1,721,094 research outputs found
How to do a scoping exercise: continuity of care
No full textThe NHS Research and Development Service, Delivery and organisation Programme (SDO), is commissioning research that directly addresses the concerns of patients and professionals. Following a national ‘listening exercise’, continuity of care was identified as a priority area of research, and the National Co-ordinating Centre of the SDO Programme commissioned a ‘scoping exercise’ to define and
limit the field of research on this subject. As this seems set to become a more common exercise, we explain how we interpreted the task of ‘scoping’, using some innovative methods. We raise some issues prevalent in many kinds of short-term research, and discuss some of the challenges and advantages of working in a multi-disciplinary team
Pulse oximetry in low-income settings: a case study of Kenyan hospitals
Get PDFPulse oximeters are low-cost, easy to use, and effective at detecting hypoxemia (low blood oxygen levels), a common complication of bronchiolitis, asthma, and pneumonia, the leading infectious cause of death in children worldwide. However, pulse oximeters are often unavailable in lowincome settings, and if available, often underused, yet little research investigates why.
In this thesis, I examine pulse oximeter implementation in low-income settings, focusing on Kenyan hospitals as a case study, and using a mixed-methods approach. I conducted a systematic literature review, examining how pulse oximeter use with children at admission to hospital impacts health outcomes; I then conducted quantitative analyses of 28,000 children admitted to seven Kenyan hospitals to determine with which children pulse oximeters are used, and pulse oximetryâs impact on treatment provision; these analyses informed the qualitative research component, for which I conducted interviews with 30 healthcare workers (HCWs) and staff in 14 Kenyan hospitals and employed theoretical frameworks to determine how HCWs decide whether to use pulse oximeters, and the barriers to pulse oximetry.
I found that pulse oximeter use varies substantially between and within Kenyan hospitals over time. After adjusting for case-mix and signs of illness severity, HCWs were most likely to use pulse oximeters with children with a very high respiratory rate, indrawing and/or who were not alert; children who obtained a pulse oximeter reading were more likely to be prescribed oxygen than if a pulse oximeter was not used; and children with a reading below 90% were more likely to be prescribed oxygen than those with higher readings, suggesting that HCW decision-making is influenced by international and national guidelines. However, HCWs sometimes cannot use pulse oximeters when they intend to, because of insufficient pulse oximeter availability, largely due to inefficient and confusing procurement processes and repair delays. Furthermore, HCWs sometimes use pulse oximeters incorrectly or misinterpret their results, because of insufficient training.
Pulse oximeter promotion programme planners can use the recommendations I provide to effectively target barriers to pulse oximeter uptake in low-income settings. Increased pulse oximetry implementation could enable early detection of hypoxemia, improving accurate diagnosis, and supporting prompt, effective treatment, which could help reduce mortality in children needing oxygen, in line with Sustainable Development Goal 3. </p
The value of electronic patient records for determining the prevalence and prognosis of cognitive and physical frailty in a large hospital-based cohort
Get PDFOlder people with frailty account for an increasing proportion of hospital admissions but access to specialised geriatric care varies. Data on the burden of cognitive and physical frailty hospital-wide and by specialty are currently limited but such data are necessary for informing clinical guidance, service-planning and policy. Routine clinical data captured in hospital electronic patient records (EPRs) offers an alternative to existing prospective and administrative coding data study designs but the value of these data for measuring frailty has not yet been studied. Therefore, my thesis aimed to evaluate ‘the value of hospital EPRs for determining the prevalence and prognosis of cognitive and physical frailty’ primarily using data from a large hospital-based cohort, i.e., the Oxford Cognitive Comorbidity, Ageing and Frailty Research Database-Electronic Patient Records (ORCHARD-EPR) study.First, in a systematic review/meta-analysis of 45 hospital-wide and general medicine cohorts, I showed that global frailty, measured using validated tools, was prevalent in older people with unplanned hospital admissions although heterogeneity was high and not explained by frailty tool, setting, or risk of bias. Despite variation in prevalence, frailty was consistently associated with mortality, length of stay (LoS) and discharge destination including after adjustment for confounders, although findings on readmissions were mixed. Notably, cognitive impairment, and in particular delirium, was poorly ascertained by all the frailty measures used in included studies and therefore prevalence of cognitive frailty and the degree of overlap with physical frailty was uncertain. In addition, all studies were either small prospective studies or large administrative datasets based on ICD-10 diagnostic coding except for three which used EPR data but were not validated.Second, I assembled, cleaned and validated data from the Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database-Electronic Patient Record (ORCHARD-EPR) 2017-2019 dataset which contains pseudo-anonymised Oxfordshire University Hospital NHS Foundation Trust EPR data for >=100,000 unplanned hospital admissions. Importantly, ORCHARD-EPR includes the results of mandatory cognitive screening in those >=70 years (existing dementia diagnosis, delirium diagnosis informed by the Confusion Assessment Methods-CAM and recorded as “certain” or “uncertain”, Abbreviated Mental Test-AMT). I validated cognitive frailty data from the cognitive screen for general medicine admissions in ORCHARD-EPR against a reference cohort. The prevalence of cognitive frailty (certain delirium, dementia, AMT<8) in general medicine admissions was 35% in ORCHARD-EPR (increasing to 41% when uncertain delirium diagnosis was included) compared to 50% in the reference data with the difference in prevalence largely explained by lower rates of delirium diagnosis in ORCHARD-EPR.Third, I determined that cognitive frailty (certain+uncertain delirium, dementia, AMT<8) was present in 35% of all ORCHARD-EPR admissions (n=51,202) across 29 specialties, with delirium the most common diagnosis. I also showed that any cognitive frailty predicted survival over up to four years of follow-up as well as LoS, delayed discharge, and discharge destination over and above age, sex, comorbidity and illness severity, with associations strongest for delirium. Additionally, only delirium in non-care home residents predicted readmission.Fourth, using a modified version of the Hospital Frailty Risk Score to measure physical frailty from ICD-10 codes, I found that moderate/severe physical frailty was present in 73% of individuals with cognitive frailty, but only 46% with physical frailty were cognitively frail. Despite being independently associated with survival, physical frailty added little to mortality risk in those with cognitive frailty but added markedly to LoS and risks of delayed discharge and discharge to a destination other than home.In conclusion, routinely acquired clinical frailty data is a valuable tool for research, capable of combining large, inclusive, hospital-wide sampling with accurate ascertainment as shown using ORCHARD-EPR. Similar approaches could be adopted at other centres but will likely only be useful if routine screening is embedded into the EPR and shown to reliably identify frail patients. Moreover, findings of high frailty prevalence across multiple specialties and impact on outcomes supports more widespread implementation of routine cognitive and physical frailty screening in older people with unplanned hospital admission in line with current guidance. Additionally, findings support increased emphasis on delirium in policy and research
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
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