1,720,986 research outputs found
Process Evaluation of the A2B randomised controlled trial: an exploration of the factors influencing successful implementation, delivery, and outcomes in an intensive care sedation study
No full textBackground: choice of sedation of critically ill patients is a core element of intensive care practice. The A2B trial tested the effectiveness of two alpha agonist sedatives versus propofol in reducing time on mechanical ventilation in 38 intensive care units (ICUs) in the United Kingdom (UK). To evaluate both how this complex trial was implemented and how this may have influenced trial outcomes, an understanding of the contextual and practice variation across multiple sites was required. Aim and Objectives: the aim of this process evaluation of the A2B trial was to determine how the intervention was delivered, the extent to which it was delivered as intended, and the impact this had on outcomes. Specifically, we aimed to: 1. Establish the degree to which the A2B intervention was delivered as intended, specifically in relation to fidelity, dose and reach across patients. 2. Understand factors that impacted on successful delivery of both the A2B intervention and trial, in relation to attitudes and perceptions of staff, including context and standard care. Design and methods: a mixed-methods, multi-phase design was used following extensive pre-trial exploration of current practice. Quantitative data were drawn from the main trial database covering 38 sites to assess the intervention’s fidelity, dose and reach in each site. Data were analysed descriptively and provided a low-moderate-high rating. Qualitative data were collected by interviews mid-trial (phase 1) and end of trial (phase2). Participants were recruited from a random sample of 30 ICUs active at the time of sampling and included the principal investigator, research nurses and clinical staff. Semi-structured interviews, informed by the trial’s logic model, lasted 45 – 60 minutes. Data collection focused on whether the intervention could be delivered as intended, factors that impacted upon successful delivery and understanding intervention adherence. Analysis used a framework approach based on the logic model. Data collection and qualitative analyses were completed prior to knowing the primary results of the trial. Results: site intervention adherence ratings for fidelity, dose and reach were low (4), moderate (20) and high (14). Participants from 12 ICUs in each of Phase 1 (33 staff) and 2 (36 staff) provided qualitative data; participating ICUs differed between phases. Factors identified in Phase 1 focused on intervention delivery and trial conduct and incorporated both organisational and participant-related factors. In Phase 2 participant-related factors included clinician preference, individual equipoise, clinician resistance and staff capability and capacity, while A2B trial-related factors included concerns relating to safety and side effects, overnight deep sedation practice, patient comfort and trial documentation. Many of these factors were impacted by the COVID-19 pandemic, particularly in regard to staffing numbers and experience. Limitations: due to the impact of the COVID-19 pandemic most data collection occurred remotely through video-conferencing rather than planned at site observation and interviews. Conclusion: optimal sedation practice is influenced by multiple factors related to clinician perceptions, capacity and capability. Priorities in care focus on short term safety and comfort. Limitations in staffing mean that longer term consequences related to recovery and rehabilitation are second tier considerations. Future work: findings highlight the multiple contextual factors, including both organisational and participant-related characteristics, that should be considered when planning both clinical trials and changes to routine care. Multiple strategies for achieving behaviour change when implementing complex interventions are essential
Clinical pharmacist’s views on the role of alpha-2- agonists in practice and research for the management of agitation, sedation, and delirium (ASD)
No full textIntroduction: patients in the intensive care (ICU) commonly receive analgesics and sedatives to facilitate mechanical ventilation. Recommendations suggest patients are kept as lightly sedated as feasible. Studies report an inconsistent association between deep sedation, prolonged ventilation and ICU stay. Opinions around patients ‘wakefulness’ include discomfort and the potential increased prevalence of psychological morbidity.2 Alpha-2-agonists (clonidine and dexmedetomidine) are agents used in ASD management and reported to produce lighter sedation. The aim of this project was to explore ICU pharmacist’s perspective on ASD practice over UK.Objectives: explore ICU pharmacist’s views on: ASD practices,sedation research priority, importance of A2B clinical trial and the impact of Covid19; determine the prevalence of clonidine and dexmedetomidine prescribing.Methods: an online survey was devised on Survey Monkey.The survey was designed in 2 sections: -1. Respondents provided responses based on a ‘point prevalence’ of clonidine and dexmedetomidine prescriptions, on day of completion.2. Their local ICU sedation practice, their views on priority of sedation research, the A2B study and whether they believed ASD was more challenging during the Covid19 pandemic.The online survey was distributed via the UK Clinical Pharmacy Association Critical Care Group (UKCPACCG), the NIHR Critical Care National Speciality Group (NSG), the UK Critical Care Research Group and Twitter.The survey remained active for 12 weeks from 30.3.2021with reminders sent for completion every fortnight.Results: there were 121 respondents, all but 1 were ICU pharmacists. There are approximately 243 ICU pharmacist posts in the UK, this represents a response rate of approximately 50%.37 (30%) of respondent reported clonidine (but not dexmedetomidine) was prescribed in their ICU; 7 (6%) described dexmedetomidine only; and 76 (63%) reported both.In describing ASD during Covid-19 pandemic, 107 (88%)respondents reported it had become more challenging.83 (69%) of respondents stated that clonidine usage increased during the pandemic (27 (22%) no change). 46(39%) stated that dexmedetomidine usage increased during the pandemic (50 (42%) no change).Among the respondents 98 (81%) ‘strongly agreed’, and 20 (17%) ‘agreed’ that research involving ASD is a priority. A2B is set to compare clinical and cost effectiveness of propofol, clonidine, and dexmedetomidine as primary sedative for ICU patients. 49 (40%) of respondents reported participating in A2B. 65 (54%) respondents felt that A2B was a ‘very important’, and 63 (52%) said it was an‘important’ research question.Conclusion: this survey reported widespread use of alpha-2-agonists in ASD practice. Almost two-thirds of ICUs report using both agents. Clonidine use is the most prevalent. Given the paucity of high quality clinical effectiveness and safety data for this drug, clinical trials which assess clinical effectiveness, including ASD are a priority. Respondents endorsed that ASD research is a priority, with ASD management much more challenging during the Covid19 pandemic.Limitations include that the design was a brief online survey; although had a high pharmacist response it did not incorporate the views of other members of the ICU team.<br/
The experience of bedside nurses delivering and intensive care sedation study: a process evaluation within the A2B study
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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
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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