80 research outputs found
Exploring modifiable factors towards COPD guideline non-concordance and development of an electronic integrated COPD proforma to improve emergency department interdisciplinary staff concordance: Mixed methods and modified Delphi study
No full textChronic obstructive pulmonary disease is a prevalent chronic illness. It is a significant cause of avoidable hospital presentations and the fifth leading cause of death in Australia. An Electronic Integrated COPD Proforma (E-ICP), endorsed and informed by interdisciplinary staff from the Emergency Department (ED), was prioritised using frequency scores to be the most pragmatic solution to mitigate identified barriers of guideline non concordance. The unprecedented pace of clinical care in the ED often only facilitates acute management which exhausts patients, primary care givers and tertiary hospital resources with readmissions and exacerbations. Achieving a consistent pharmacological and nonpharmacological management concordant with the COPD-X plan guidelines is expected to improve health related quality of life in patients with COPD.
OBJECTIVES: This research explored barriers and modifiable factors causing guideline non-concordance that assist the development of an electronic integrated COPD care proforma (E-ICP), through a process of national interdisciplinary (Emergency departments and Respiratory departments), expert consensus.
METHODS: This mixed methods research involved a convergent integrated mixed methods approach that included a systematic review (phase-1), qualitative interdisciplinary staff interviews (phase-2), and an E-modified Delphi method (phase-3) for the development of an electronic proforma with guideline recommendations for use in emergency departments (EDs) in the Australian health system. Phase 2 of this research comprised qualitative interviews with data analysis aligning with Braun and Clarkes (2006), thematic analysis method. The Theoretical Domains Framework including capability, opportunity, motivation, and a behaviour change wheel (COM-B BCW) was adopted as a priori to systematically extract data through all phases. The outcomes propose a range of implementation strategies to the clinical stakeholders/policy makers on improved guideline concordance. In Phase 3, a modified Delphi study was employed to select interventions for the proforma. This phase used a consensus process of three iteration surveys including quantitative survey and qualitative interview thematic analysis on each indicator.
RESULTS: Barriers and modifiable factors explored in this study included lack of knowledge (guidelines and referral methods), skills, staffing, time constraints, memory attention and decision making, professional role identity confusion, and clinical behaviour regulation. Development of an electronic proforma with interdisciplinary staff/patient resources and direct referrals from national interdisciplinary experts from ED and respiratory departments was prioritised as an implementation strategy to address all modifiable factors. The E-ICP demonstrated acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts.
CONCLUSION: Future outcomes from the E-ICP are its potential to facilitate direct referrals from the ED, leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life including improved interdisciplinary guideline concordance
Dr. Issac Clark, 1979
No full textDr. Issac Clark and a man exchange a handshake and a plaque award over a podium as others look on.The Atlanta University Center Robert W. Woodruff Library acknowledges the generous support of the National Endowment for Humanities - Humanities Collections and Reference Resources Implementation Project Grant in supporting the processing and digitization of a number of its major archival collections as part of the project: Spreading the Word: Expanding Access to African American Religious Archival Collections at the Atlanta University Center Robert W. Woodruff Library.</em
Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study
No full textINTRODUCTION: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. AIM: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. METHODS: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. RESULTS: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. CONCLUSION: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence
Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol
No full textINTRODUCTION: Multifarious chronic obstructive pulmonary disease (COPD) guidelines have been published by local, national and global respiratory societies. These guidelines subsume holistic evidence based on recommendations to diagnose, treat, prevent and manage acute exacerbation with COPD. Despite the existing comprehensive recommendations, readmission rates and hospitalisations have increased in the last decade. Evidence to date has reported suboptimal clinical guidelines concordance. Acute exacerbations of COPD (AECOPD) is a common hospital presentation due to varied causes such as infective exacerbations, worsening disease condition, medication non-adherence, lack of education and incomprehensive discharge planning. AECOPD directly and indirectly causes economic burden, disrupts health-related quality of life (HRQol), hasten lung function decline and increases overall morbidity and mortality. COPD being a multimodal chronic disease, consistent interdisciplinary interventions from the time of admission to discharge may reduce readmissions and enhance HRQol among these patients and their families. METHODS AND ANALYSIS: This protocol adheres to the Joanna Briggs Institute methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Qualitative, quantitative and mixed methods studies will append this study to explore determinants of COPD guidelines concordance. Comprehensive three-tier search strategies will be used to search nine databases (COCHRANE, EBSCO HOST, MEDLINE, SCIENCE DIRECT, JBI, SCOPUS, WEB OF SCIENCE, WILEY and DARE) in May 2020. Two independent reviewers will screen abstracts and full-text articles in consonance with inclusion criteria. The convergent integrative method narrative review will contribute a deeper understanding of any discrepancies found in the existing evidence. Quality of the studies will be reported and Theoretical Domains Framework (TDF) will be used as a priori to synthesis data. Identified barriers, facilitators and corresponding clinical behavioural change solutions will be categorised using TDF indicators to provide future research and implementation recommendations. ETHICS AND DISSEMINATION: Ethical approval is not required and results dissemination will occur through peer-reviewed publication
Austin Papers: Series II, Part I, 1794-1817
No full textCopy of transcript for a letter addressed to Issac Tomlinson and Co. or Issac Tomlinson and Sons, in which the author explains taking out loans in order to transport goods
A pastoral leadership model of mutuality for greater true vine Baptist church, 2016
No full textThe purpose of this project is to promote transformative change within a local church by establishing an ethos of mutuality built upon mutually shared religious beliefs rather than shared culture or age. The pastor of a predominantly African-American church of approximately two hundred members located in the City of Pensacola in the panhandle of Florida observed that there was no perceived cooperative and collaborative exchange between those who shared a culture (individuals bound together with certain beliefs, interests, and culture) or those who were from the same generation within the church. The church being studied is an urban inner-city ministry comprised of 71 % adults and 29% youths. Culturally, the differences among members are more geographical in their origin than racial. Pensacola, a city with a fluid population, attracts people from different communities within the nation. Utilizing the concepts of task competence, transactional commitment, and transformative consciousness (consistent mental awareness of transformative praxis) for the pastor and the membership, this project addresses transformative change (ministry involvement, organizational commitment, and membership retention) as well as attitudes, behaviors, and actions within the local church. The project includes the development of a four-lesson series that addresses the idea of mutuality (embracing shared core beliefs and ideas). The project enrolled twenty-one people representing each ministry subgroup within the church. The group completed a pre-test and post-test (questionnaire) and participated in all group session activities designed to develop mutuality in the areas of core shared beliefs such as spiritual growth, and the church's direction of ministry, vision, and mission. The effectiveness of the lesson plan series was evaluated based on increased unity, behavioral attitudes towards each other, and praxis in the ministry. The community known as the Greater True Vine Missionary Baptist Church of Pensacola, Florida is the project's primary focus. The hoped for outcome of the project was to create greater unity and organizational commitment among the church's members as a result of their renewed focus on their shared core religious beliefs
The movement op thought in Egypt under the middle kingdom and the empire and in china from the Han dynasty to the Ming dynasty A comparative study, 1956
No full textProgrammed exosome fusion for energy generation in living cells
No full text© 2021, The Author(s), under exclusive licence to Springer Nature Limited.Biological membrane-enclosed organelles are fascinating examples of spatially confined nanoreactors for biocatalytic transformations such as cascade reactions involving multiple enzymes; however, the fabrication of their synthetic mimics remains a considerable challenge. Here we demonstrate supramolecular chemistry-based bridging of two membranes leading to controlled fusion of exosomes that act as nanoreactors for effective biocatalytic cascades, with prolonged functionality inside of living cells. Exosome membrane proteins were chemically engineered with a catechol moiety to drive fusion by supramolecular complexation to bridge the membranes. This strategy successfully encapsulated multiple enzymes and assembled the minimal electron transport chain in the plasma membrane, leading to tuneable, enhanced catalytic cascade activity capable of ATP synthesis inside of tissue spheroids. This nanoreactor was functional for many hours after uptake into living cells, showed successful penetration into tissue spheroids and repaired the damaged region by supplying ATP, all of which represent an advance in the mimicking of nature’s own organelles. [Figure not available: see fulltext.].11Nsciescopu
Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review
No full textBackground: COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and international guidelines, the COPD burden to frontline healthcare services has increased in the last decade. Suboptimal guidelines concordance can be disruptive to health-related quality of life (HRQoL), hastening pulmonary function decline and surging overall morbidity and mortality. A lack of concordance with guidelines has created an escalating economic burden on health-care systems. Identifying interdisciplinary interventions to facilitate improved adherence to guidelines may significantly reduce re-admissions, enhance HRQoL amongst patients and their families, and facilitate economic efficiency. Materials and Methods: This review adhered to the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews and the PRISMA ScR reporting guidelines. Two independent reviewers screened abstracts and full text articles in consonance with inclusion criteria. The convergent integrative JBI method collated quantitative, qualitative and mixed methods studies from nine databases. JBI critical appraisal tools were utilised to assess the quality of research papers. The theoretical domains framework (TDF) along with a specifically developed COPD data extraction tool were adopted as a priori to collect and collate data. Identified barriers and corresponding clinical behavioural change solutions were categorised using TDF domains and behavior change wheel (BCW) to provide future research and implementation recommendations. Results: Searches returned 1068 studies from which 37 studies were included (see Figure 1). COPD recommendations identified to be discordant with clinical practice included initiating non-invasive ventilation, over-or under-prescription of corticosteroids and antibiotics, and a lack of discharging patients with a smoking cessation plan or pulmonary rehabilitation. TDF domains with highest frequency scores were knowledge, environmental resources, and clinical behaviour regulation. Electronic order sets/digital proforma with guideline resources at point of care and easily accessible digital community referrals to target both pharmacological and non-pharmacological management appear to be a solution to improve concordance. Conclusion: Implementation of consistent quality improvement intervention within hospitals for patients with COPD may exclude any implementation gap and prevent readmissions. Electronic proformas with digital referrals will assist with future evaluation audits to prioritise and target interventions to improve guidelines concordance
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