressing overcrowding develop bespoke models to explore potential improvements but ignore the organisational context in which they would be implemented, and few influence practice. There is interest in whether reusable models, for ED crowding and in healthcare generally, could have more impact. We developed a configurable approach for tackling ED overcrowding. A reusable queuing model for exploring drivers of ED performance was augmented by a qualitative approach for exploring the implementation context and a generic framework for assessing the likely compatibility of interventions with a given organisation. At the hospital where the approach was developed it directly informed strategy. We describe reuse of the approach at three hospitals. One project was completed and well-received by hospital management, two were terminated partway when data problems surfaced. The primary contribution of this work is its novelty in considering, alongside quantitative modelling, evidence-based interventions to overcrowding and qualitative assessment of a hospital’s aptitude and capability to adopt different interventions. A secondary contribution is to further the debate on model reuse, particularly by introducing more complex, modelling-centred approaches that acknowledge how models must relate to tangible interventions with reasonable prospects of being adopted locally
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study
No full textObjectives: to investigate whether a care pathway for older hip fracture patients can reduce length of stay while maintaining the quality of clinical care. Design: prospective study of patients admitted 12 months before and after implementation of a care pathway for the management of femoral neck fracture. Audit data for corresponding time periods from nearby orthopaedic units was used to control for secular trends. Setting: teaching hospital. Subjects: patients aged 65 years and over with a femoral neck fracture. Exclusion criteria: multiple fractures, fractures due to malignancy, re-fracture, total hip replacement, previously entered into the study, operation performed elsewhere. Three-hundred and ninety-five (99%) and 369 (97%) case records were available for full analysis. Main outcome measures: primary outcome: length of stay on the orthopaedic unit. Secondary outcomes: ambulation at discharge, discharge destination, in-hospital complications, 30 day mortality, readmission within 30 days of discharge, post-operative days the patient first sat out of bed and walked. Results: mean length of stay increased by 6.5 days (95% confidence interval 3.5–9.5 days, P < 0.0005) in the second period with a significant improvement in ambulation on discharge (odds ratio 1.6, 95% confidence interval 1.0–2.6, P = 0.033) and a trend towards reduction in admission to long term care (odds ratio 0.6, 95% confidence interval 0.3–1.0, P = 0.058). Conclusions: this care pathway was associated with longer hospital stay and improved clinical outcomes. Care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources
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