1,721,085 research outputs found
Developing a methodology for the evaluation of acute and critical care outcomes in resource-limited settings
Get PDFThe burden of acute and critical illness in LMICs is high, and proportionally higher with poorer outcomes than in HIC. Structured surveillance, enabling systematic evaluation of acute and critical care outcomes, is largely lacking in LMICs. Many tools, including but not limited to prognostic models and decision-support tools, developed in HIC are mostly not validated in LMICs. In addition, acute and critical care skills training, necessary for improving the quality of care and outcomes, is not readily accessible for many healthcare workers. This thesis describes a baseline profile of acute and critical care services in Sri Lanka; the development and implementation of a national, electronic, critical and acute care surveillance system and an assessment of the feasibility of HIC decision-support tools in LMIC settings. It further describes a co-designed, sustainable, national acute and critical care training programme, supported by the surveillance platform.
Baseline profile: Overall ICU mortality was 17% but no severity of illness data was available. Overall, only 5.1% of those who had CPR attempted in hospital were alive after 24 hours, with most arrests anticipated by the junior medical team. Only 4.4% of wards use DNAR instructions. The 99 national ICUâs had relatively (to other LMICs) good staffing; 790 doctors (1.6 per bed) and 1989 nurses (3.9 per bed, 87.9% ICUs had 1:1 nurse to patient ratio). Evaluation of the applicability of APACHE II was hampered by arterial blood gases and electrolytes being available in only 18.7% and 63.4 % of ICU admissions respectively, and complete case records (for APACHE II) was only available in 1.6% of instances.
A surveillance platform for acute and critical care, fusing mobile data entry with visual analytics, was developed and implemented in 56 Sri Lankan hospitals, supporting clinicians in finding ICU beds. The dataset confirmed the low availability of variables commonly used to detect deterioration in acutely unwell ward patients; respiratory rate (65.24 %), mentation (32.89%) and oxygen saturation (23.94%), in a cohort of 16,386 patients. The platform was used for the validation of prognostic models and EWS tools, which showed that the performance of single variable trigger systems was comparable to more complex EWSâs regarding identification of at-risk patients. A simpler critical care prognostic model, (TropICS), based on variables more commonly available in LMICs and collected through the platform, was derived and evaluated, and shown to outperform APACHE II in this setting. The platform can also support critical care training; the thesis describes the development, execution, and evaluation of two clinically focused training programmes. A 2-year modular programme in Bangladesh, India and Nepal showed a positive impact on patient outcomes. In Sri Lanka, a peer-delivered, acute and critical care structured training programme was delivered to over 4,500 nurses, physiotherapists and doctors, increasing knowledge and confidence.
In summary, the work in this thesis describes a setting-adapted acute and critical care surveillance system, enabling the evaluation of the feasibility and performance of prognostication and decision-support tools, providing a template for LMIC settings. The studies show the importance of evaluation of clinical and benchmarking tools for feasibility and performance, and their adaptation where necessary, prior to their implementation in LMICs. In addition, the studies show that locally developed, sustainable training programmes aimed at improving outcomes in critically ill patients are possible in resource-limited settings. This thesis provides evidence that a clinician-led data platform in a LMIC can provide opportunities to evaluate (and potentially improve) outcomes by an inter-dependent cycle of enhanced information availability, quality improvement, capacity-building, training, and research.</p
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
Get PDF“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
Get PDFWe 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
Get PDFWe 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
Organisation, staffing and resources of critical care units in Kenya
No full textObjectiveTo describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors.Materials and methodsAn online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care.ResultsThe survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A total of 598 critical care beds were reported with a median of 6 beds (interquartile range [IQR] 5-11) per unit, with 26% beds (n = 157) being non functional. The proportion of ICU beds to total hospital beds was 3.8% (IQR 1.9-10.4). Most of the units (80%, n = 48) were mixed/general units with an open model of care (60%, n = 36). Consultants-in-charge were mainly anesthesiologists (69%, n = 37). The nurse-to-bed ratio was predominantly 1:2 with half of the nurses formally trained in critical care. Most units (83%, n = 47) had a dedicated ventilator for each bed, however 63% (n = 39) lacked high flow nasal therapy. While basic multiparametric monitoring was ubiquitous, invasive blood pressure measurement capacity was low (3% of beds, IQR 0-81%), and capnography moderate (31% of beds, IQR 0-77%). Blood gas analysers were widely available (93%, n = 56), with 80% reported as functional. Differences between the public and private sector were narrow.ConclusionThis study shows an established critical care network in Kenya, in terms of staffing density, availability of basic monitoring and ventilation resources. The public and private sector are equally represented albeit with modest differences. Potential areas for improvement include training, use of invasive blood pressure and functionality of blood gas analysers
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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