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Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, Spinks T, Talaulikar G. Older patients and dialysis shared decision-making. Insights from an ethnographic discourse analysis of interviews and clinical interactions. Patient Educ Couns 2024; 122:108124. [PMID: 38232671 DOI: 10.1016/j.pec.2023.108124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To describe and analyse the perspectives and communication practices of kidney clinicians and older patients (aged 60 +) during collaborative education and decision-making about dialysis. METHODS This qualitative study drew on pluralistic data sources and analytical approaches investigating elicited semi-structured interviews (n = 31) with doctors (n = 8), nurses (n = 8) and patients (n = 15), combined with ethnographic observations, written artefacts and audio-recorded naturally-occurring interactions (n = 23, education sessions n = 4; consultations n = 19) in a tertiary Australian kidney outpatient clinic. Data were analysed for themes and linguistic discourse features. RESULTS Five themes were identified across all data sources: 1) lost opportunity in education; 2) persistent disease knowledge gaps; 3) putting up with dialysis; 4) perceived and real involvement in decision-making and 5) complex role of family as decision-making brokers. CONCLUSION As the first study to complement interviews with evidence from naturally-occurring kidney interactions, this study balances the perspectives of how older patients and their clinicians view chronic kidney disease education, with how decision-making about dialysis is reflected in practice. PRACTICE IMPLICATIONS The study provides suggestions for contextualized, multi-perspectives formal and informal training for improving decision-making about dialysis, spanning from indications to boost communication efficiency, to reducing unexplained jargon, incorporating patient navigators and exploring different dialysis modalities.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia.
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Laura J Chien
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Alice Kennard
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Giles Walters
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Tony Spinks
- Canberra Hospital Renal Service, Canberra, Australia
| | - Girish Talaulikar
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
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Chien LJ, Slade D, Goncharov L, Taylor J, Dahm MR, Brady B, McMahon J, Raine SE, Thornton A. Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study. J Clin Nurs 2024. [PMID: 38528438 DOI: 10.1111/jocn.17107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/08/2023] [Accepted: 01/19/2024] [Indexed: 03/27/2024]
Abstract
AIM To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. DESIGN A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. METHODS We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact. RESULTS Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. CONCLUSION Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. RELEVANCE TO CLINICAL PRACTICE Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. REPORTING METHOD We adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION We interviewed patients on study wards pre and post intervention.
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Affiliation(s)
- Laura J Chien
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Liza Goncharov
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, Sydney, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia
| | - Maria R Dahm
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Bernadette Brady
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia
- St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, Sydney, Australia
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Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, Spinks T, Talaulikar G. Shared decision making in chronic kidney disease: a qualitative study of the impact of communication practices on treatment decisions for older patients. BMC Nephrol 2023; 24:383. [PMID: 38129771 PMCID: PMC10734071 DOI: 10.1186/s12882-023-03406-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Effective interpersonal communication is critical for shared decision-making (SDM). Previous SDM communication training in nephrology has lacked context-specific evidence from ethnographic analysis of SDM interactions with older patients considering treatment options of end stage kidney disease (ESKD). This study explores communication strategies in SDM discussions in nephrology, specifically focusing on older patients considering dialysis as kidney replacement therapy (KRT). METHODS We conducted a qualitative study analysing naturally-occurring audio-recorded clinical interactions (n = 12) between Australian kidney doctors, patients aged 60+, and carers. Linguistic ethnography and qualitative socially-oriented functional approaches were used for analysis. RESULTS Two types of communication strategies emerged: (1) Managing and advancing treatment decisions: involving active checking of knowledge, clear explanations of options, and local issue resolution. (2) Pulling back: Deferring or delaying decisions through mixed messaging. Specifically for non-English speaking patients, pulling back was further characterised by communication challenges deferring decision-making including ineffective issue management, and reliance on family as interpreters. Age was not an explicit topic of discussion among participants when it came to making decisions about KRT but was highly relevant to treatment decision-making. Doctors appeared reluctant to broach non-dialysis conservative management, even when it appears clinically appropriate. Conservative care, an alternative to KRT suitable for older patients with co-morbidities, was only explicitly discussed when prompted by patients or carers. CONCLUSIONS The findings highlight the impact of different communication strategies on SDM discussions in nephrology. This study calls for linguistic-informed contextualised communication training and provides foundational evidence for nephrology-specific communication skills training in SDM for KRT among older patients. There is urgent need for doctors to become confident and competent in discussing non-dialysis conservative management. Further international research should explore naturally-occurring SDM interactions in nephrology with other vulnerable groups to enhance evidence and training integration.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia.
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Diana Slade
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Laura J Chien
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Alice Kennard
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Giles Walters
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Tony Spinks
- Canberra Hospital Renal Service, Canberra, Australia
| | - Girish Talaulikar
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
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Liu M, Whittam S, Thornton A, Goncharov L, Slade D, McElduff B, Kelly P, Law CK, Walsh S, Pollnow V, Cuffe J, McMahon J, Aggar C, Bilo J, Bowen K, Chow JSF, Duffy K, Everett B, Ferguson C, Frost SA, Gleeson N, Hackett K, Komusanac I, Marshall S, May S, McErlean G, Melbourne G, Murphy J, Newbury J, Newman D, Rihari-Thomas J, Sciuriaga H, Sturgess L, Taylor J, Tuqiri K, McInnes E, Middleton S. Correction: the ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation. BMC Nurs 2023; 22:445. [PMID: 38001514 PMCID: PMC10668453 DOI: 10.1186/s12912-023-01589-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Affiliation(s)
- Mark Liu
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Susan Whittam
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Liza Goncharov
- Institute for Communication in Healthcare, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Acton, ACT, 2601, Australia
| | - Diana Slade
- Institute for Communication in Healthcare, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Acton, ACT, 2601, Australia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Patrick Kelly
- School of Public Health, University of Sydney, Edward Ford Building, A27 Fisher Road, Camperdown, NSW, 2006, Australia
| | - Chi Kin Law
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92‑94 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Sarah Walsh
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Vivien Pollnow
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Jayde Cuffe
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Christina Aggar
- Southern Cross University, Military Road, East Lismore, NSW, 2480, Australia
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Jacqueline Bilo
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Karen Bowen
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Josephine S F Chow
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
| | - Katharine Duffy
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Bronwyn Everett
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Caleb Ferguson
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Steven A Frost
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Narelle Gleeson
- Lismore Base Hospital, 60 Uralba Street, Lismore, NSW, 2480, Australia
| | - Kate Hackett
- South Eastern Sydney Local Health District, The Sutherland Hospital and Community Health Service, Corner The Kingsway and Kareena Road, Caringbah, NSW, 2229, Australia
| | - Ivanka Komusanac
- Sydney Local Health District, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Sonia Marshall
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
| | - Sharon May
- Fairfield Hospital, Polding Street and Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Gemma McErlean
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Gregory Melbourne
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
| | - Jade Murphy
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Joanne Newbury
- The Sutherland Hospital, Corner The Kingsway and Kareena Road, Caringbah, NSW, 2229, Australia
| | - Deb Newman
- Lismore Base Hospital, 60 Uralba Street, Lismore, NSW, 2480, Australia
| | - John Rihari-Thomas
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Hayley Sciuriaga
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Lauren Sturgess
- St George Hospital, Gray Street, Kogarah, NSW, 2217, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Karen Tuqiri
- Prince of Wales Hospital, 320‑346 Barker Street, Randwick, NSW, 2031, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia.
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5
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Liu M, Whittam S, Thornton A, Goncharov L, Slade D, McElduff B, Kelly P, Law CK, Walsh S, Pollnow V, Cuffe J, McMahon J, Aggar C, Bilo J, Bowen K, Chow JSF, Duffy K, Everett B, Ferguson C, Frost SA, Gleeson N, Hackett K, Komusanac I, Marshall S, May S, McErlean G, Melbourne G, Murphy J, Newbury J, Newman D, Rihari-Thomas J, Sciuriaga H, Sturgess L, Taylor J, Tuqiri K, McInnes E, Middleton S. The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation. BMC Nurs 2023; 22:275. [PMID: 37605224 PMCID: PMC10440862 DOI: 10.1186/s12912-023-01439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients' bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost-benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries. METHODS A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses' education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and 'Code Blue' calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses' perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses' and medical officers' perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost-benefit analysis and post-trial process evaluation will also be undertaken. DISCUSSION If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.
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Grants
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- 1196352 National Health and Medical Research Council Investigator Leadership Grant
- New South Wales Nursing and Midwifery Strategy Reserve Fund
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Affiliation(s)
- Mark Liu
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Susan Whittam
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Liza Goncharov
- Institute for Communication in Healthcare, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Acton, ACT, 2601, Australia
| | - Diana Slade
- Institute for Communication in Healthcare, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Acton, ACT, 2601, Australia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Patrick Kelly
- School of Public Health, University of Sydney, Edward Ford Building, A27 Fisher Road, Camperdown, NSW, 2006, Australia
| | - Chi Kin Law
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Sarah Walsh
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Vivien Pollnow
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Jayde Cuffe
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Christina Aggar
- Southern Cross University, Military Road, East Lismore, NSW, 2480, Australia
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Jacqueline Bilo
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Karen Bowen
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Josephine S F Chow
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
| | - Katharine Duffy
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Bronwyn Everett
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Caleb Ferguson
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Steven A Frost
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Narelle Gleeson
- Lismore Base Hospital, 60 Uralba Street, Lismore, NSW, 2480, Australia
| | - Kate Hackett
- South Eastern Sydney Local Health District, The Sutherland Hospital and Community Health Service, Corner The Kingsway and Kareena Road, Caringbah, NSW, 2229, Australia
| | - Ivanka Komusanac
- Sydney Local Health District, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Sonia Marshall
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
| | - Sharon May
- Fairfield Hospital, Polding Street and Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Gemma McErlean
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Gregory Melbourne
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
| | - Jade Murphy
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Joanne Newbury
- The Sutherland Hospital, Corner The Kingsway and Kareena Road, Caringbah, NSW, 2229, Australia
| | - Deb Newman
- Lismore Base Hospital, 60 Uralba Street, Lismore, NSW, 2480, Australia
| | - John Rihari-Thomas
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Hayley Sciuriaga
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Lauren Sturgess
- St George Hospital, Gray Street, Kogarah, NSW, 2217, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Karen Tuqiri
- Prince of Wales Hospital, 320-346 Barker Street, Randwick, NSW, 2031, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia.
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Rihari-Thomas J, Whittam S, Goncharov L, Slade D, McElduff B, Pritchard T, McMahon J, Coventry A, Coughlan K, Steadward Y, Taylor J, Thornton A, Riddell K, Tuqiri K, Olesen K, Dahm MR, Chien L, Kelly P, McInnes E, Middleton S. Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Chien LJ, Slade D, Dahm MR, Brady B, Roberts E, Goncharov L, Taylor J, Eggins S, Thornton A. Improving patient-centred care through a tailored intervention addressing nursing clinical handover communication in its organizational and cultural context. J Adv Nurs 2022; 78:1413-1430. [PMID: 35038346 PMCID: PMC9304151 DOI: 10.1111/jan.15110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 12/05/2022]
Abstract
Aims To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover. Design Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention. Methods Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data. Results Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications. Conclusions Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success. Impact Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals.
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Affiliation(s)
- Laura J Chien
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Diana Slade
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Maria R Dahm
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bernadette Brady
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Liza Goncharov
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia.,Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, New South Wales, Australia
| | - Suzanne Eggins
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia.,Australian Catholic University, Sydney, New South Wales, Australia
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8
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Adams ST, Slade D, Shuttleworth P, West C, Scott M, Benson A, Tokala A, Walsh CJ. Reading a preoperative CT scan to guide complex abdominal wall reconstructive surgery. Hernia 2022; 27:265-272. [PMID: 34988686 DOI: 10.1007/s10029-021-02548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
Computed tomography (CT) scanning is the imaging modality of choice when planning the overall management and operative approach to complex abdominal wall hernias. Despite its availability and well-recognised benefits there are no guidelines or recommendations regarding how best to read or report such scans for this application. In this paper we aim to outline an approach to interpreting preoperative CT scans in abdominal wall reconstruction (AWR). This approach breaks up the interpretive process into 4 steps-concentrating on the hernia or hernias, any complicating features of the hernia(s), the surrounding soft tissues and the abdominopelvic cavity as a whole-and was developed as a distillation of the authors' collective experience. We describe the key features that should be looked for at each of the four steps and the rationale for their inclusion.
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Affiliation(s)
- S T Adams
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK. .,Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, Wirral, CH49 5PE, UK. .,Department of General Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK.
| | - D Slade
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, Lancashire, UK
| | - P Shuttleworth
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, Wirral, CH49 5PE, UK
| | - C West
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - M Scott
- Department of General Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - A Benson
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - A Tokala
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, Lancashire, UK
| | - C J Walsh
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, Wirral, CH49 5PE, UK
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9
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Parker SG, Halligan S, Berrevoet F, de Beaux AC, East B, Eker HH, Jensen KK, Jorgensen LN, Montgomery A, Morales-Conde S, Miserez M, Renard Y, Sanders DL, Simons M, Slade D, Torkington J, Blackwell S, Dames N, Windsor ACJ, Mallett S. Reporting guideline for interventional trials of primary and incisional ventral hernia repair. Br J Surg 2021; 108:1050-1055. [PMID: 34286842 DOI: 10.1093/bjs/znab157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/02/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary and incisional ventral hernia trials collect unstandardized inconsistent data, limiting data interpretation and comparison. This study aimed to create two minimum data sets for primary and incisional ventral hernia interventional trials to standardize data collection and improve trial comparison. To support these data sets, standardized patient-reported outcome measures and trial methodology criteria were created. METHODS To construct these data sets, nominal group technique methodology was employed, involving 15 internationally recognized abdominal wall surgeons and two patient representatives. Initially a maximum data set was created from previous systematic and panellist reviews. Thereafter, three stages of voting took place: stage 1, selection of the number of variables for data set inclusion; stage 2, selection of variables to be included; and stage 3, selection of variable definitions and detection methods. A steering committee interpreted and analysed the data. RESULTS The maximum data set contained 245 variables. The three stages of voting commenced in October 2019 and had been completed by July 2020. The final primary ventral hernia data set included 32 variables, the incisional ventral hernia data set included 40 variables, the patient-reported outcome measures tool contained 25 questions, and 40 methodological criteria were chosen. The best known variable definitions were selected for accurate variable description. CT was selected as the optimal preoperative descriptor of hernia morphology. Standardized follow-up at 30 days, 1 year, and 5 years was selected. CONCLUSION These minimum data sets, patient-reported outcome measures, and methodological criteria have allowed creation of a manual for investigators aiming to undertake primary ventral hernia or incisional ventral hernia interventional trials. Adopting these data sets will improve trial methods and comparisons.
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Affiliation(s)
- S G Parker
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - A C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B East
- 3rd Department of Surgery, Motol University Hospital, 1st and 2nd Medical Faculty of Charles University, Prague, Czech Republic
| | - H H Eker
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K K Jensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L N Jorgensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Montgomery
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals of the Katholieke Universiteit Leuven, Leuven, Belgium
| | - Y Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - D L Sanders
- Department of General and Upper Gastrointestinal Surgery, North Devon District Hospital, Barnstaple, UK
| | - M Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | - D Slade
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | | | - N Dames
- Patient Representative, Glasgow, UK
| | - A C J Windsor
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Mallett
- Centre for Medical Imaging, University College London, London, UK
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10
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Goodmaker CJG, Kopczynska M, Meskell R, Slade D. Paving the road to recovery: the colorectal surgery ERAS pathway during the COVID-19 pandemic. Br J Surg 2021; 108:e322-e323. [PMID: 34227658 PMCID: PMC8406880 DOI: 10.1093/bjs/znab208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 12/02/2022]
Affiliation(s)
- C J G Goodmaker
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - M Kopczynska
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - R Meskell
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - D Slade
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
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11
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Collins GP, Booth S, Cherrill LR, Slade D, Morland C, Hopkins L, Nagy E, Linton K, Fox CP, Lewis D, Davies A, Turner G, Rees G, Yap C, Cwynarski K. ROMIDEPSIN AND CARFILZOMIB IN RELAPSED / REFRACTORY PERIPHERAL T‐CELL LYMPHOMA WITH ASSESSMENT OF H23B AS A PREDICTIVE BIOMARKER – THE UK NCRI SEAMLESS PHASE 1/2 ROMICAR TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.126_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- G. P. Collins
- NIHR Oxford Biomedical Research Centre Churchill Hospital Haematology Oxford UK
| | - S. Booth
- Churchill Hospital Clinical Haematology Oxford UK
| | - L. R. Cherrill
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - D. Slade
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - C. Morland
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - L. Hopkins
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - E. Nagy
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - K. Linton
- Christie Hospital Medical onology Manchester UK
| | - C. P. Fox
- Nottingham University Hospitals NHS Foundation Trust Haematology Nottingham UK
| | - D. Lewis
- Plymouth Hospitals NHS Trust Haematology Plymouth UK
| | - A. Davies
- University of Southampton CRUK/NIHR Experimental Cancer Medicines Centre Southampton UK
| | - G. Turner
- Oxford University Hospitals NHS Foundation Trust Cellular Pathology Oxford UK
| | - G. Rees
- Oxford University Hospitals NHS Foundation Trust Cellular Pathology Oxford UK
| | - C. Yap
- Institute of Cancer Research Clinical Studies London UK
| | - K. Cwynarski
- University College London Hospitals NHS Foundation Trust Haematology London UK
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12
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Yap J, Slade D, Goddard H, Dawson C, Ganesan R, Velangi S, Sahu B, Kaur B, Hughes A, Luesley D. Sinecatechins ointment as a potential novel treatment for usual type vulval intraepithelial neoplasia: a single-centre double-blind randomised control study. BJOG 2021; 128:1047-1055. [PMID: 33075197 DOI: 10.1111/1471-0528.16574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of 10% sinecatechins (Veregen® ) ointment against placebo in the treatment of usual type vulvar intraepithelial neoplasia (uVIN). DESIGN A Phase II double-blind randomised control trial. SETTING A tertiary gynaecological oncology referral centre. POPULATION All women diagnosed with primary and recurrent uVIN. METHODS Eligible patients were randomised 1:1 to receive either sinecatechins or placebo ointment (applied three times daily for 16 weeks) and were followed up at 2, 4, 8, 16, 32 and 52 weeks. MAIN OUTCOME MEASURES The primary outcome measure, recorded at 16 and 32 weeks, was histological response (HR). Secondary outcome measures included clinical (CR) response, toxicity, quality of life and pain scores. RESULTS There was no observed difference in HR between the two arms. However, of the 26 patients who were randomised, all 13 patients who received sinecatechins showed either complete (n = 5) or partial (n = 8) CR, when best CR was evaluated. In placebo group, three patients had complete CR, two had partial CR, six had stable disease and two were lost to follow up. Patients in the sinecatechins group showed a statistically significant improvement in best observed CR as compared with the placebo group (P = 0.002). There was no difference in toxicity reported in either group. CONCLUSION Although we did not observe a difference in HR between the two treatment arms, we found that 10% sinecatechins application is safe and shows promise in inducing clinical resolution of uVIN lesions and symptom improvement, thus warranting further investigation in a larger multicentre study. TWEETABLE ABSTRACT A randomised control study indicating that sinecatechins ointment may be a novel treatment for uVIN.
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Affiliation(s)
- J Yap
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - D Slade
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - H Goddard
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - C Dawson
- Department of Microbiology & Infection, Warwick Medical School, University of Warwick, Coventry, UK
| | - R Ganesan
- Department of Histopathology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - S Velangi
- Department of Dermatology, Queen Elizabeth Hospital, Birmingham, UK
| | - B Sahu
- Department of Obstetrics and Gynaecology, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - B Kaur
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - A Hughes
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - D Luesley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
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13
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Averell C, Germain G, Laliberté F, Duh M, Lima R, Slade D. P218 ASTHMA-RELATED EXACERBATIONS AND SABA USE ASSOCIATED WITH ONCE-DAILY FLUTICASONE FUROATE/VILANTEROL COMPARED TO TWICE-DAILY BUDESONIDE/FORMOTEROL. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Scholz B, Goncharov L, Emmerich N, Lu VN, Chapman M, Clark SJ, Wilson T, Slade D, Mitchell I. Clinicians' accounts of communication with patients in end-of-life care contexts: A systematic review. Patient Educ Couns 2020; 103:1913-1921. [PMID: 32650998 DOI: 10.1016/j.pec.2020.06.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Communication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians' understandings of communication in end-of-life care. METHODS A systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms "palliative care," "terminal care" or "end-of-life care," and "communication". Articles were assessed for quality using a modified JQI-QARI tool. RESULTS The findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication. CONCLUSION Training needs for effective communication in end-of-life contexts are not currently being met. PRACTICE IMPLICATIONS Clinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.
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Affiliation(s)
- Brett Scholz
- Medical School, The Australian National University, Canberra, Australia.
| | - Liza Goncharov
- School of Literature, Languages and Linguistics, The Australian National University, Canberra, Australia
| | - Nathan Emmerich
- Medical School, The Australian National University, Canberra, Australia
| | - Vinh N Lu
- College of Business and Economics, The Australian National University, Canberra, Australia
| | - Michael Chapman
- Medical School, The Australian National University, Canberra, Australia; Canberra Health Service, ACT Health, Canberra, Australia
| | - Shannon J Clark
- School of Literature, Languages and Linguistics, The Australian National University, Canberra, Australia
| | - Tracey Wilson
- Medical Intensive Care Unit, University of Maryland, Baltimore, USA
| | - Diana Slade
- School of Literature, Languages and Linguistics, The Australian National University, Canberra, Australia
| | - Imogen Mitchell
- Medical School, The Australian National University, Canberra, Australia; Canberra Health Service, ACT Health, Canberra, Australia
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15
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Pun J, Chan EA, Eggins S, Slade D. Training in communication and interaction during shift-to-shift nursing handovers in a bilingual hospital: A case study. Nurse Educ Today 2020; 84:104212. [PMID: 31669969 DOI: 10.1016/j.nedt.2019.104212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 07/06/2019] [Accepted: 09/14/2019] [Indexed: 06/10/2023]
Abstract
AIM To explore the perceptions and practices of nurses on handovers. BACKGROUND At handover, accountability must be transferred to ensure a consistent quality of patient care. Studies highlighted unstructured handovers as a major factor contributing to critical incidents. The design of handover training requires a systematic method for evaluating nurses' practices. DESIGN An explorative case study, qualitative design that combined ethnography with discourse analysis. METHODS A training programme based on these practices was administered to 50 nurses, and a protocol focused on CARE was implemented. The nurses' perceptions and practices were evaluated, and 80 handovers were recorded. RESULTS Three areas likely to enhance the continuity of care emerged: 1) explicit transfer of responsibility by outgoing nurses; 2) responsible engagement of incoming nurses in the handover and 3) adherence to a systematic handover structure. CONCLUSION The change in practice from monologic handovers with passive incoming nurses before training to interactive and collaborative handovers, where all nurses appeared to take an active role in clarifying patients' cases, after training was significant.
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Affiliation(s)
- Jack Pun
- Department of English, The City University of Hong Kong, Hong Kong, China.
| | - E Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Suzanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Australia
| | - Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Australia
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16
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Dretchen K, Tuttle R, Popescu L, Mesa Z, Robben M, Slade D, Hill S, Croutch C, Mesa M. P402 INTRANASAL EPINEPHRINE EFFECTS ON PHARMACOKINETICS AND HEART RATE IN A NASAL CONGESTION CANINE MODEL. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Thomas S, Reynolds D, Morrall MCHJ, Limond J, Chevignard M, Calaminus G, Poggi G, Bennett E, Frappaz D, Slade D, Gautier J, McQuilton P, Massimino M, Grundy R. The European Society of Paediatric Oncology Ependymoma-II program Core-Plus model: Development and initial implementation of a cognitive test protocol for an international brain tumour trial. Eur J Paediatr Neurol 2019; 23:560-570. [PMID: 31182404 DOI: 10.1016/j.ejpn.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
Abstract
It is increasingly accepted that survival alone is an inadequate measure of the success of childhood brain tumour treatments. Consequently, there is growing emphasis on capturing quality of survival. Ependymomas are the third most frequently occurring brain tumours in childhood and present significant clinical challenges. European Society of Paediatric Oncology Ependymoma II is a comprehensive international program aiming to evaluate outcomes under different treatment regimens and improve diagnostic accuracy. Importantly, there has been agreement to lower the age at which children with posterior fossa ependymoma undergo focal irradiation from three years to either eighteen months or one year of age. Hitherto radiotherapy in Europe had been reserved for children over three years due to concerns over adverse cognitive outcomes following irradiation of the developing brain. There is therefore a duty of care to include longitudinal cognitive follow-up and this has been agreed as an essential trial outcome. Discussions between representatives of 18 participating European countries over 10 years have yielded European consensus for an internationally accepted test battery for follow-up of childhood ependymoma survivors. The 'Core-Plus' model incorporates a two-tier approach to assessment by specifying core tests to establish a minimum dataset where resources are limited, whilst maintaining scope for comprehensive assessment where feasible. The challenges leading to the development of the Core-Plus model are presented alongside learning from the initial stages of the trial. We propose that this model could provide a solution for future international trials addressing both childhood brain tumours and other conditions associated with cognitive morbidity.
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Affiliation(s)
- S Thomas
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - D Reynolds
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - M C H J Morrall
- Department of Paediatric Neuropsychology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - J Limond
- Psychology, College of Life and Environmental Sciences, Washington Singer Laboratories, University of Exeter, Perry Road, EX4 4QG, UK
| | - M Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, 14, rue du Val d'Osne, 94410, Saint Maurice, France; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
| | - G Calaminus
- University Children's Hospital Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - G Poggi
- Neuro-Oncological Rehabilitation Unit- IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - E Bennett
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - D Frappaz
- Institut d'Hématologie Oncologie pédiatrique, Lyon, France
| | - D Slade
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - J Gautier
- Institut d'Hématologie Oncologie pédiatrique, Lyon, France
| | - P McQuilton
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - M Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Grundy
- Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Pun J, Chan EA, Man M, Eggins S, Slade D. Pre- and post evaluations of the effects of the Connect, Ask, Respond and Empathise (CARE) protocol on nursing handover: A case study of a bilingual hospital in Hong Kong. J Clin Nurs 2019; 28:3001-3011. [PMID: 30938014 DOI: 10.1111/jocn.14871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/15/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate (a) the perceived effects of the training provided to nurses under a standardised Connect, Ask, Respond and Empathise (CARE) protocol; (b) the ability to enhance the effectiveness of the ISBAR checklist; (c) any increase in nurses' spoken interactions and/or improved comprehension of the patient conditions upon the transfer of responsibility. BACKGROUND Nursing handover is a pivotal act of communication with effects on both patient safety and risk management. Previous studies of critical incidents have highlighted ineffective communication, including a lack of interaction and incomplete and unstructured handovers, as a major contributor to patient harm. DESIGN A pre- and post evaluation study involving a questionnaire survey before and after the 3-hours training. METHODS Forty-nine randomly selected bilingual nurses with no previous professional development experience in handover communication were trained according to the CARE protocol, and their perceptions of nursing handovers were assessed before and after training using questionnaire. The STROBE checklist is used (See File S1). RESULTS Training of the CARE protocol improved key areas of the handover process. All participating nurses exhibited significant improvements in their perceptions of effective handover from before to after training. Particularly, improvements were observed in the interactive frequency and quality and completeness of the presented patient information per handover. CONCLUSIONS The nurses reported a deeper understanding of their perceptions of handover after a patient-centred intervention, a better quality of interactions (e.g., querying and checking by incoming nurses), a greater focus when managing handovers and a more complete and comprehensive transfer of information between nurses. RELEVANCE TO CLINICAL PRACTICE CARE protocol-based training yielded significant improvements in nursing handover practice.
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Affiliation(s)
- Jack Pun
- Department of English, The City University of Hong Kong, Hong Kong SAR, China
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Manbo Man
- Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Suanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
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Collins BJ, Slade D, Ryan K, Mathias R, Shan A, Algaier J, Aillon K, Waidyanatha S. Development and Validation of an Analytical Method to Quantitate Tris(chloroisopropyl)phosphate in Rat and Mouse Plasma using Gas Chromatography with Flame Photometric Detection. J Anal Toxicol 2019; 43:36-44. [PMID: 30060005 DOI: 10.1093/jat/bky048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 11/14/2022] Open
Abstract
Tris(chloropropyl)phosphate (TCPP) is an organophosphorus flame retardant (OPFR) and plasticizer increasingly used in consumer products and as a replacement for brominated flame retardants. Commercially available TCPP is a mixture of four structural isomers the most abundant of which is tris(1-chloro-2-propyl)phosphate (TCPP-1). Although there is a widespread use of TCPP and potential for human exposure, there is limited data on the safety or toxicity of TCPP. The National Toxicology Program is conducting long-term studies to examine the toxicity of the TCPP in rats after lifetime exposure, including perinatal oral exposure. Quantitative estimates of internal dose are essential to interpret toxicological findings in rodents. To aid in this, a method was fully validated to quantitate the most abundant isomer, TCPP-1, in female Harlan Sprague Dawley (HSD) rat and B6C3F1 mouse plasma with partial validation in male rat plasma, and male and female mouse plasma. The method used protein precipitation using trichloroacetic acid followed by the extraction with toluene, and analysis by gas chromatography with flame photometric detection. The performance of the method was evaluated over 5-70 ng TCPP-1/mL plasma. The method was linear (r ≥ 0.99), accurate (inter-day relative error: ≤ ± -7.2) and precise (inter-batch relative standard deviation: ≤27.5%). The validated method has lower limits of quantitation and detection of ~5 and 0.9 ng/mL, respectively, in female HSD rat plasma and can be used on samples as small as 50 μL demonstrating the applicability to plasma samples from toxicology studies.
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Affiliation(s)
- B J Collins
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, 111 Alexander Dr., Research Triangle Park, NC, USA
| | - D Slade
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, USA
| | - K Ryan
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, 111 Alexander Dr., Research Triangle Park, NC, USA
| | - R Mathias
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, USA
| | - A Shan
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, USA
| | - J Algaier
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, USA
| | - K Aillon
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, USA
| | - S Waidyanatha
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, 111 Alexander Dr., Research Triangle Park, NC, USA
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Walsh C, Battersby C, Suggett N, Slade D. Lessons from cadaveric dissection in AWR. Hernia 2019; 23:175-176. [DOI: 10.1007/s10029-018-1793-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 06/09/2018] [Indexed: 10/28/2022]
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Slade D, Murray KA, Pun JKH, Eggins S. Nurses’ perceptions of mandatory bedside clinical handovers: An Australian hospital study. J Nurs Manag 2018; 27:161-171. [DOI: 10.1111/jonm.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
| | - Kristen A. Murray
- Department of English; The Hong Kong Polytechnic University; Hong Kong SAR China
| | - Jack K. H. Pun
- Department of English; City University of Hong Kong; Hong Kong SAR China
| | - Suzanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
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Slade D, Pun J, Murray KA, Eggins S. Benefits of Health Care Communication Training for Nurses Conducting Bedside Handovers: An Australian Hospital Case Study. J Contin Educ Nurs 2018; 49:329-336. [DOI: 10.3928/00220124-20180613-09] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/27/2018] [Indexed: 11/20/2022]
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Pun JKH, Chan EA, Wang S, Slade D. Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China. Patient Educ Couns 2018; 101:1193-1206. [PMID: 29422231 DOI: 10.1016/j.pec.2018.01.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide an integrative review of literature on health communication in East Asia and detail culturally-specific influences. METHODS Using PRISMA model, search of PubMed, PsychInfo, Web of Knowledge, ERIC and CINAHL databases were conducted for studies between January 2000 and March 2017, using the terms 'clinician/health professional-patient', 'nurse/doctor-patient, 'communication' and 'Asia'. RESULTS 38 studies were included: Mainland China, Hong Kong, Japan, South Korea, and Taiwan. The existing body of research on clinician patient communication in East Asia can be classified: 1) understanding the roles and expectations of the nurse, clinician, patient, and family in clinician-patient consultations: a) nurse-patient communication; b) doctor-patient communication; c) the role of family member; and 2) factors affecting quality of care: d) cultural attitudes towards death and terminal illnesses; e) communication preferences affecting trust, decision-making and patient satisfaction; f) the extent to which patient centred care is being implemented in practice; and g) communication practices in multilingual/multi-disciplinary environments. CONCLUSION The review detailed the complexity and heterogeneity of clinician-patient communication across East Asia. The studies reviewed indicate that research in East Asia is starting to move beyond a preference for Western-based communication practices. PRACTICE IMPLICATIONS There is a need to consider local culture in understanding and interpreting medical encounters in East Asia. The paper highlights the need for a specific culturally-appropriate model of health communication in East Asia which may significantly improve relationships between clinicians and patients.
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Affiliation(s)
- Jack K H Pun
- Department of English, The City University of Hong Kong, 83, Tat Chee Avenue, Kowloon, Hong Kong, China; Department of Education, St Antony's College, University of Oxford, 15 Norham Gardens, Oxford, United Kingdom; The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia.
| | - E Angela Chan
- The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia; School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Sophie Wang
- Faculty of Arts and Social Science, The University of Technology Sydney, Sydney, Australia
| | - Diana Slade
- The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia; School of Literature, Language and Linguistics, ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australia
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Slade D, Chandler E, Pun J, Lam M, Matthiessen C, Williams G, Espindola E, Veloso F, Tsui K, Tang S, Tang K. Effective Healthcare Worker-Patient Communication in Hong Kong Accident and Emergency Departments. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200201] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction This paper reports on research conducted within a Hong Kong (HK) accident and emergency department (AED), which investigated the effectiveness of health care worker-patient communication over the course of patients' journeys from triage to disposition. Methods The research combined qualitative and quantitative ethnographic methods with linguistically-oriented discourse analysis of audiotaped interactions between patients and health care workers. It involved: (1) observations, (2) semi-structured interviews with management and health care workers, (3) surveys with AED staff, (4) audio-recordings of 10 patients' journeys, and (5) follow-up interviews with patients. Results The paper described the typically complex communication networks involved in AED care. It then exemplified how certain communicative strategies, balancing the communication of medical knowledge with interpersonal communication, could be used to achieve positive healthcare outcomes. This was illustrated by a case study of one patient's journey through the AED, pinpointing health care workers' effective use of communication strategies, their effect on the patient's participation and subsequently the patient's understanding and evaluation of the care he received. Conclusion The high stress nature of AEDs inevitably poses challenges to communication. The results of this study, however, strongly suggest a correlation between health care workers' use of effective, interpersonally sensitive communication strategies and positive patient outcomes. Health care worker-patient communication that effectively balances interpersonal communication with the communication of medical expertise is integral to ensuring patients' participation in, understanding of, and satisfaction with their healthcare. These communication strategies should be required components in health care worker communication training. (Hong Kong j.emerg.med. 2015;22:69-83)
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Affiliation(s)
| | - E Chandler
- Department of English, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - J Pun
- Department of English, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - M Lam
- Department of English, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Cmim Matthiessen
- Department of English, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - G Williams
- Department of English, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - E Espindola
- Department of English, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Fod Veloso
- Department of English, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Kl Tsui
- Tuen Mun Hospital, Accident & Emergency Department, Tsing Chung Koon Road, Tuen Mun, New Territores, Hong Kong
| | - Syh Tang
- Quality & Safety Division, New Territories West Cluster, Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Ks Tang
- Tuen Mun Hospital, Accident & Emergency Department, Tsing Chung Koon Road, Tuen Mun, New Territores, Hong Kong
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Leung CCH, Pun J, Lock G, Slade D, Gomersall CD, Wong WT, Joynt GM. Exploring the scope of communication content of mechanically ventilated patients. J Crit Care 2017; 44:136-141. [PMID: 29102851 DOI: 10.1016/j.jcrc.2017.10.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Ineffective communication during mechanical ventilation (MV) and critical illness is distressing to many patients. This study aimed to describe the scope of communication content of ventilated critically ill patients. MATERIALS AND METHODS We performed a prospective qualitative interview study in a multidisciplinary intensive care unit. Ten alert, orientated adult patients who previously underwent MV for at least 24h and were able to speak at the time of interview were recruited. Semi-structured interviews with stimulated recall technique were conducted. A descriptive thematic analysis was performed of the patient-generated content using a free coding technique, where recurrent themes and subthemes were noted, coded and analyzed. RESULTS Patients' communication content included medical discussions with clinicians; communication with family to provide advice or comfort, make requests and plans, express feelings and convey personal perspectives on medical care; and expression of their own psychoemotional needs. CONCLUSIONS The scope of communication content of ventilated ICU patients was broad, extending far beyond task-focused subject matter. Content ranged from conveying symptom-related messages to active participation in medical discussions, to conversing with family about a range of complex multi-dimensional issues, to sharing their own psychoemotional experiences. These patient-centered needs should be recognized and addressed in communication strategies.
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Affiliation(s)
- Czarina C H Leung
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Jack Pun
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Graham Lock
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Diana Slade
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Charles D Gomersall
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Wai Tat Wong
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Gavin M Joynt
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
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26
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Ng GWY, Pun JKH, So EHK, Chiu WWH, Leung ASH, Stone YH, Lam CL, Lai SPW, Leung RPW, Luk HW, Leung AKH, Au Yeung KW, Lai KY, Slade D, Chan EA. Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses. BMJ Open 2017; 7:e015721. [PMID: 28801406 PMCID: PMC5724079 DOI: 10.1136/bmjopen-2016-015721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. DESIGN A mixed-methods design with quantitative and sequential qualitative components was used. SETTING AND PARTICIPANTS Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. RESULTS The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. CONCLUSIONS Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.
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Affiliation(s)
- George Wing Yiu Ng
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Jack Kwok Hung Pun
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- Department of Education, St Antony’s College, University of Oxford, Oxfordshire, Oxford, UK
| | - Eric Hang Kwong So
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wendy Wai Hang Chiu
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Avis Siu Ha Leung
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Yuk Han Stone
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Chung Ling Lam
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Sarah Pui Wa Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Rowlina Pui Wah Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Hing Wah Luk
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Anne Kit Hung Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kin Wah Au Yeung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kang Yiu Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Diana Slade
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- School of Literature, Languages and Linguistics, Australian National University, Canberra, Australia
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
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Pun JK, Chan EA, Murray KA, Slade D, Matthiessen CM. Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department. J Clin Nurs 2017; 26:3396-3407. [PMID: 28001321 DOI: 10.1111/jocn.13699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. BACKGROUND Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. DESIGN A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. METHODS Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. RESULTS Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a consultation. CONCLUSION The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges. RELEVANCE TO CLINICAL PRACTICE The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings.
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Affiliation(s)
- Jack Kh Pun
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.,Department of Education, St Antony's College, University of Oxford, Oxford, UK
| | - Engle Angela Chan
- The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kristen A Murray
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China
| | - Diana Slade
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.,Department of Education, St Antony's College, University of Oxford, Oxford, UK.,Faculty of Arts and Social Science, The University of Technology Sydney, Australia
| | - Christian Mim Matthiessen
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China
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Abstract
This paper applies qualitative discourse analysis to 'shift-change handovers', events in which nurses hand over care for their patients to their colleagues. To improve patient safety, satisfaction and inclusion, hospitals increasingly require nursing staff to hand over at the patient's bedside, rather than in staff-only areas. However, bedside handover is for many a new and challenging communicative practice. To evaluate how effectively nurses achieve bedside handover, we observed, audio-recorded and transcribed nursing shift-change handovers in a short stay medical ward at an Australian public hospital. Drawing on discourse analysis influenced by systemic functional linguistics we identify four handover styles: exclusive vs inclusive and objectifying vs agentive. The styles capture interactional/interpersonal meaning choices associated with whether and how nurses include patients during handover, and informational/ideational meaning choices associated with whether or not nurses select and organise clinical information in ways that recognise patients' agency. We argue that the co-occurrence of inclusive with agentive and exclusive with objectifying styles demonstrates that how nurses talk about their patients is powerfully influenced by whether and how they also talk to them. In noting the continued dominance of exclusive objectifying styles in handover interactions, we suggest that institutional change needs to be supported by communication training.
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Affiliation(s)
| | - Diana Slade
- University of Technology Sydney and Hong Kong Polytechnic University
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Eggins S, Slade D. Communication in Clinical Handover: Improving the Safety and Quality of the Patient Experience. J Public Health Res 2015; 4:666. [PMID: 26753165 PMCID: PMC4693345 DOI: 10.4081/jphr.2015.666] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Suzanne Eggins
- Faculty of Arts and Social Sciences, University of Technology, Sydney; International Research Centre for Communication in Health Care, Sydney, Australia
| | - Diana Slade
- Faculty of Arts and Social Sciences, University of Technology, Sydney; International Research Centre for Communication in Health Care, Sydney, Australia
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30
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Pun JKH, Matthiessen CMIM, Murray KA, Slade D. Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong. Int J Emerg Med 2015; 8:48. [PMID: 26667242 PMCID: PMC4678128 DOI: 10.1186/s12245-015-0095-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates clinicians’ views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Methods Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. Results The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians’ engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. Conclusions These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear and consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the conditions that foster successful communication. The research provides a model for future research on the relationship between communication and the quality and safety of the patient safety.
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Affiliation(s)
- Jack K H Pun
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China. .,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia. .,Department of Education, St Antony's College, University of Oxford, Oxford, UK.
| | - Christian M I M Matthiessen
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia
| | - Kristen A Murray
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia
| | - Diana Slade
- Department of English, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong; & The University of Technology Sydney, Sydney, Australia.,Faculty of Arts and Social Science, The University of Technology Sydney, Sydney, Australia
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Abstract
BACKGROUND Communication in emergency departments (EDs), often between several health professionals and patients and relatives, is a major cause of patient complaint and error; however, communication-skills teaching for medical students largely focuses on individual clinician-patient interactions. CONTEXT We developed and implemented an evidence-informed online resource, Communication for Health in Emergency Contexts (CHEC; http://www.chec.meu.medicine.unimelb.edu.au/resources) to raise medical students' awareness of the challenges of communication in the ED, and to provide students with communication strategies for addressing these challenges. The foundation of the CHEC resource was the findings and data from a large research project conducted at five emergency departments in Australia over the period 2006-2009. From this, we developed ED scenarios and teaching vignettes using authentic communication data. The project included a nationwide medical curriculum scoping phase, involving interviews with medical students and educators, on ED communication curriculum needs in order to inform the educational activities. INNOVATION The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey, whereas insights from ED medical and nursing staff provide learning opportunities about interprofessional communication for medical students. Evaluation suggests that students find the resource useful, and that the resource has been successfully embedded in medical and junior doctor training on communication and quality and safety. IMPLICATIONS The CHEC resource enhances the capacity of busy clinical educators to raise students' awareness of the communication needs of emergency health care by focusing on communication in high-stress, time-pressured settings using a web format. The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey.
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Affiliation(s)
| | | | | | | | | | - Diana Slade
- University of Technology, Sydney, Australia.,Hong Kong Polytechnic University, Hong Kong
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Chandler E, Slade D, Pun J, Lock G, Matthiessen CMIM, Espindola E, Ng C. Communication in Hong Kong Accident and Emergency Departments: The Clinicians' Perspectives. Glob Qual Nurs Res 2015; 2:2333393615576714. [PMID: 28462303 PMCID: PMC5342630 DOI: 10.1177/2333393615576714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 01/07/2015] [Accepted: 01/29/2015] [Indexed: 12/30/2022] Open
Abstract
In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs). In light of the Hong Kong Hospital Authority’s policy emphasis on patient-centered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and time-burdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice.
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Affiliation(s)
- Eloise Chandler
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Diana Slade
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jack Pun
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Graham Lock
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Christian M I M Matthiessen
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Elaine Espindola
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Carman Ng
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Rider EA, Kurtz S, Slade D, Longmaid HE, Ho MJ, Pun JKH, Eggins S, Branch WT. The International Charter for Human Values in Healthcare: an interprofessional global collaboration to enhance values and communication in healthcare. Patient Educ Couns 2014; 96:273-80. [PMID: 25103181 DOI: 10.1016/j.pec.2014.06.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The human dimensions of healthcare--core values and skilled communication necessary for every healthcare interaction--are fundamental to compassionate, ethical, and safe relationship-centered care. The objectives of this paper are to: describe the development of the International Charter for Human Values in Healthcare which delineates core values, articulate the role of skilled communication in enacting these values, and provide examples showing translation of the Charter's values into action. METHODS We describe development of the Charter using combined qualitative research methods and the international, interprofessional collaboration of institutions and individuals worldwide. RESULTS We identified five fundamental categories of human values for every healthcare interaction--Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare--and delineated subvalues within each category. We have disseminated the Charter internationally and incorporated it into education/training. Diverse healthcare partners have joined in this work. CONCLUSION We chronicle the development and dissemination of the International Charter for Human Values in Healthcare, the role of skilled communication in demonstrating values, and provide examples of educational and clinical programs integrating these values. PRACTICE IMPLICATIONS The Charter identifies and promotes core values clinicians and educators can demonstrate through skilled communication and use to advance humanistic educational programs and practice.
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Affiliation(s)
- Elizabeth A Rider
- Department of Pediatrics, Harvard Medical School, Boston, USA; Institute for Professionalism & Ethical Practice, and Department of Medicine, Boston Children's Hospital, Boston, USA; International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia.
| | - Suzanne Kurtz
- International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia; College of Veterinary Medicine, Washington State University, Pullman, USA; University of Calgary (Professor Emerita), AB, Canada
| | - Diana Slade
- International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia; Department of English, Hong Kong Polytechnic University, Kowloon, Hong Kong; Faculty of Arts and Social Sciences, University of Technology Sydney, New South Wales, Australia
| | - H Esterbrook Longmaid
- International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia; Department of Radiology, Beth Israel Deaconess Hospital-Milton, Milton, USA
| | - Ming-Jung Ho
- International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia; Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jack Kwok-hung Pun
- International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia; Department of Education, St Antony's College, Oxford University, Oxford, UK
| | - Suzanne Eggins
- International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia; Faculty of Arts and Social Sciences, University of Technology Sydney, New South Wales, Australia
| | - William T Branch
- International Research Centre for Communication in Healthcare, Hong Kong Polytechnic University, HK and University of Technology Sydney, NSW, Australia; Department of Medicine, Emory University School of Medicine, Atlanta, USA
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Eggins S, Slade D. Clinical handover as an interactive event: informational and interactional communication strategies in effective shift-change handovers. Commun Med 2014; 9:215-27. [PMID: 24575676 DOI: 10.1558/cam.v9i3.215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical handover -- the transfer between clinicians of responsibility and accountability for patients and their care (AMA 2006) -- is a pivotal and high-risk communicative event in hospital practice. Studies focusing on critical incidents, mortality, risk and patient harm in hospitals have highlighted ineffective communication -- including incomplete and unstructured clinical handovers -- as a major contributing factor (NSW Health 2005; ACSQHC 2010). In Australia, as internationally, Health Departments and hospital management have responded by introducing standardised handover communication protocols. This paper problematises one such protocol - the ISBAR tool - and argues that the narrow understanding of communication on which such protocols are based may seriously constrain their ability to shape effective handovers. Based on analysis of audio-recorded shift-change clinical handovers between medical staff we argue that handover communication must be conceptualised as inherently interactive and that attempts to describe, model and teach handover practice must recognise both informational and interactive communication strategies. By comparing the communicative performance of participants in authentic handover events we identify communication strategies that are more and less likely to lead to an effective handover and demonstrate the importance of focusing close up on communication to improve the quality and safety of healthcare interactions.
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Slade D, Matthiessen CM, Rider EA, Pun Kwok Hung J. The International Centre for Communication in Healthcare: Creating Safer and More Compassionate Healthcare Systems around the World. IJWPC 2014. [DOI: 10.26443/ijwpc.v1i1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The role of communication in healthcare receives increasing attention, yet little research exists that brings together perspectives from interprofessional healthcare researchers and practitioners with linguists and communication specialists. The International Centre for Communication in Healthcare[1] is a response to increasing recognition of the central role of communication and relationships in the delivery of safe, effective and compassionate healthcare.Objective: To develop a worldwide, multidisciplinary collaborative of internationally recognized healthcare professionals and communication experts working together to translate research into education and practice to improve patient safety, communication and relationships in healthcare.Methods: The International Collaborative for Communication in Healthcare (a precursor to the Centre) began in 2010, and was founded at Hong Kong Polytechnic University (PolyU) in March 2011. We initiated research collaborations and presented colloquia, workshops and papers at international conferences.Results: The Centre, co-convened by PolyU and University of Technology, Sydney, was formally launched at PolyU in June 2013 with over 50 members from over 10 countries. The Centre is developing a strategic research agenda for communication in healthcare to improve the quality and safety of patient care, and to mobilize knowledge and expertise gained from research to guide teaching and implementation of communication skills and compassionate care in healthcare education and practice. In an early initiative in 2011, we created the International Charter for Human Values in Healthcare[2], a collaborative effort involving people, organizations and institutions around the world working together to restore core human values to healthcare. The values of the International Charter inform the Centre’s research, education and practice initiatives.Conclusions: Effective communication is increasingly recognized as integral to safe, effective, and compassionate healthcare. The International Centre for Communication in Healthcare brings together interdisciplinary researchers, educators and practitioners from diverse disciplines to explore and improve communication and relationships in healthcare settings around the world.References1. The International Centre for Communication in Healthcare. Hong Kong Polytechnic University and University of Technology, Sydney. http://icchweb.org2. The International Charter for Human Values in Healthcare. December 2, 2012. http://charterforhealthcarevalues.org
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Rider EA, Ho MJ, Branch, Jr WT, Slade D, Kurtz S, Pun Kwok Hung J. Restoring Core Values: An International Charter for Human Values in Healthcare. IJWPC 2014. [DOI: 10.26443/ijwpc.v1i1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The human dimensions of healthcare are fundamental to the practice of compassionate, safe, and ethical relationship-centered care. Attending to the human dimensions improves patient and clinician satisfaction, outcomes and quality of care; however, these dimensions have not received the emphasis necessary to make them central to every healthcare encounter. We established an international collaborative effort to identify and promote the human dimensions of care.Objectives: a) To describe work to date on the International Charter for Human Values in Healthcare; b) To discuss translation of the Charter’s universal values into education, research, and practice.Methods: An international working group of expert educators, clinicians, linguists, and researchers identified initial values that should be present in every healthcare interaction. The working group and four additional groups -- National Academies of Practice (NAP) USA, International Conference on Communication in Healthcare, Interprofessional Patient-Centered Care Conference, American Academy on Communication in Healthcare Forum -- identified values for all healthcare interactions and prioritized top values. The NAP group also prioritized top values for interprofessional interactions. Additional data was gathered via a Delphi process and 2 focus groups of Harvard Macy Institute scholars and faculty.Results: Through iterative content analyses and consensus, we identified 5 categories of core human values that should be present in every healthcare interaction: Capacity for Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare. Through further consensus and Delphi methodology, we identified values within each category.Conclusions: The International Charter for Human Values in Healthcare [1] is a cooperative effort to restore core human values to healthcare around the world. Major healthcare and education partners have joined this international effort. We are working to develop methods to translate the Charter’s universal values into education (teaching, assessment, curricula), research and practice.ReferenceThe International Charter for Human Values in Healthcare. http://charterforhealthcarevalues.org
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37
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Forde C, Farrer K, Meskell R, Anderson I, Slade D, Lees N, Watson D, Carlson G. PP045-MON LONG TERM METABOLIC AND CLINICAL EFFECTS OF PREOPERATIVE CARBOHYDRATE LOADING. A PROSPECTIVE RANDOMISED CLINICAL TRIAL. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1744-1161(12)70384-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Natarajan K, Meyer MR, Jackson BM, Slade D, Roberts C, Hinnebusch AG, Marton MJ. Transcriptional profiling shows that Gcn4p is a master regulator of gene expression during amino acid starvation in yeast. Mol Cell Biol 2001; 21:4347-4368. [PMID: 11390663 DOI: 10.1128/mcb.21.13.4347-4368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Starvation for amino acids induces Gcn4p, a transcriptional activator of amino acid biosynthetic genes in Saccharomyces cerevisiae. In an effort to identify all genes regulated by Gcn4p during amino acid starvation, we performed cDNA microarray analysis. Data from 21 pairs of hybridization experiments using two different strains derived from S288c revealed that more than 1,000 genes were induced, and a similar number were repressed, by a factor of 2 or more in response to histidine starvation imposed by 3-aminotriazole (3AT). Profiling of a gcn4Delta strain and a constitutively induced mutant showed that Gcn4p is required for the full induction by 3AT of at least 539 genes, termed Gcn4p targets. Genes in every amino acid biosynthetic pathway except cysteine and genes encoding amino acid precursors, vitamin biosynthetic enzymes, peroxisomal components, mitochondrial carrier proteins, and autophagy proteins were all identified as Gcn4p targets. Unexpectedly, genes involved in amino acid biosynthesis represent only a quarter of the Gcn4p target genes. Gcn4p also activates genes involved in glycogen homeostasis, and mutant analysis showed that Gcn4p suppresses glycogen levels in amino acid-starved cells. Numerous genes encoding protein kinases and transcription factors were identified as targets, suggesting that Gcn4p is a master regulator of gene expression. Interestingly, expression profiles for 3AT and the alkylating agent methyl methanesulfonate (MMS) overlapped extensively, and MMS induced GCN4 translation. Thus, the broad transcriptional response evoked by Gcn4p is produced by diverse stress conditions. Finally, profiling of a gcn4Delta mutant uncovered an alternative induction pathway operating at many Gcn4p target genes in histidine-starved cells.
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Affiliation(s)
- K Natarajan
- Laboratory of Gene Regulation and Development, National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA
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39
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Natarajan K, Meyer MR, Jackson BM, Slade D, Roberts C, Hinnebusch AG, Marton MJ. Transcriptional profiling shows that Gcn4p is a master regulator of gene expression during amino acid starvation in yeast. Mol Cell Biol 2001; 21:4347-68. [PMID: 11390663 PMCID: PMC87095 DOI: 10.1128/mcb.21.13.4347-4368.2001] [Citation(s) in RCA: 551] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2001] [Accepted: 04/03/2001] [Indexed: 11/20/2022] Open
Abstract
Starvation for amino acids induces Gcn4p, a transcriptional activator of amino acid biosynthetic genes in Saccharomyces cerevisiae. In an effort to identify all genes regulated by Gcn4p during amino acid starvation, we performed cDNA microarray analysis. Data from 21 pairs of hybridization experiments using two different strains derived from S288c revealed that more than 1,000 genes were induced, and a similar number were repressed, by a factor of 2 or more in response to histidine starvation imposed by 3-aminotriazole (3AT). Profiling of a gcn4Delta strain and a constitutively induced mutant showed that Gcn4p is required for the full induction by 3AT of at least 539 genes, termed Gcn4p targets. Genes in every amino acid biosynthetic pathway except cysteine and genes encoding amino acid precursors, vitamin biosynthetic enzymes, peroxisomal components, mitochondrial carrier proteins, and autophagy proteins were all identified as Gcn4p targets. Unexpectedly, genes involved in amino acid biosynthesis represent only a quarter of the Gcn4p target genes. Gcn4p also activates genes involved in glycogen homeostasis, and mutant analysis showed that Gcn4p suppresses glycogen levels in amino acid-starved cells. Numerous genes encoding protein kinases and transcription factors were identified as targets, suggesting that Gcn4p is a master regulator of gene expression. Interestingly, expression profiles for 3AT and the alkylating agent methyl methanesulfonate (MMS) overlapped extensively, and MMS induced GCN4 translation. Thus, the broad transcriptional response evoked by Gcn4p is produced by diverse stress conditions. Finally, profiling of a gcn4Delta mutant uncovered an alternative induction pathway operating at many Gcn4p target genes in histidine-starved cells.
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Affiliation(s)
- K Natarajan
- Laboratory of Gene Regulation and Development, National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA
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Hughes TR, Marton MJ, Jones AR, Roberts CJ, Stoughton R, Armour CD, Bennett HA, Coffey E, Dai H, He YD, Kidd MJ, King AM, Meyer MR, Slade D, Lum PY, Stepaniants SB, Shoemaker DD, Gachotte D, Chakraburtty K, Simon J, Bard M, Friend SH. Functional discovery via a compendium of expression profiles. Cell 2000; 102:109-26. [PMID: 10929718 DOI: 10.1016/s0092-8674(00)00015-5] [Citation(s) in RCA: 1623] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ascertaining the impact of uncharacterized perturbations on the cell is a fundamental problem in biology. Here, we describe how a single assay can be used to monitor hundreds of different cellular functions simultaneously. We constructed a reference database or "compendium" of expression profiles corresponding to 300 diverse mutations and chemical treatments in S. cerevisiae, and we show that the cellular pathways affected can be determined by pattern matching, even among very subtle profiles. The utility of this approach is validated by examining profiles caused by deletions of uncharacterized genes: we identify and experimentally confirm that eight uncharacterized open reading frames encode proteins required for sterol metabolism, cell wall function, mitochondrial respiration, or protein synthesis. We also show that the compendium can be used to characterize pharmacological perturbations by identifying a novel target of the commonly used drug dyclonine.
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Affiliation(s)
- T R Hughes
- Rosetta Inpharmatics, Inc., Kirkland, Washington 98034, USA
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Hughes TR, Roberts CJ, Dai H, Jones AR, Meyer MR, Slade D, Burchard J, Dow S, Ward TR, Kidd MJ, Friend SH, Marton MJ. Widespread aneuploidy revealed by DNA microarray expression profiling. Nat Genet 2000; 25:333-7. [PMID: 10888885 DOI: 10.1038/77116] [Citation(s) in RCA: 348] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Expression profiling using DNA microarrays holds great promise for a variety of research applications, including the systematic characterization of genes discovered by sequencing projects. To demonstrate the general usefulness of this approach, we recently obtained expression profiles for nearly 300 Saccharomyces cerevisiae deletion mutants. Approximately 8% of the mutants profiled exhibited chromosome-wide expression biases, leading to spurious correlations among profiles. Competitive hybridization of genomic DNA from the mutant strains and their isogenic parental wild-type strains showed they were aneuploid for whole chromosomes or chromosomal segments. Expression profile data published by several other laboratories also suggest the use of aneuploid strains. In five separate cases, the extra chromosome harboured a close homologue of the deleted gene; in two cases, a clear growth advantage for cells acquiring the extra chromosome was demonstrated. Our results have implications for interpreting whole-genome expression data, particularly from cells known to suffer genomic instability, such as malignant or immortalized cells.
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Affiliation(s)
- T R Hughes
- Rosetta Inpharmatics, Inc., Kirkland, Washington, USA
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Abstract
OBJECTIVE To review gradual snare occlusion for the management of complex or recurrent graft infection. PATIENTS AND METHODS Medical records of patients treated with gradual snare occlusion following graft infection were reviewed for indication for operation, type of bypass and graft material used. In addition, infecting organism, grade of infection (Szilágyi) and outcome were recorded. RESULTS Four femoropopliteal, two extra-anatomic (axillofemoral) and aortobifemoral bypasses were included in this study. All had chronic infection (Szilágyi grade III) with onset of 4 to 24 months and two of which were recurrent. The causative organisms were coagulase-negative staphylococci, Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus in three patients, with no organism isolated in the remaining cases. There was no loss of limb following gradual snare occlusion but there was only one death due to aortic stump rupture 2 weeks later. CONCLUSION Gradual snare occlusion is an alternative for the management of chronic or recurrent graft infection.
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Affiliation(s)
- A Egun
- Department of Surgery, Vascular Studies Unit, South Manchester University Hospital, Nell Lane, Manchester, West Didsbury, M20 8LR, UK
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Slade D, Allen J. Aspirin and surgical bleeding. Br J Plast Surg 1999; 52:243. [PMID: 10474488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Marton MJ, DeRisi JL, Bennett HA, Iyer VR, Meyer MR, Roberts CJ, Stoughton R, Burchard J, Slade D, Dai H, Bassett DE, Hartwell LH, Brown PO, Friend SH. Drug target validation and identification of secondary drug target effects using DNA microarrays. Nat Med 1998; 4:1293-301. [PMID: 9809554 DOI: 10.1038/3282] [Citation(s) in RCA: 507] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe here a method for drug target validation and identification of secondary drug target effects based on genome-wide gene expression patterns. The method is demonstrated by several experiments, including treatment of yeast mutant strains defective in calcineurin, immunophilins or other genes with the immunosuppressants cyclosporin A or FK506. Presence or absence of the characteristic drug 'signature' pattern of altered gene expression in drug-treated cells with a mutation in the gene encoding a putative target established whether that target was required to generate the drug signature. Drug dependent effects were seen in 'targetless' cells, showing that FK506 affects additional pathways independent of calcineurin and the immunophilins. The described method permits the direct confirmation of drug targets and recognition of drug-dependent changes in gene expression that are modulated through pathways distinct from the drug's intended target. Such a method may prove useful in improving the efficiency of drug development programs.
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Affiliation(s)
- M J Marton
- Rosetta Inpharmatics, Kirkland, Washington 98034, USA
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Alagiri M, Chottiner S, Ratner V, Slade D, Hanno P. Interstitial Cystitis: Unexplained Associations With Other Chronic Disease and Pain Syndromes. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Alagiri
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania and the Interstitial Cystitis Association, New York, New York
| | - S. Chottiner
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania and the Interstitial Cystitis Association, New York, New York
| | - V. Ratner
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania and the Interstitial Cystitis Association, New York, New York
| | - D. Slade
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania and the Interstitial Cystitis Association, New York, New York
| | - P.M. Hanno
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania and the Interstitial Cystitis Association, New York, New York
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46
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Abstract
OBJECTIVE To determine the prevalence of concomitant disease in individuals with interstitial cystitis and to compare these results to the general population. METHODS We used a questionnaire-based study evaluating 12 disease processes and a survey of interstitial cystitis characteristics. The population was 2,405 individuals with interstitial cystitis who responded to the initial survey and an additional 277 individuals who were randomly selected and individually contacted. RESULTS Allergies, irritable bowel syndrome, and sensitive skin were the most common diseases in the interstitial cystitis population. In comparison to the general population, individuals with interstitial cystitis are 100 times more likely to have inflammatory bowel disease and 30 times more likely to have systemic lupus erythematosus. In addition, allergies, irritable bowel syndrome, sensitive skin, and fibromyalgia have an increased association with interstitial cystitis. CONCLUSIONS Interstitial cystitis has, as yet, an unexplained association with certain other chronic disease and pain syndromes.
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Affiliation(s)
- M Alagiri
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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47
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Abstract
OBJECTIVES To establish that conventional protocols often do not provide an adequate framework for managing interstitial cystitis, and to describe the special role of the urologic caregiver in developing a collaborative relationship with interstitial cystitis (IC) patients that can allay fears and provide hope that this devastating disease can be managed effectively. METHODS Epidemiologic studies and a decade of experience of IC patients and their physicians are utilized in developing a rationale for a collaborative relationship between urologic caregivers and IC patients. RESULTS The symptoms of interstitial cystitis-pain, urgency, and urinary frequency-can have a profoundly disruptive effect on patients' lives and present unique challenges to physicians as urologic caregivers. The impact of IC on patients' lives needs to be accounted for empathetically, and appropriate referrals for depression, sexuality, or relationship problems should be made. Pain should be managed aggressively, and patients who have had delayed diagnosis or who have not responded to the traditional treatments should be educated about the array of medical, complementary/alternative, and self-help modalities available. CONCLUSIONS A successful treatment paradigm requires that physicians and patients be knowledgeable about the array of medical and complementary/alternative therapies and that these be applied in a systematic but creative way. Through empathic support, information, and a flexible treatment protocol, patients will learn to trust the medical process and take an active part in the management of IC.
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Affiliation(s)
- D Slade
- Intersitial Cystitis Association, New York, New York 10159, USA
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48
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Ratner V, Slade D, Greene G. Interstitial cystitis. A patient's perspective. Urol Clin North Am 1994; 21:1-5. [PMID: 8284831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Interstitial cystitis is a debilitating bladder disorder that affects up to 450,000 people in the United States, 90% of whom are women. Confusion in defining and understanding interstitial cystitis has resulted in the failure to diagnose and treat thousands of afflicted patients, committing them to a life of intractable pain. Even with diagnosis, there are no uniformly effective treatments. It is extremely important that these patients have the understanding and support of the medical community, and they should develop a constructive and effective relationship with their physician and other urologic caregivers.
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Affiliation(s)
- V Ratner
- Interstitial Cystitis Association, New York, New York
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49
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Slade D, Foley MM, Cohen S. Reengineering along departmental product flowlines. Top Health Inf Manage 1994; 14:37-42. [PMID: 10131590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This article describes how a medical records department responded to relocating, upgrading a departmental computer system, incorporating severity of illness abstracting, and implementing continuous quality improvement techniques by reengineering along department flowlines over a five-year period. Areas of the department that were restructured were storage and retrieval, record completion, and data collection and reporting functions.
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Affiliation(s)
- D Slade
- Pennsylvania Hospital, Philadelphia
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50
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Ratner V, Slade D. The Interstitial Cystitis Association: patients working for a cure. Semin Urol 1991; 9:72. [PMID: 1853015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- V Ratner
- Interstitial Cystitis Association, New York, NY 10159
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