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Rai S, Neeman T, Brown R, Sundararajan K, Rajamani A, Miu M, Panwar R, Nourse M, van Haren FM, Mitchell I, Needham DM. Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study. CRIT CARE RESUSC 2024; 26:8-15. [PMID: 38690186 PMCID: PMC11056421 DOI: 10.1016/j.ccrj.2023.10.011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 05/02/2024]
Abstract
Objective To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors. Design Prospective, multicentre observational cohort study. Setting Four tertiary medical-surgical ICUs in Australia. Participants Intubated and non-intubated adult ICU survivors. Main outcome measures Primary outcomes: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. Secondary outcomes: HRQOL, using EuroQol-5D-5L questionnaire. Results Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66-3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53-3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions. Conclusions Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.
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Affiliation(s)
- Sumeet Rai
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Teresa Neeman
- Biological Data Science Institute, College of Science, Australian National University, Canberra, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Arvind Rajamani
- Nepean Clinical School, University of Sydney, Kingswood, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, Australia
| | | | - Rakshit Panwar
- Intensive Care Unit, John Hunter Hospital, New Lambton, Australia
| | - Mary Nourse
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Frank M.P. van Haren
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, St. George Hospital, Kogarah, Sydney, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Dale M. Needham
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA
- John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
| | - for the PRICE study investigators
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
- Biological Data Science Institute, College of Science, Australian National University, Canberra, Australia
- Research School of Psychology, Australian National University, Canberra, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Nepean Clinical School, University of Sydney, Kingswood, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, Australia
- Nepean Hospital, Kingswood, Sydney, Australia
- Intensive Care Unit, John Hunter Hospital, New Lambton, Australia
- Intensive Care Unit, St. George Hospital, Kogarah, Sydney, Australia
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA
- John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
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van der Vegt AH, Campbell V, Mitchell I, Malycha J, Simpson J, Flenady T, Flabouris A, Lane PJ, Mehta N, Kalke VR, Decoyna JA, Es’haghi N, Liu CH, Scott IA. Systematic review and longitudinal analysis of implementing Artificial Intelligence to predict clinical deterioration in adult hospitals: what is known and what remains uncertain. J Am Med Inform Assoc 2024; 31:509-524. [PMID: 37964688 PMCID: PMC10797271 DOI: 10.1093/jamia/ocad220] [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: 09/08/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To identify factors influencing implementation of machine learning algorithms (MLAs) that predict clinical deterioration in hospitalized adult patients and relate these to a validated implementation framework. MATERIALS AND METHODS A systematic review of studies of implemented or trialed real-time clinical deterioration prediction MLAs was undertaken, which identified: how MLA implementation was measured; impact of MLAs on clinical processes and patient outcomes; and barriers, enablers and uncertainties within the implementation process. Review findings were then mapped to the SALIENT end-to-end implementation framework to identify the implementation stages at which these factors applied. RESULTS Thirty-seven articles relating to 14 groups of MLAs were identified, each trialing or implementing a bespoke algorithm. One hundred and seven distinct implementation evaluation metrics were identified. Four groups reported decreased hospital mortality, 1 significantly. We identified 24 barriers, 40 enablers, and 14 uncertainties and mapped these to the 5 stages of the SALIENT implementation framework. DISCUSSION Algorithm performance across implementation stages decreased between in silico and trial stages. Silent plus pilot trial inclusion was associated with decreased mortality, as was the use of logistic regression algorithms that used less than 39 variables. Mitigation of alert fatigue via alert suppression and threshold configuration was commonly employed across groups. CONCLUSIONS : There is evidence that real-world implementation of clinical deterioration prediction MLAs may improve clinical outcomes. Various factors identified as influencing success or failure of implementation can be mapped to different stages of implementation, thereby providing useful and practical guidance for implementers.
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Affiliation(s)
- Anton H van der Vegt
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Victoria Campbell
- Intensive Care Unit, Sunshine Coast Hospital and Health Service, Birtynia, QLD 4575, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Imogen Mitchell
- Office of Research and Education, Canberra Health Services, Canberra, ACT 2601, Australia
| | - James Malycha
- Department of Critical Care Medicine, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Joanna Simpson
- Eastern Health Intensive Care Services, Eastern Health, Box Hill, VIC 3128, Australia
| | - Tracy Flenady
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Arthas Flabouris
- Intensive Care Department, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Paul J Lane
- Safety Quality & Innovation, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Naitik Mehta
- Patient Safety and Quality, Clinical Excellence Queensland, Brisbane, QLD 4001, Australia
| | - Vikrant R Kalke
- Patient Safety and Quality, Clinical Excellence Queensland, Brisbane, QLD 4001, Australia
| | - Jovie A Decoyna
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Nicholas Es’haghi
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Chun-Huei Liu
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia
| | - Ian A Scott
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4102, Australia
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
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Scholz B, Kirk L, Warner T, O'Brien L, Kecskes Z, Mitchell I. From a Single Voice to Diversity: Reframing 'Representation' in Patient Engagement. Qual Health Res 2024:10497323231221674. [PMID: 38229426 DOI: 10.1177/10497323231221674] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
There has been a growing emphasis on consumer representation in the development of health policy, services, research, and education. Existing literature has critiqued how discourses of representativeness can disempower consumers working in health systems. The context of the current study is consumer engagement in the development of COVID-19 triage policy and practice in a local health service. Consumer engagement has often been an afterthought in the COVID response, with few examples of consumers in agenda-setting or decision-making roles. In the Australian Capital Territory, 26 consumer, carer, and community groups worked together with academics and clinicians to develop these principles. Interviews were conducted with stakeholders (including consumers, clinicians, and other health professionals) to evaluate the development of triage principles. A discursive psychological approach to analysis was used to explore participants' understandings about and constructions of consumers being representative (or not) and how this may reproduce power imbalances against consumers. The results explore two distinct ways in which participants talked about consumer representativeness: the first drawing on rhetoric about consumers as lay members of the public (as distinct from being professionally engaged in the health sector), and the second in terms of consumer representatives being diverse and having intersectional identities and experiences. Expectations about consumers to be representative of the general population may reproduce traditional power imbalances and silence lived experience expertise. These power imbalances may be challenged by a shift in the way representativeness is conceptualised to requiring health services to seek out diverse and intersectionally marginalised consumers.
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Affiliation(s)
- Brett Scholz
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Lucy Kirk
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Terri Warner
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Lauren O'Brien
- ACT Disability, Aged and Carer Advocacy Service, Canberra, ACT, Australia
| | - Zsuzsoka Kecskes
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
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Adigbli D, Yang L, Hammond N, Annane D, Arabi Y, Bilotta F, Bohé J, Brunkhorst FM, Cavalcanti AB, Cook D, Engel C, Green-LaRoche D, He W, Henderson W, Hoedemaekers C, Iapichino G, Kalfon P, Rosa GDL, MacKenzie I, Mélot C, Mitchell I, Oksanen T, Polli F, Preiser JC, Soriano FG, Wang LC, Yuan J, Delaney A, Tanna GLD, Finfer S. Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis. Crit Care Sci 2023; 35:345-354. [PMID: 38265316 PMCID: PMC10802778 DOI: 10.5935/2965-2774.20230162-en] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/06/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. DATA SOURCES MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. METHODS Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. PRIMARY ENDPOINT In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. DISCUSSION This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?'Protocol version 0.4 - 06/26/2023PROSPERO registration:CRD42021278869.
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Affiliation(s)
- Derick Adigbli
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Li Yang
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Naomi Hammond
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | | | - Yaseen Arabi
- Intensive Care Department, Medical Director of Respiratory
Services, King Saud Bin Abdulaziz University for Health Sciences - Riyadh, Saudi
Arabia
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine,
Policlinico Umberto I, Sapienza University of Rome - Rome, Italy
| | - Julien Bohé
- Service d’Anesthésie-Réanimation-Médecine
Intensive, Groupement Hospitalier Sud, Hospices Civils de Lyon,
Pierre-Bénite, France
| | - Frank Martin Brunkhorst
- Department of Anaesthesiology and Intensive Care Medicine, Jena
University Hospital - Jena, Germany
| | | | - Deborah Cook
- Critical Care Medicine, St Joseph’s Healthcare Hamilton - Ontario,
Canada
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology,
Leipzig University, Leipzig, Germany
| | | | - Wei He
- Department of Critical Care Medicine, Beijing Tong Ren Hospital,
Capital Medical University - Beijing, China
| | - William Henderson
- VA Emergency Operations Centre, UBC Hospital, University of
British Columbia - Columbia, Canada
| | - Cornelia Hoedemaekers
- Department of Critical Care, Radboud University Nijmegen Medical
Centre -Nijmegen, The Netherlands
| | - Gaetano Iapichino
- Anestesiologia e Rianimazione, Universitá degli Studi di
Milano - Milano, Italy
| | | | - Gisela de La Rosa
- Intensive Care Department, Hospital Pablo Tobon Uribe - Medellin,
Colombia
| | - Iain MacKenzie
- InterSystems Corporation - Cambridge, Mass. , United States
| | | | | | - Tuomas Oksanen
- Department of Anesthesiology and Intensive Care, Helsinki
University Hospital and University of Helsinki - Helsinki, Finland
| | | | | | - Francisco Garcia Soriano
- Department of Critical Care Medicine, Hospital das Clinicas,
Universidade de São Paulo - São Paulo, Brazil
| | - Ling-Cong Wang
- Intensive Care Unit, The First Affiliated Hospital of Zhejiang
Traditional Chinese Medical University - Zhejiang, China
| | - Jiaxiang Yuan
- Department of Laparoscopic Surgery, The First Affiliated Hospital
of Zhengzhou University - Zhengzhou, China
| | - Anthony Delaney
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Gian Luca Di Tanna
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
| | - Simon Finfer
- Critical Care Division, The George Institute for Global Health -
New South Wales, Australia
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Rai S, Brace C, Ross P, Darvall J, Haines K, Mitchell I, van Haren F, Pilcher D. Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis. Crit Care Med 2023; 51:1328-1338. [PMID: 37219961 PMCID: PMC10497207 DOI: 10.1097/ccm.0000000000005943] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To characterize and compare trends in ICU admission, hospital outcomes, and resource utilization for critically ill very elderly patients (≥ 80 yr old) compared with the younger cohort (16-79 yr old). DESIGN A retrospective multicenter cohort study. SETTING One-hundred ninety-four ICUs contributing data to the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database between January 2006 and December 2018. PATIENTS Adult (≥ 16 yr) patients admitted to Australian and New Zealand ICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Very elderly patients with a mean ± sd age of 84.8 ± 3.7 years accounted for 14.8% (232,582/1,568,959) of all adult ICU admissions. They had higher comorbid disease burden and illness severity scores compared with the younger cohort. Hospital (15.4% vs 7.8%, p < 0.001) and ICU mortality (8.5% vs 5.2%, p < 0.001) were higher in the very elderly. They stayed fewer days in ICU, but longer in hospital and had more ICU readmissions. Among survivors, a lower proportion of very elderly was discharged home (65.2% vs 82.4%, p < 0.001), and a higher proportion was discharged to chronic care/nursing home facilities (20.1% vs 7.8%, p < 0.001). Although there was no change in the proportion of very elderly ICU admissions over the study period, they showed a greater decline in risk-adjusted mortality (6.3% [95% CI, 5.9%-6.7%] vs 4.0% [95% CI, 3.7%-4.2%] relative reduction per year, p < 0.001) compared with the younger cohort. The mortality of very elderly unplanned ICU admissions improved faster than the younger cohort ( p < 0.001), whereas improvements in mortality among elective surgical ICU admissions were similar in both groups ( p = 0.45). CONCLUSIONS The proportion of ICU admissions greater than or equal to 80 years old did not change over the 13-year study period. Although their mortality was higher, they showed improved survivorship over time, especially in the unplanned ICU admission subgroup. A higher proportion of survivors were discharged to chronic care facilities.
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Affiliation(s)
- Sumeet Rai
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Acton, Canberra, Australia
- Intensive Care Unit, Canberra Health Services, Garran, Canberra, Australia
| | - Charlotte Brace
- Department of Anaesthesia, Auckland City District Health Board, Auckland, New Zealand
| | - Paul Ross
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, St. Kilda Rd, Prahran, Melbourne, Australia
| | - Jai Darvall
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Kimberley Haines
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Acton, Canberra, Australia
- Intensive Care Unit, Canberra Health Services, Garran, Canberra, Australia
| | - Frank van Haren
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Acton, Canberra, Australia
- Intensive Care Unit, St George Hospital, Sydney, Australia
| | - David Pilcher
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, St. Kilda Rd, Prahran, Melbourne, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resources Evaluation, Camberwell, Melbourne, Australia
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Considine J, Hutchinson AM, Mitchell I, Bohingamu Mudiyanselage S, Mohebbi M, Watts JJ, Bucknall T. Vital sign assessment and nursing interventions in medical and surgical patients with rapid response system triggers. J Clin Nurs 2023; 32:7310-7320. [PMID: 37365897 PMCID: PMC10946594 DOI: 10.1111/jocn.16810] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
AIM(S) To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration. DESIGN This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients. METHODS The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24-h periods within the same week were audited at three time points: pre-intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post-intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi-square test. RESULTS A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre-Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre-Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre-Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers. CONCLUSION When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. RELEVANCE TO CLINICAL PRACTICE Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under-recognised element of the organisational response to deteriorating patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date. IMPACT This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards. REPORTING METHOD The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Eastern Health PartnershipBox HillAustralia
| | - Alison M. Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Barwon Health PartnershipGeelongAustralia
| | - Imogen Mitchell
- Research and Academic PartnershipsCanberra Health ServicesCanberraAustralian Capital TerritoryAustralia
- Australian National University College of Health and MedicineCanberraAustralian Capital TerritoryAustralia
| | - Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | | | - Jennifer J. Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Tracey Bucknall
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Alfred Health PartnershipMelbourneAustralia
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Viana JN, Pilbeam C, Howard M, Scholz B, Ge Z, Fisser C, Mitchell I, Raman S, Leach J. Maintaining High-Touch in High-Tech Digital Health Monitoring and Multi-Omics Prognostication: Ethical, Equity, and Societal Considerations in Precision Health for Palliative Care. OMICS 2023; 27:461-473. [PMID: 37861713 DOI: 10.1089/omi.2023.0120] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Advances in digital health, systems biology, environmental monitoring, and artificial intelligence (AI) continue to revolutionize health care, ushering a precision health future. More than disease treatment and prevention, precision health aims at maintaining good health throughout the lifespan. However, how can precision health impact care for people with a terminal or life-limiting condition? We examine here the ethical, equity, and societal/relational implications of two precision health modalities, (1) integrated systems biology/multi-omics analysis for disease prognostication and (2) digital health technologies for health status monitoring and communication. We focus on three main ethical and societal considerations: benefits and risks associated with integration of these modalities into the palliative care system; inclusion of underrepresented and marginalized groups in technology development and deployment; and the impact of high-tech modalities on palliative care's highly personalized and "high-touch" practice. We conclude with 10 recommendations for ensuring that precision health technologies, such as multi-omics prognostication and digital health monitoring, for palliative care are developed, tested, and implemented ethically, inclusively, and equitably.
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Affiliation(s)
- John Noel Viana
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Caitlin Pilbeam
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mark Howard
- Monash Data Futures Institute, Monash University, Clayton, Australia
- Department of Philosophy, School of Philosophical, Historical and International Studies, Monash University, Clayton, Australia
| | - Brett Scholz
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Zongyuan Ge
- Monash Data Futures Institute, Monash University, Clayton, Australia
- Department of Data Science & AI, Monash University, Clayton, Australia
| | - Carys Fisser
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Sujatha Raman
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
| | - Joan Leach
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
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Kirk LE, Mitchell I. Has the COVID-19 pandemic unmasked the fragility of the Australian health care system? Med J Aust 2023. [PMID: 37161524 DOI: 10.5694/mja2.51946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Lucy E Kirk
- Hunter New England Local Health District, NSW Health, Newcastle, NSW
| | - Imogen Mitchell
- Canberra Health Services, Canberra, ACT
- Australian National University, Canberra, ACT
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Kelly M, Mitchell I, Walker I, Mears J, Scholz B. "I can't make all this work." End of life care provision in natural disasters: a qualitative study. BMC Palliat Care 2023; 22:21. [PMID: 36899357 PMCID: PMC9999053 DOI: 10.1186/s12904-023-01137-0] [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: 07/21/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Natural disasters are becoming more frequent and severe and profoundly impact the end-of-life care experience, including service provision. There is a paucity of research examining healthcare workers' experiences in responding to care demands when disasters strike. This research aimed to fill this gap by exploring end-of-life care providers' perceptions of the impact of natural disasters on end-of-life care. METHODS Between Feb 2021-June 2021 ten in-depth semi-structured interviews were conducted with healthcare professionals providing end-of-life care during recent natural disasters, COVID-19, and/or fires and floods. Interviews were audio-recorded, transcribed, and analysed using a hybrid inductive and deductive thematic approach. RESULTS The overarching theme from the healthcare workers' accounts was of being unable to provide effective compassionate and quality care - "I can't make all this work." They spoke of the considerable burdens the system imposed on them, of being overextended and overwhelmed, having their roles overturned, and losing the human element of care for those at end-of-life. CONCLUSION There is urgent need to pioneer effective solutions to minimise the distress of healthcare professionals in delivering end-of-life care in disaster contexts, and to improve the experience of those dying.
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Affiliation(s)
- Marguerite Kelly
- School of Medicine and Psychology, Australian National University, 54 Mills Road, 2601, Acton, ACT, Australia.
| | - Imogen Mitchell
- School of Medicine and Psychology, Australian National University, 54 Mills Road, 2601, Acton, ACT, Australia
| | - Iain Walker
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Mears
- School of Social Sciences, Western Sydney University, NSW, Australia
| | - Brett Scholz
- School of Medicine and Psychology, Australian National University, 54 Mills Road, 2601, Acton, ACT, Australia
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10
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Kelly M, Mitchell I, Walker I, Mears J, Scholz B. End-of-life care in natural disasters including epidemics and pandemics: a systematic review. BMJ Support Palliat Care 2023; 13:1-14. [PMID: 33731463 DOI: 10.1136/bmjspcare-2021-002973] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Natural disasters are becoming more frequent and severe, and place additional strains on end-of-life care services and users. Although end-of-life and palliative care are considered essential components of disaster planning and response, there are gaps in understandings about their real-life application, and how natural disasters impact end-of-life care. OBJECTIVE To synthesise existing evidence of the impacts of natural disasters (eg, bushfires, communicable pandemics, etc) on end-of-life care. METHODS A systematic review with a narrative synthesis was undertaken. The review was registered on PROSPERO (registration: CRD42020176319). PubMed, Scopus, PsycINFO, Science Direct and Web of Science were searched for studies published in English between 2003 and 2020, with findings explicitly mentioning end-of-life care impacts in relation to a natural disaster. Articles were appraised for quality using a JBI-QARI tool. RESULTS Thirty-six empirical studies met the inclusion criteria and quality assessment. Findings were synthesised into three key themes: impacts on service provision, impacts on service providers and impacts on service users. This review demonstrates that natural disasters impact profoundly on end-of-life care, representing a stark departure from a palliative care approach. CONCLUSIONS Clinical practitioners, policy makers and researchers must continue to collaborate for viable solutions to achieve universal access to compassionate and respectful end-of-life care, during natural disasters. Using models, policies and practices already developed in palliative care, involving those most impacted in disaster planning and anticipating barriers, such as resource shortages, enables development of end-of-life care policies and practices that can be rapidly implemented during natural disasters.
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Affiliation(s)
- Marguerite Kelly
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Imogen Mitchell
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Iain Walker
- Research School of Psychology, Australian National University, Acton, Australian Capital Territory, Australia
| | - Jane Mears
- School of Social Science, Western Sydney University - Liverpool City Campus, Liverpool, New South Wales, Australia
| | - Brett Scholz
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
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11
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Johnston K, O’Reilly CL, Scholz B, Georgousopoulou EN, Mitchell I. The "affected" pharmacist and the "business as usual" pharmacist: Exploring the experiences of pharmacists during COVID-19 through cluster analysis. J Am Pharm Assoc (2003) 2023; 63:144-150.e2. [PMID: 36270908 PMCID: PMC9519361 DOI: 10.1016/j.japh.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/10/2022] [Accepted: 09/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The global coronavirus disease 2019 (COVID-19) pandemic has necessitated considerable changes in the delivery of pharmacy services, with pharmacists experiencing increasing demands and a high rate of burnout. The ability to categorize pharmacists based on their burnout risk and associated factors could be used to tailor burnout interventions. OBJECTIVE This study aimed to identify subgroups (profiles) of pharmacists and use these profiles to describe interventions tailored to improve pharmacist's well-being. METHODS A survey was disseminated to pharmacists working in Australia during April and June 2020. The survey measured demographics, burnout, and psychosocial factors associated with working during COVID-19. A two-step cluster analysis was used to categorize pharmacists based on burnout and other variables. RESULTS A total of 647 survey responses contained data that were used for analysis. Participants were mostly female (75.7%) and working full time (65.2%). The final cluster analysis yielded an acceptable two-cluster model describing 2 very different pharmacist experiences, using 10 variables. Cluster 2 (representing 53.1% of participants) describes the "affected" pharmacist, who has a high degree of burnout, works in community pharmacy, experiences incivility, is less likely to report sufficient precautionary measures in their workplace, and has had an increase in workload and overtime. In contrast, cluster 1 (representing 46.9% of participants) describes the profile of a "business as usual" hospital pharmacist with the opposite experiences. Interventions focused on the "affected" pharmacist such as financial support to employ specialized staff and equitable access to personal protective equipment should be available to community pharmacists, to reduce the risk to these frontline workers. CONCLUSION The use of cluster analysis has identified 2 distinct profiles of pharmacists working during COVID-19. The "affected" pharmacist warrants targeted interventions to address the high burnout experienced in this group.
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Affiliation(s)
- Karlee Johnston
- Correspondence: Karlee Johnston, BSPharm, MClinPharm, Adv.Prac.Pharm, FSHPA, Lecturer, Australian National University Medical School, Florey Bldg., 54 Mills Rd., Acton ACT 2601, Australia. (K. Johnston)
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12
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Paterson C, Davis D, Roche M, Bissett B, Roberts C, Turner M, Baldock E, Mitchell I. What are the long-term holistic health consequences of COVID-19 among survivors? An umbrella systematic review. J Med Virol 2022; 94:5653-5668. [PMID: 36002399 PMCID: PMC9539336 DOI: 10.1002/jmv.28086] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 01/06/2023]
Abstract
Many people who have survived COVID-19 have experienced negative persistent impacts on health. Impacts on health have included persistent respiratory symptoms, decreased quality of life, fatigue, impaired functional capacity, memory deficits, psychological impacts, and difficulties in returning to paid employment. Evidence is yet to be pooled to inform future directions in research and practice, to determine the physical, psychological, social, and spiritual impacts of the illness which extend beyond the acute phase of COVID-19 survivors. This umbrella review (review of systematic reviews) critically synthesized physical (including abnormal laboratory parameters), psychological, social, and spiritual impacts which extended beyond the acute phase of COVID-19 survivors. The search strategy was based on the sample, phenomena of interest, design, evaluation, research model and all publications were double screened independently by four review authors for the eligibility criteria. Data extraction and quality assessment were conducted in parallel independently. Eighteen systematic reviews were included, which represented a total of 493 publications. Sample sizes ranged from n = 15 to n = 44 799 with a total of n = 295 455 participants. There was incomplete reporting of several significant data points including the description of the severe acute respiratory syndrome coronavirus 2 variant, COVID-19 treatments, and key clinical and demographic data. A number of physical, psychological, and social impacts were identified for individuals grappling with post-COVID condition. The long term sequalae of acute COVID-19 and size of the problem is only beginning to emerge. Further investigation is needed to ensure that those affected by post-COVID condition have their informational, spiritual, psychological, social, and physical needs met in the future.
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Affiliation(s)
- Catherine Paterson
- Faculty of HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research GroupUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- School of Nursing, Midwifery and Public HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- Canberra Health Services & ACT HealthSYNERGY Nursing & Midwifery Research CentreCanberraAustralian Capital TerritoryAustralia
- School of Nursing, Midwifery & Paramedic PracticeRobert Gordon UniversityAberdeenScotlandUK
| | - Deborah Davis
- Faculty of HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- School of Nursing, Midwifery and Public HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- Canberra Health Services & ACT HealthSYNERGY Nursing & Midwifery Research CentreCanberraAustralian Capital TerritoryAustralia
| | - Michael Roche
- Faculty of HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- School of Nursing, Midwifery and Public HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- Canberra Health Services & ACT HealthSYNERGY Nursing & Midwifery Research CentreCanberraAustralian Capital TerritoryAustralia
- Schoool of NursingUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Bernie Bissett
- Faculty of HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
| | - Cara Roberts
- Faculty of HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research GroupUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- School of Nursing, Midwifery and Public HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
| | - Murray Turner
- Faculty of HealthUniversity of CanberraBruceAustralian Capital TerritoryAustralia
| | - Emma Baldock
- Health Care Consumers' Association of the Australian Capitial TerritoryAustralia
| | - Imogen Mitchell
- Australian National UniversityCanberraAustralian Capital TerritoryAustralia
- Canberra Health ServicesCanberraAustralian Capital TerritoryAustralia
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Bucknall TK, Considine J, Harvey G, Graham ID, Rycroft-Malone J, Mitchell I, Saultry B, Watts JJ, Mohebbi M, Bohingamu Mudiyanselage S, Lotfaliany M, Hutchinson A. Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration. BMJ Qual Saf 2022; 31:818-830. [PMID: 35450936 PMCID: PMC9606509 DOI: 10.1136/bmjqs-2021-013785] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses' vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. METHODS In a pragmatic cluster randomised controlled trial, we randomised 36 inpatient wards at four acute hospitals to receive standard clinical practice guideline (CPG) dissemination to ward staff (n=18) or facilitated implementation for 6 months following standard dissemination (n=18). Expert, hospital and ward facilitators tailored facilitation techniques to promote nurses' CPG adherence. Patient records were audited pre-intervention, 6 and 12 months post-intervention on randomly selected days. Escalation of care as per hospital policy was the primary outcome at 6 and 12 months after implementation. Patients, nurses and assessors were blinded to group assignment. Analysis was by intention-to-treat. RESULTS From 10 383 audits, improved escalation as per hospital policy was evident in the intervention group at 6 months (OR 1.47, 95% CI (1.06 to 2.04)) with a complete set of vital sign measurements sustained at 12 months (OR 1.22, 95% CI (1.02 to 1.47)). There were no significant differences in escalation of care as per hospital policy between study groups at 6 or 12 months post-intervention. After adjusting for patient and hospital characteristics, a significant change from T0 in mean length of stay between groups at 12 months favoured the intervention group (-2.18 days, 95% CI (-3.53 to -0.82)). CONCLUSION Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes. TRIAL REGISTRATION NUMBER ACTRN12616000544471p.
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Affiliation(s)
- Tracey K Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Gillian Harvey
- Caring Futures Institute, Flinders University College of Nursing and Health Sciences, Bedford Park, South Australia, Australia
| | - Ian D Graham
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- School of Epidemiology and Public Health and School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Imogen Mitchell
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Bridey Saultry
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Jennifer J Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mojtaba Lotfaliany
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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14
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Hourahine B, Aradi B, Blum V, Bonafé F, Buccheri A, Camacho C, Cevallos C, Deshaye MY, Dumitrică T, Dominguez A, Ehlert S, Elstner M, van der Heide T, Hermann J, Irle S, Jakowski J, Kranz JJ, Köhler C, Kowalczyk T, Kubař T, Lee IS, Lutsker V, Maurer RJ, Min SK, Mitchell I, Negre C, Niehaus TA, Niklasson AMN, Page AJ, Pecchia A, Penazzi G, Persson MP, Řezáč J, Sánchez CG, Sternberg M, Stöhr M, Stuckenberg F, Tkatchenko A, Yu VWZ, Frauenheim T. Erratum: “DFTB+, a software package for efficient approximate density functional theory based atomistic simulations” [J. Chem. Phys. 152, 124101 (2020)]. J Chem Phys 2022; 157:039901. [DOI: 10.1063/5.0103026] [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: 11/14/2022] Open
Affiliation(s)
- B. Hourahine
- SUPA, Department of Physics, The University of Strathclyde, Glasgow G4 0NG, United Kingdom
| | - B. Aradi
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - V. Blum
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - F. Bonafé
- Max Planck Institute for the Structure and Dynamics of Matter, Hamburg, Germany
| | - A. Buccheri
- School of Chemistry, University of Bristol, Cantock’s Close, Bristol BS8 1TS, United Kingdom
| | - C. Camacho
- School of Chemistry, University of Costa Rica, San José 11501-2060, Costa Rica
| | - C. Cevallos
- School of Chemistry, University of Costa Rica, San José 11501-2060, Costa Rica
| | - M. Y. Deshaye
- Department of Chemistry and Advanced Materials Science and Engineering Center, Western Washington University, Bellingham, Washington 98225, USA
| | - T. Dumitrică
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A. Dominguez
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
- Computational Science Research Center (CSRC) Beijing and Computational Science Applied Research (CSAR) Institute Shenzhen, Shenzhen, China
| | | | - M. Elstner
- Institute of Physical Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - T. van der Heide
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - J. Hermann
- Freie Universität Berlin, Berlin, Germany
| | - S. Irle
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J. Jakowski
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J. J. Kranz
- Institute of Physical Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - C. Köhler
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - T. Kowalczyk
- Department of Chemistry and Advanced Materials Science and Engineering Center, Western Washington University, Bellingham, Washington 98225, USA
| | - T. Kubař
- Institute of Physical Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - I. S. Lee
- Department of Chemistry, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - V. Lutsker
- Institut I–Theoretische Physik, University of Regensburg, Regensburg, Germany
| | - R. J. Maurer
- Department of Chemistry, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
| | - S. K. Min
- Department of Chemistry, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - I. Mitchell
- Center for Multidimensional Carbon Materials, Institute of Basic Science, Ulsan, South Korea
| | - C. Negre
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T. A. Niehaus
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622 Villeurbanne, France
| | - A. M. N. Niklasson
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A. J. Page
- School of Environmental and Life Sciences, University of Newcastle, Callaghan, Australia
| | - A. Pecchia
- CNR-ISMN, Via Salaria km 29,600, 00014 Monterotondo, Rome
| | - G. Penazzi
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | | | - J. Řezáč
- Institute of Organic Chemistry and Biochemistry AS CR, Prague, Czech Republic
| | - C. G. Sánchez
- Instituto Interdisciplinario de Ciencias Básicas, Universidad Nacional de Cuyo, CONICET, Facultad de Ciencias Exactas y Naturales, Mendoza, Argentina
| | - M. Sternberg
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - M. Stöhr
- Department of Physics and Materials Science, University of Luxembourg, Luxembourg City, Luxembourg
| | - F. Stuckenberg
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - A. Tkatchenko
- Department of Physics and Materials Science, University of Luxembourg, Luxembourg City, Luxembourg
| | - V. W.-z. Yu
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - T. Frauenheim
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
- Computational Science Research Center (CSRC) Beijing and Computational Science Applied Research (CSAR) Institute Shenzhen, Shenzhen, China
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15
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Johnston K, O'Reilly CL, Scholz B, Mitchell I. The experiences of pharmacists during the global COVID-19 pandemic: A thematic analysis using the jobs demands-resources framework. Res Social Adm Pharm 2022; 18:3649-3655. [PMID: 35379560 PMCID: PMC8975180 DOI: 10.1016/j.sapharm.2022.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/17/2022]
Abstract
Background COVID-19 has necessitated a change to the way pharmacists are providing healthcare and has impacted the psychological wellbeing of these frontline healthcare workers. Objective To use the job demands-resources framework of burnout to describe the experiences of pharmacists working during COVID-19. Methods An online survey investigating burnout, psychosocial, and work-related factors affecting pharmacists during COVID-19 was distributed to a convenience sample of pharmacists practising in Australia during April and June 2020. The survey was distributed via social media and professional organisations. This study was a thematic analysis of the free-text question of the survey that asked participants to provide comment on anything they considered important. The job demands-resources framework of burnout was applied to the themes. Results Of 647 total survey responses, 215 (33.2%) participants responded to the free text question. Thematic analysis explored the increase in demands on pharmacists with a decreased availability of resources during COVID-19. Themes associated with high demands included an increased workload, provision of education and support to the community, taking on roles traditionally performed by others, managing medication and stock supply issues, and poor consumer behaviour. Themes representing resources, which were inadequate, included feeling supported by management and colleagues, feeling adequately trained, receiving clear and consistent communication, feeling valued and appreciated, personal safety, and recovery time. Conclusions Pharmacists have experienced increased demands and reduced resources during COVID-19 which is associated with burnout. Knowledge of these demands and resources can inform interventions at an individual, workplace, and external level. Recommendations made in this paper are aimed at increasing resources available to pharmacists.
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16
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Dixon-Woods M, Aveling EL, Campbell A, Ansari A, Tarrant C, Willars J, Pronovost P, Mitchell I, Bates DW, Dankers C, McGowan J, Martin G. What counts as a voiceable concern in decisions about speaking out in hospitals: A qualitative study. J Health Serv Res Policy 2022; 27:88-95. [PMID: 34978470 PMCID: PMC8950712 DOI: 10.1177/13558196211043800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
Objectives Those who work in health care organisations are a potentially valuable source of information about safety concerns, yet failures of voice are persistent. We propose the concept of ‘voiceable concern’ and offer an empirical exploration. Methods We conducted a qualitative study involving 165 semi-structured interviews with a range of staff (clinical, non-clinical and at different hierarchical levels) in three hospitals in two countries. Analysis was based on the constant comparative method. Results Our analysis shows that identifying what counts as a concern, and what counts as a occasion for voice by a given individual, is not a straightforward matter of applying objective criteria. It instead often involves discretionary judgement, exercised in highly specific organisational and cultural contexts. We identified four influences that shape whether incidents, events and patterns were classified as voiceable concerns: certainty that something is wrong and is an occasion for voice; system versus conduct concerns, forgivability and normalisation. Determining what counted as a voiceable concern is not a simple function of the features of the concern; also important is whether the person who noticed the concern felt it was voiceable by them. Conclusions Understanding how those who work in health care organisations come to recognise what counts as a voiceable concern is critical to understanding decisions and actions about speaking out. The concept of a voiceable concern may help to explain aspects of voice behaviour in organisations as well as informing interventions to improve voice.
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Affiliation(s)
- Mary Dixon-Woods
- Health Foundation Professor of Healthcare Improvement Studies, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK
| | - Emma L Aveling
- Research Scientist, Department of Health Policy and Management, 1857Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anne Campbell
- Research Associate, 572200The NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - Akbar Ansari
- Research Associate, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK
| | - Carolyn Tarrant
- Professor of Health Services Research, Department of Health Sciences, 4488University of Leicester, UK
| | - Janet Willars
- Honorary Visiting Fellow, Department of Health Sciences, 4488University of Leicester, UK
| | - Peter Pronovost
- Chief Clinical Transformation and Chief Quality Officer, 24575University Hospitals Cleveland, OH, USA.,Professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Western Reserve University, Cleveland, OH, USA
| | - Imogen Mitchell
- Executive Director, 104822Research and Academic Partnerships, Canberra Health Services and Australian National University
| | - David W Bates
- Chief, Division of General Internal Medicine, 1861Brigham and Women's Hospital, Boston, MA, USA
| | - Christian Dankers
- Associate Chief Quality Officer, Quality and Patient Experience, 1813Mass General Brigham, Boston, MA, USA
| | - James McGowan
- Clinical Research Associate, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK
| | - Graham Martin
- Director of Research, THIS Institute, Department of Public Health and Primary Care, 12204University of Cambridge, UK
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17
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Frame A, Grant JB, Layard E, Scholz B, Law E, Ranse K, Mitchell I, Chapman M. Bereaved caregivers’ satisfaction with end-of-life care. Progress in Palliative Care 2021. [DOI: 10.1080/09699260.2021.2005756] [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: 10/19/2022]
Affiliation(s)
- Abbey Frame
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Elizabeth Layard
- Psychosocial Liaison, Palliative Care, The Canberra Hospital, Canberra, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Eleanor Law
- Division of Cancer, Ambulatory and Community Health Support (CACHS), The Canberra Hospital, Canberra, Australia
| | - Kristen Ranse
- School of Nursing & Midwifery, Griffith University, Griffith, Australia
| | - Imogen Mitchell
- ANU Medical School, The Australian National University, Canberra, Australia
| | - Michael Chapman
- ANU Medical School, The Australian National University, Canberra, Australia
- Palliative Care, The Canberra Hospital, Canberra, Australia
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18
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Mitchell I, Lacey J, Anstey M, Corbett C, Douglas C, Drummond C, Hensley M, Mills A, Scott C, Slee JA, Weil J, Scholz B, Burke B, D'Este C. Understanding end-of-life care in Australian hospitals. AUST HEALTH REV 2021; 45:AH20223. [PMID: 34074379 DOI: 10.1071/ah20223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022]
Abstract
Objective To explore end-of-life care in the ward and intensive care unit (ICU) environment in nine Australian hospitals in a retrospective observational study. Methods In total, 1693 in-hospital deaths, 356 in ICU, were reviewed, including patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care. Results Most patients (n =1430, 84%) were aged ≥60 years, with a low percentage (n =208, 12%) having an end-of-life care plan on admission. Following admission, 82% (n =1391) of patients were recognised as dying, but the time between recognition of dying to death was short (ICU (staying 4-48h) median 0.34 days (first quartile (Q1), third quartile (Q3): 0.16, 0.72); Ward (staying more than 48h) median 2.1 days (Q1, Q3: 0.96, 4.3)). Although 41% (n =621) patients were referred for specialist palliative care, most referrals were within the last few days of life (2.3 days (0.88, 5.9)) and 62% of patients (n =1047) experienced active intervention in their final 48h. Conclusions Late recognition of dying can expose patients to active interventions and minimises timely palliative care. To attain alignment to the National Consensus Statement to improve experiences of end-of-life care, a nationally coordinated approach is needed. What is known about the topic? The majority of Australian patient deaths occur in hospitals whose care needs to align to the Australian Commission on Safety and Quality in Health Care's National Consensus Statement, essential elements of safe and high -quality end -of -life care. What does this paper add? The largest Australian study of hospital deaths reveals only 12% of patients have existing advance care plans, recognition of death is predominantly within the last 48h of life, with 60% receiving investigations and interventions during this time with late symptom relief. What are the implications for practitioners? Given the poor alignment with the National Consensus Statement, a nationally coordinated approach would improve the patient experience of end-of-life care.
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Affiliation(s)
- Imogen Mitchell
- ANU Medical School, The Australian National University; Canberra Health Services, ACT, Australia
| | - Jeanette Lacey
- John Hunter Hospital, Medicine and Interventional Services, Newcastle, NSW, Australia
| | | | | | - Carol Douglas
- Palliative and Supportive Care, Royal Brisbane and Women's Hospital, Qld, Australia
| | | | - Michel Hensley
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; and University of Newcastle, NSW, Australia
| | - Amber Mills
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Vic., Australia
| | - Caroline Scott
- Centre of Palliative Care, St Vincent's Hospital, Melbourne, Vic., Australia
| | | | - Jennifer Weil
- University of Melbourne, Department of Medicine, Vic., Australia
| | - Brett Scholz
- ANU Medical School, The Australian National University; Canberra Health Services, ACT, Australia
| | - Brandon Burke
- Christchurch Hospital, Christchurch, New Zealand; and University of Otago Christchurch School of Medicine, New Zealand
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, ACT, Australia
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19
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Johnston K, O'Reilly CL, Scholz B, Georgousopoulou EN, Mitchell I. Burnout and the challenges facing pharmacists during COVID-19: results of a national survey. Int J Clin Pharm 2021; 43:716-725. [PMID: 33851288 PMCID: PMC8043093 DOI: 10.1007/s11096-021-01268-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Background COVID-19 has impacted the psychological wellbeing of healthcare workers and has forced pharmacists to adapt their services. Objective To measure burnout and describe the work and psychosocial factors affecting pharmacists during COVID-19, and to compare males and females. Setting An online survey was distributed to a convenience sample of pharmacists practicing in any setting in Australia during April and June 2020. Method The survey collected demographic data, burnout scores using the validated Maslach Burnout Inventory (MBI), psychosocial and work-related variables using questions adapted from previous surveys. It was tested for readability by a group of pharmacists and academic clinicians before distribution via social media and professional organisations. Main outcome measure Burnout was calculated using mean MBI scores, descriptive statistics were used to report work and psychosocial variables and Pearson's chi-square compared males and females. Results Overall, 647 responses were analysed. Most participants were female n = 487 (75.7%) with hospital n = 269 (42.2%) and community n = 253 (39.9%) pharmacists well represented. Mean (SD) for emotional exhaustion (possible range 0-54) and depersonalisation (possible range 0-30) were 28.5 (13.39) and 7.98 (5.64), which were higher (increased burnout) than reported pre-COVID-19. Personal accomplishment (range 0-48, lower scores associated with burnout) mean (SD) 36.58 (7.56), was similar to previously reported. Males reported higher depersonalisation indicating more withdrawal and cynicism. Working overtime, medication supply and patient incivility were reported to affect work. Conclusion Pharmacists are experiencing burnout, with work and psychosocial factors affecting them during COVID-19. Knowledge of this and that males experience more depersonalisation is valuable to inform advocacy and interventions to support pharmacists.
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Affiliation(s)
- Karlee Johnston
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia.
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney NSW, Australia
| | - Brett Scholz
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia
| | - Ekavi N Georgousopoulou
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia
| | - Imogen Mitchell
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia
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20
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Johnston K, O'Reilly CL, Cooper G, Mitchell I. The burden of COVID-19 on pharmacists. J Am Pharm Assoc (2003) 2021; 61:e61-e64. [PMID: 33189556 PMCID: PMC7580693 DOI: 10.1016/j.japh.2020.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 12/16/2022]
Abstract
The unprecedented changes brought about by the global coronavirus disease 2019 (COVID-19) pandemic have had important impacts on society. The pandemic has provided an opportunity to highlight the crucial role pharmacists play in the provision of health care. The critical and unique role of pharmacists in pandemics and other disasters has been highlighted in the past (severe acute respiratory syndrome and Ebola outbreaks) and more recently with reports of the contributions of pharmacists during the global COVID-19 pandemic. Many reports have documented that health care professionals are experiencing significant psychological morbidity as a result of providing essential care and services during the global COVID-19 pandemic. In these reports, pharmacists are not well represented, and, therefore, it is essential to understand the impact of COVID-19 on pharmacists across multiple practice settings. This is particularly true as the experiences of pharmacists working through previous pandemics and disasters, and the associated psychological burden, are likely to offer insights and be useful in supporting the psychological well-being of pharmacists during the global COVID-19 pandemic. Research into the effect of the global COVID-19 pandemic on pharmacists should improve the understanding of the impact and the psychological morbidity associated with their role as frontline health care professionals.
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21
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Balantekin AB, Band HR, Bass CD, Bergeron DE, Berish D, Bowden NS, Brodsky JP, Bryan CD, Classen T, Conant AJ, Deichert G, Diwan MV, Dolinski MJ, Erickson A, Foust BT, Gaison JK, Galindo-Uribarri A, Gilbert CE, Hackett BT, Hans S, Hansell AB, Heeger KM, Heffron B, Jaffe DE, Ji X, Jones DC, Kyzylova O, Lane CE, Langford TJ, LaRosa J, Littlejohn BR, Lu X, Maricic J, Mendenhall MP, Milincic R, Mitchell I, Mueller PE, Mumm HP, Napolitano J, Neilson R, Nikkel JA, Norcini D, Nour S, Palomino-Gallo JL, Pushin DA, Qian X, Romero-Romero E, Rosero R, Surukuchi PT, Tyra MA, Varner RL, White C, Wilhelmi J, Woolverton A, Yeh M, Zhang A, Zhang C, Zhang X. Nonfuel Antineutrino Contributions in the High Flux Isotope Reactor. ACTA ACUST UNITED AC 2020; 101. [PMID: 33336123 DOI: 10.1103/physrevc.101.054605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Reactor neutrino experiments have seen major improvements in precision in recent years. With the experimental uncertainties becoming lower than those from theory, carefully considering all sources of ν ¯ e is important when making theoretical predictions. One source of ν ¯ e that is often neglected arises from the irradiation of the nonfuel materials in reactors. The ν ¯ e rates and energies from these sources vary widely based on the reactor type, configuration, and sampling stage during the reactor cycle and have to be carefully considered for each experiment independently. In this article, we present a formalism for selecting the possible ν ¯ e sources arising from the neutron captures on reactor and target materials. We apply this formalism to the High Flux Isotope Reactor (HFIR) at Oak Ridge National Laboratory, the ν ¯ e source for the the Precision Reactor Oscillation and Spectrum Measurement (PROSPECT) experiment. Overall, we observe that the nonfuel ν ¯ e contributions from HFIR to PROSPECT amount to 1% above the inverse beta decay threshold with a maximum contribution of 9% in the 1.8-2.0 MeV range. Nonfuel contributions can be particularly high for research reactors like HFIR because of the choice of structural and reflector material in addition to the intentional irradiation of target material for isotope production. We show that typical commercial pressurized water reactors fueled with low-enriched uranium will have significantly smaller nonfuel ν ¯ e contribution.
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Affiliation(s)
- A B Balantekin
- Department of Physics, University of Wisconsin, Madison, Madison, WI 53706, USA
| | - H R Band
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - C D Bass
- Department of Physics, Le Moyne College, Syracuse, NY 13214, USA
| | - D E Bergeron
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - D Berish
- Department of Physics, Temple University, Philadelphia, PA 19122, USA
| | - N S Bowden
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - J P Brodsky
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - C D Bryan
- High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - T Classen
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - A J Conant
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.,High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - G Deichert
- High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - M V Diwan
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, PA 19104, USA
| | - A Erickson
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - B T Foust
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - J K Gaison
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - A Galindo-Uribarri
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.,Department of Physics and Astronomy, University of Tennessee, Knoxville, TN 37996, USA
| | - C E Gilbert
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.,Department of Physics and Astronomy, University of Tennessee, Knoxville, TN 37996, USA
| | - B T Hackett
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.,Department of Physics and Astronomy, University of Tennessee, Knoxville, TN 37996, USA
| | - S Hans
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - A B Hansell
- Department of Physics, Temple University, Philadelphia, PA 19122, USA
| | - K M Heeger
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - B Heffron
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.,Department of Physics and Astronomy, University of Tennessee, Knoxville, TN 37996, USA
| | - D E Jaffe
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - X Ji
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - D C Jones
- Department of Physics, Temple University, Philadelphia, PA 19122, USA
| | - O Kyzylova
- Department of Physics, Drexel University, Philadelphia, PA 19104, USA
| | - C E Lane
- Department of Physics, Drexel University, Philadelphia, PA 19104, USA
| | - T J Langford
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - J LaRosa
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - B R Littlejohn
- Department of Physics, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - X Lu
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.,Department of Physics and Astronomy, University of Tennessee, Knoxville, TN 37996, USA
| | - J Maricic
- Department of Physics & Astronomy, University of Hawaii, Honolulu, HA 96822, USA
| | - M P Mendenhall
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - R Milincic
- Department of Physics & Astronomy, University of Hawaii, Honolulu, HA 96822, USA
| | - I Mitchell
- Department of Physics & Astronomy, University of Hawaii, Honolulu, HA 96822, USA
| | - P E Mueller
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - H P Mumm
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - J Napolitano
- Department of Physics, Temple University, Philadelphia, PA 19122, USA
| | - R Neilson
- Department of Physics, Drexel University, Philadelphia, PA 19104, USA
| | - J A Nikkel
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - D Norcini
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - S Nour
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - J L Palomino-Gallo
- Department of Physics, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - D A Pushin
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - X Qian
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - E Romero-Romero
- High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.,Department of Physics, Temple University, Philadelphia, PA 19122, USA
| | - R Rosero
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - P T Surukuchi
- Wright Laboratory, Department of Physics, Yale University, New Haven, CT 06520, USA
| | - M A Tyra
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - R L Varner
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA
| | - C White
- Department of Physics, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - J Wilhelmi
- Department of Physics, Temple University, Philadelphia, PA 19122, USA
| | - A Woolverton
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - M Yeh
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - A Zhang
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - C Zhang
- Brookhaven National Laboratory, Upton, NY 11973, USA
| | - X Zhang
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
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22
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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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23
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Affiliation(s)
- Lucy E Kirk
- Australian National University, Canberra, ACT
| | - Imogen Mitchell
- Australian National University, Canberra, ACT.,Canberra Hospital, Canberra, ACT
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24
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Hourahine B, Aradi B, Blum V, Bonafé F, Buccheri A, Camacho C, Cevallos C, Deshaye MY, Dumitrică T, Dominguez A, Ehlert S, Elstner M, van der Heide T, Hermann J, Irle S, Kranz JJ, Köhler C, Kowalczyk T, Kubař T, Lee IS, Lutsker V, Maurer RJ, Min SK, Mitchell I, Negre C, Niehaus TA, Niklasson AMN, Page AJ, Pecchia A, Penazzi G, Persson MP, Řezáč J, Sánchez CG, Sternberg M, Stöhr M, Stuckenberg F, Tkatchenko A, Yu VWZ, Frauenheim T. DFTB+, a software package for efficient approximate density functional theory based atomistic simulations. J Chem Phys 2020; 152:124101. [PMID: 32241125 DOI: 10.1063/1.5143190] [Citation(s) in RCA: 350] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
DFTB+ is a versatile community developed open source software package offering fast and efficient methods for carrying out atomistic quantum mechanical simulations. By implementing various methods approximating density functional theory (DFT), such as the density functional based tight binding (DFTB) and the extended tight binding method, it enables simulations of large systems and long timescales with reasonable accuracy while being considerably faster for typical simulations than the respective ab initio methods. Based on the DFTB framework, it additionally offers approximated versions of various DFT extensions including hybrid functionals, time dependent formalism for treating excited systems, electron transport using non-equilibrium Green's functions, and many more. DFTB+ can be used as a user-friendly standalone application in addition to being embedded into other software packages as a library or acting as a calculation-server accessed by socket communication. We give an overview of the recently developed capabilities of the DFTB+ code, demonstrating with a few use case examples, discuss the strengths and weaknesses of the various features, and also discuss on-going developments and possible future perspectives.
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Affiliation(s)
- B Hourahine
- SUPA, Department of Physics, The University of Strathclyde, Glasgow G4 0NG, United Kingdom
| | - B Aradi
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - V Blum
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - F Bonafé
- Max Planck Institute for the Structure and Dynamics of Matter, Hamburg, Germany
| | - A Buccheri
- School of Chemistry, University of Bristol, Cantock's Close, Bristol BS8 1TS, United Kingdom
| | - C Camacho
- School of Chemistry, University of Costa Rica, San José 11501-2060, Costa Rica
| | - C Cevallos
- School of Chemistry, University of Costa Rica, San José 11501-2060, Costa Rica
| | - M Y Deshaye
- Department of Chemistry and Advanced Materials Science and Engineering Center, Western Washington University, Bellingham, Washington 98225, USA
| | - T Dumitrică
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Dominguez
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - S Ehlert
- University of Bonn, Bonn, Germany
| | - M Elstner
- Institute of Physical Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - T van der Heide
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - J Hermann
- Freie Universität Berlin, Berlin, Germany
| | - S Irle
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J J Kranz
- Institute of Physical Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - C Köhler
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - T Kowalczyk
- Department of Chemistry and Advanced Materials Science and Engineering Center, Western Washington University, Bellingham, Washington 98225, USA
| | - T Kubař
- Institute of Physical Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - I S Lee
- Department of Chemistry, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - V Lutsker
- Institut I - Theoretische Physik, University of Regensburg, Regensburg, Germany
| | - R J Maurer
- Department of Chemistry, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
| | - S K Min
- Department of Chemistry, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - I Mitchell
- Center for Multidimensional Carbon Materials, Institute for Basic Science (IBS), Ulsan 44919, South Korea
| | - C Negre
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T A Niehaus
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, Institut Lumière Matière, F-69622 Villeurbanne, France
| | - A M N Niklasson
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A J Page
- School of Environmental and Life Sciences, University of Newcastle, Callaghan, Australia
| | - A Pecchia
- CNR-ISMN, Via Salaria km 29.300, 00015 Monterotondo Stazione, Rome, Italy
| | - G Penazzi
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - M P Persson
- Dassault Systemes, Cambridge, United Kingdom
| | - J Řezáč
- Institute of Organic Chemistry and Biochemistry AS CR, Prague, Czech Republic
| | - C G Sánchez
- Instituto Interdisciplinario de Ciencias Básicas, Universidad Nacional de Cuyo, CONICET, Facultad de Ciencias Exactas y Naturales, Mendoza, Argentina
| | - M Sternberg
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - M Stöhr
- Department of Physics and Materials Science, University of Luxembourg, L-1511 Luxembourg City, Luxembourg
| | - F Stuckenberg
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
| | - A Tkatchenko
- Department of Physics and Materials Science, University of Luxembourg, L-1511 Luxembourg City, Luxembourg
| | - V W-Z Yu
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - T Frauenheim
- Bremen Center for Computational Materials Science, University of Bremen, Bremen, Germany
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25
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Georgousopoulou E, Haskell J, Mitchell I. Very low internal consistency in modified early warning score parameters: audit of 873,182 physiological observation sets of 15,103 inpatients. Aust Crit Care 2020. [DOI: 10.1016/j.aucc.2020.04.150] [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: 11/28/2022] Open
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26
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Maubach N, Batten M, Jones S, Chen J, Scholz B, Davis A, Bromley J, Burke B, Tan R, Hurwitz M, Rodgers H, Mitchell I. End‐of‐life care in an Australian acute hospital: a retrospective observational study. Intern Med J 2019; 49:1400-1405. [DOI: 10.1111/imj.14305] [Citation(s) in RCA: 4] [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: 10/11/2018] [Revised: 02/18/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ninya Maubach
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Monique Batten
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Scott Jones
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Judy Chen
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Brett Scholz
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Alison Davis
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Jonathan Bromley
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Brandon Burke
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Ren Tan
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Mark Hurwitz
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Helen Rodgers
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Imogen Mitchell
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
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Adey D, An FP, Balantekin AB, Band HR, Bishai M, Blyth S, Cao D, Cao GF, Cao J, Chang JF, Chang Y, Chen HS, Chen SM, Chen Y, Chen YX, Cheng J, Cheng ZK, Cherwinka JJ, Chu MC, Chukanov A, Cummings JP, Dash N, Deng FS, Ding YY, Diwan MV, Dohnal T, Dove J, Dvořák M, Dwyer DA, Gonchar M, Gong GH, Gong H, Gu WQ, Guo JY, Guo L, Guo XH, Guo YH, Guo Z, Hackenburg RW, Hans S, He M, Heeger KM, Heng YK, Higuera A, Hor YK, Hsiung YB, Hu BZ, Hu JR, Hu T, Hu ZJ, Huang HX, Huang XT, Huang YB, Huber P, Jaffe DE, Jen KL, Ji XL, Ji XP, Johnson RA, Jones D, Kang L, Kettell SH, Koerner LW, Kohn S, Kramer M, Langford TJ, Lee J, Lee JHC, Lei RT, Leitner R, Leung JKC, Li C, Li F, Li HL, Li QJ, Li S, Li SC, Li SJ, Li WD, Li XN, Li XQ, Li YF, Li ZB, Liang H, Lin CJ, Lin GL, Lin S, Ling JJ, Link JM, Littenberg L, Littlejohn BR, Liu JC, Liu JL, Liu Y, Liu YH, Lu C, Lu HQ, Lu JS, Luk KB, Ma XB, Ma XY, Ma YQ, Marshall C, Martinez Caicedo DA, McDonald KT, McKeown RD, Mitchell I, Mora Lepin L, Napolitano J, Naumov D, Naumova E, Ochoa-Ricoux JP, Olshevskiy A, Pan HR, Park J, Patton S, Pec V, Peng JC, Pinsky L, Pun CSJ, Qi FZ, Qi M, Qian X, Raper N, Ren J, Rosero R, Roskovec B, Ruan XC, Steiner H, Sun JL, Treskov K, Tse WH, Tull CE, Viren B, Vorobel V, Wang CH, Wang J, Wang M, Wang NY, Wang RG, Wang W, Wang W, Wang X, Wang Y, Wang YF, Wang Z, Wang Z, Wang ZM, Wei HY, Wei LH, Wen LJ, Whisnant K, White CG, Wong HLH, Wong SCF, Worcester E, Wu Q, Wu WJ, Xia DM, Xing ZZ, Xu JL, Xue T, Yang CG, Yang L, Yang MS, Yang YZ, Ye M, Yeh M, Young BL, Yu HZ, Yu ZY, Yue BB, Zeng S, Zeng Y, Zhan L, Zhang C, Zhang CC, Zhang FY, Zhang HH, Zhang JW, Zhang QM, Zhang R, Zhang XF, Zhang XT, Zhang YM, Zhang YM, Zhang YX, Zhang YY, Zhang ZJ, Zhang ZP, Zhang ZY, Zhao J, Zhou L, Zhuang HL, Zou JH. Extraction of the ^{235}U and ^{239}Pu Antineutrino Spectra at Daya Bay. Phys Rev Lett 2019; 123:111801. [PMID: 31573238 DOI: 10.1103/physrevlett.123.111801] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/04/2019] [Indexed: 06/10/2023]
Abstract
This Letter reports the first extraction of individual antineutrino spectra from ^{235}U and ^{239}Pu fission and an improved measurement of the prompt energy spectrum of reactor antineutrinos at Daya Bay. The analysis uses 3.5×10^{6} inverse beta-decay candidates in four near antineutrino detectors in 1958 days. The individual antineutrino spectra of the two dominant isotopes, ^{235}U and ^{239}Pu, are extracted using the evolution of the prompt spectrum as a function of the isotope fission fractions. In the energy window of 4-6 MeV, a 7% (9%) excess of events is observed for the ^{235}U (^{239}Pu) spectrum compared with the normalized Huber-Mueller model prediction. The significance of discrepancy is 4.0σ for ^{235}U spectral shape compared with the Huber-Mueller model prediction. The shape of the measured inverse beta-decay prompt energy spectrum disagrees with the prediction of the Huber-Mueller model at 5.3σ. In the energy range of 4-6 MeV, a maximal local discrepancy of 6.3σ is observed.
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Affiliation(s)
- D Adey
- Institute of High Energy Physics, Beijing
| | - F P An
- Institute of Modern Physics, East China University of Science and Technology, Shanghai
| | | | - H R Band
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - M Bishai
- Brookhaven National Laboratory, Upton, New York 11973
| | - S Blyth
- Department of Physics, National Taiwan University, Taipei
| | - D Cao
- Nanjing University, Nanjing
| | - G F Cao
- Institute of High Energy Physics, Beijing
| | - J Cao
- Institute of High Energy Physics, Beijing
| | - J F Chang
- Institute of High Energy Physics, Beijing
| | - Y Chang
- National United University, Miao-Li
| | - H S Chen
- Institute of High Energy Physics, Beijing
| | - S M Chen
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Y Chen
- Shenzhen University, Shenzhen
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - Y X Chen
- North China Electric Power University, Beijing
| | - J Cheng
- Institute of High Energy Physics, Beijing
| | - Z K Cheng
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | | | - M C Chu
- Chinese University of Hong Kong, Hong Kong
| | - A Chukanov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | | | - N Dash
- Institute of High Energy Physics, Beijing
| | - F S Deng
- University of Science and Technology of China, Hefei
| | - Y Y Ding
- Institute of High Energy Physics, Beijing
| | - M V Diwan
- Brookhaven National Laboratory, Upton, New York 11973
| | - T Dohnal
- Charles University, Faculty of Mathematics and Physics, Prague
| | - J Dove
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801
| | - M Dvořák
- Charles University, Faculty of Mathematics and Physics, Prague
| | - D A Dwyer
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - M Gonchar
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - G H Gong
- Department of Engineering Physics, Tsinghua University, Beijing
| | - H Gong
- Department of Engineering Physics, Tsinghua University, Beijing
| | - W Q Gu
- Brookhaven National Laboratory, Upton, New York 11973
| | - J Y Guo
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - L Guo
- Department of Engineering Physics, Tsinghua University, Beijing
| | - X H Guo
- Beijing Normal University, Beijing
| | - Y H Guo
- Department of Nuclear Science and Technology, School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an
| | - Z Guo
- Department of Engineering Physics, Tsinghua University, Beijing
| | | | - S Hans
- Brookhaven National Laboratory, Upton, New York 11973
| | - M He
- Institute of High Energy Physics, Beijing
| | - K M Heeger
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - Y K Heng
- Institute of High Energy Physics, Beijing
| | - A Higuera
- Department of Physics, University of Houston, Houston, Texas 77204
| | - Y K Hor
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - Y B Hsiung
- Department of Physics, National Taiwan University, Taipei
| | - B Z Hu
- Department of Physics, National Taiwan University, Taipei
| | - J R Hu
- Institute of High Energy Physics, Beijing
| | - T Hu
- Institute of High Energy Physics, Beijing
| | - Z J Hu
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - H X Huang
- China Institute of Atomic Energy, Beijing
| | | | - Y B Huang
- Institute of High Energy Physics, Beijing
| | - P Huber
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - D E Jaffe
- Brookhaven National Laboratory, Upton, New York 11973
| | - K L Jen
- Institute of Physics, National Chiao-Tung University, Hsinchu
| | - X L Ji
- Institute of High Energy Physics, Beijing
| | - X P Ji
- Brookhaven National Laboratory, Upton, New York 11973
| | - R A Johnson
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221
| | - D Jones
- Department of Physics, College of Science and Technology, Temple University, Philadelphia, Pennsylvania 19122
| | - L Kang
- Dongguan University of Technology, Dongguan
| | - S H Kettell
- Brookhaven National Laboratory, Upton, New York 11973
| | - L W Koerner
- Department of Physics, University of Houston, Houston, Texas 77204
| | - S Kohn
- Department of Physics, University of California, Berkeley, California 94720
| | - M Kramer
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - T J Langford
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - J Lee
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - J H C Lee
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - R T Lei
- Dongguan University of Technology, Dongguan
| | - R Leitner
- Charles University, Faculty of Mathematics and Physics, Prague
| | - J K C Leung
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - C Li
- Shandong University, Jinan
| | - F Li
- Institute of High Energy Physics, Beijing
| | - H L Li
- Institute of High Energy Physics, Beijing
| | - Q J Li
- Institute of High Energy Physics, Beijing
| | - S Li
- Dongguan University of Technology, Dongguan
| | - S C Li
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - S J Li
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - W D Li
- Institute of High Energy Physics, Beijing
| | - X N Li
- Institute of High Energy Physics, Beijing
| | - X Q Li
- School of Physics, Nankai University, Tianjin
| | - Y F Li
- Institute of High Energy Physics, Beijing
| | - Z B Li
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - H Liang
- University of Science and Technology of China, Hefei
| | - C J Lin
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - G L Lin
- Institute of Physics, National Chiao-Tung University, Hsinchu
| | - S Lin
- Dongguan University of Technology, Dongguan
| | - J J Ling
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J M Link
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - L Littenberg
- Brookhaven National Laboratory, Upton, New York 11973
| | - B R Littlejohn
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - J C Liu
- Institute of High Energy Physics, Beijing
| | - J L Liu
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - Y Liu
- Shandong University, Jinan
| | | | - C Lu
- Joseph Henry Laboratories, Princeton University, Princeton, New Jersey 08544
| | - H Q Lu
- Institute of High Energy Physics, Beijing
| | - J S Lu
- Institute of High Energy Physics, Beijing
| | - K B Luk
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - X B Ma
- North China Electric Power University, Beijing
| | - X Y Ma
- Institute of High Energy Physics, Beijing
| | - Y Q Ma
- Institute of High Energy Physics, Beijing
| | - C Marshall
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - D A Martinez Caicedo
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - K T McDonald
- Joseph Henry Laboratories, Princeton University, Princeton, New Jersey 08544
| | - R D McKeown
- California Institute of Technology, Pasadena, California 91125
- College of William and Mary, Williamsburg, Virginia 23187
| | - I Mitchell
- Department of Physics, University of Houston, Houston, Texas 77204
| | - L Mora Lepin
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - J Napolitano
- Department of Physics, College of Science and Technology, Temple University, Philadelphia, Pennsylvania 19122
| | - D Naumov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - E Naumova
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - J P Ochoa-Ricoux
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
- Department of Physics and Astronomy, University of California, Irvine, California 92697
| | - A Olshevskiy
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - H-R Pan
- Department of Physics, National Taiwan University, Taipei
| | - J Park
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - S Patton
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - V Pec
- Charles University, Faculty of Mathematics and Physics, Prague
| | - J C Peng
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801
| | - L Pinsky
- Department of Physics, University of Houston, Houston, Texas 77204
| | - C S J Pun
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - F Z Qi
- Institute of High Energy Physics, Beijing
| | - M Qi
- Nanjing University, Nanjing
| | - X Qian
- Brookhaven National Laboratory, Upton, New York 11973
| | - N Raper
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J Ren
- China Institute of Atomic Energy, Beijing
| | - R Rosero
- Brookhaven National Laboratory, Upton, New York 11973
| | - B Roskovec
- Department of Physics and Astronomy, University of California, Irvine, California 92697
| | - X C Ruan
- China Institute of Atomic Energy, Beijing
| | - H Steiner
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - J L Sun
- China General Nuclear Power Group, Shenzhen
| | - K Treskov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - W-H Tse
- Chinese University of Hong Kong, Hong Kong
| | - C E Tull
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - B Viren
- Brookhaven National Laboratory, Upton, New York 11973
| | - V Vorobel
- Charles University, Faculty of Mathematics and Physics, Prague
| | - C H Wang
- National United University, Miao-Li
| | - J Wang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - M Wang
- Shandong University, Jinan
| | - N Y Wang
- Beijing Normal University, Beijing
| | - R G Wang
- Institute of High Energy Physics, Beijing
| | - W Wang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
- College of William and Mary, Williamsburg, Virginia 23187
| | - W Wang
- Nanjing University, Nanjing
| | - X Wang
- College of Electronic Science and Engineering, National University of Defense Technology, Changsha
| | - Y Wang
- Nanjing University, Nanjing
| | - Y F Wang
- Institute of High Energy Physics, Beijing
| | - Z Wang
- Institute of High Energy Physics, Beijing
| | - Z Wang
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Z M Wang
- Institute of High Energy Physics, Beijing
| | - H Y Wei
- Brookhaven National Laboratory, Upton, New York 11973
| | - L H Wei
- Institute of High Energy Physics, Beijing
| | - L J Wen
- Institute of High Energy Physics, Beijing
| | | | - C G White
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - H L H Wong
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - S C F Wong
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - E Worcester
- Brookhaven National Laboratory, Upton, New York 11973
| | - Q Wu
- Shandong University, Jinan
| | - W J Wu
- Institute of High Energy Physics, Beijing
| | - D M Xia
- Chongqing University, Chongqing
| | - Z Z Xing
- Institute of High Energy Physics, Beijing
| | - J L Xu
- Institute of High Energy Physics, Beijing
| | - T Xue
- Department of Engineering Physics, Tsinghua University, Beijing
| | - C G Yang
- Institute of High Energy Physics, Beijing
| | - L Yang
- Dongguan University of Technology, Dongguan
| | - M S Yang
- Institute of High Energy Physics, Beijing
| | - Y Z Yang
- Department of Engineering Physics, Tsinghua University, Beijing
| | - M Ye
- Institute of High Energy Physics, Beijing
| | - M Yeh
- Brookhaven National Laboratory, Upton, New York 11973
| | - B L Young
- Iowa State University, Ames, Iowa 50011
| | - H Z Yu
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - Z Y Yu
- Institute of High Energy Physics, Beijing
| | - B B Yue
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - S Zeng
- Institute of High Energy Physics, Beijing
| | - Y Zeng
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - L Zhan
- Institute of High Energy Physics, Beijing
| | - C Zhang
- Brookhaven National Laboratory, Upton, New York 11973
| | - C C Zhang
- Institute of High Energy Physics, Beijing
| | - F Y Zhang
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - H H Zhang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J W Zhang
- Institute of High Energy Physics, Beijing
| | - Q M Zhang
- Department of Nuclear Science and Technology, School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an
| | | | - X F Zhang
- Institute of High Energy Physics, Beijing
| | - X T Zhang
- Institute of High Energy Physics, Beijing
| | - Y M Zhang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - Y M Zhang
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Y X Zhang
- China General Nuclear Power Group, Shenzhen
| | - Y Y Zhang
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - Z J Zhang
- Dongguan University of Technology, Dongguan
| | - Z P Zhang
- University of Science and Technology of China, Hefei
| | - Z Y Zhang
- Institute of High Energy Physics, Beijing
| | - J Zhao
- Institute of High Energy Physics, Beijing
| | - L Zhou
- Institute of High Energy Physics, Beijing
| | - H L Zhuang
- Institute of High Energy Physics, Beijing
| | - J H Zou
- Institute of High Energy Physics, Beijing
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Scholz B, Bevan A, Georgousopoulou E, Collier A, Mitchell I. Consumer and carer leadership in palliative care academia and practice: A systematic review with narrative synthesis. Palliat Med 2019; 33:959-968. [PMID: 31199194 DOI: 10.1177/0269216319854012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Contemporary health policies call for consumers to be part of all aspects of service planning, implementation, delivery and evaluation. The extent to which consumers are part of the systemic decision-making levels of palliative care appears to vary between and within services and organisations. AIM The aim of this systematic review is to develop understandings about consumer and carer leadership in palliative care. DESIGN A systematic, narrative synthesis approach was adopted due to the heterogeneity of included studies. The review was registered on PROSPERO prospectively (PROSPERO 2018 CRD42018111625). DATA SOURCES PubMed, Scopus and PsycINFO were searched for all studies published in English specifically focusing on consumers' leadership in palliative care organisations and systems. Articles were appraised for quality using a modified JBI-QARI tool. RESULTS Eleven studies met the inclusion criteria and quality assessment. Consumers are currently involved in leadership of palliative care teaching, research and services. Findings highlight the benefits of consumer leadership in palliative care including more relevant, higher-quality services, teaching and research. Across the included studies, it was not clear the extent to which consumer leaders had influence in relation to setting agendas across the palliative care sector. CONCLUSION The findings suggest that more could be done to support consumer leadership within palliative care. Academics and clinicians might improve the relevance of their work if they are able to more meaningfully partner with consumers in systemic roles in palliative care.
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Affiliation(s)
- Brett Scholz
- 1 Medical School, The Australian National University, Acton, ACT, Australia
| | - Alan Bevan
- 2 Consumer Representative, Adelaide, SA, Australia
| | | | - Aileen Collier
- 3 School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Imogen Mitchell
- 1 Medical School, The Australian National University, Acton, ACT, Australia
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Rai S, Anthony L, Needham DM, Georgousopoulou EN, Sudheer B, Brown R, Mitchell I, van Haren F. Barriers to rehabilitation after critical illness: a survey of multidisciplinary healthcare professionals caring for ICU survivors in an acute care hospital. Aust Crit Care 2019; 33:264-271. [PMID: 31402265 DOI: 10.1016/j.aucc.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/03/2018] [Revised: 04/04/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND There is scant literature on the barriers to rehabilitation for patients discharged from the intensive care unit (ICU) to acute care wards. OBJECTIVES The objective of this study was to assess ward-based rehabilitation practices and barriers and assess knowledge and perceptions of ward clinicians regarding health concerns of ICU survivors. METHODS, DESIGN, SETTING, AND PARTICIPANTS This was a single-centre survey of multidisciplinary healthcare professionals caring for ICU survivors in an Australian tertiary teaching hospital. MAIN OUTCOME MEASURES The main outcome measures were knowledge of post-intensive care syndrome (PICS) amongst ward clinicians, perceptions of ongoing health concerns with current rehabilitation practices, and barriers to inpatient rehabilitation for ICU survivors. RESULTS The overall survey response rate was 35% (198/573 potential staff). Most respondents (66%, 126/190) were unfamiliar with the term PICS. A majority of the respondents perceived new-onset physical weakness, sleep disturbances, and delirium as common health concerns amongst ICU survivors on acute care wards. There were multifaceted barriers to patient mobilisation, with inadequate multidisciplinary staffing, lack of medical order for mobilisation, and inadequate physical space near the bed as common institutional barriers and patient frailty and cardiovascular instability as the commonly perceived patient-related barriers. A majority of the surveyed ward clinicians (66%, 115/173) would value education on health concerns of ICU survivors to provide better patient care. CONCLUSION There are multiple potentially modifiable barriers to the ongoing rehabilitation of ICU survivors in an acute care hospital. Addressing these barriers may have benefits for the ongoing care of ICU survivors.
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Affiliation(s)
- Sumeet Rai
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia.
| | - Lakmali Anthony
- Australian National University Medical School, Canberra, Australia
| | - Dale M Needham
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA; John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
| | | | - Bindu Sudheer
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian Catholic University, Watson, Canberra, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Imogen Mitchell
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia
| | - Frank van Haren
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; University of Canberra, Bruce, Canberra, Australia
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Forbat L, Johnston N, Mitchell I. Defining 'specialist palliative care': findings from a Delphi study of clinicians. AUST HEALTH REV 2019; 44:313-321. [PMID: 31248475 DOI: 10.1071/ah18198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/20/2019] [Indexed: 11/23/2022]
Abstract
Objective This study aimed to achieve consensus regarding what distinguishes specialist from non-specialist palliative care to inform service organisation and delivery to patients with life-limiting conditions. Methods A three-phase Delphi study was undertaken, involving qualitative interviews and two questionnaire cycles. Thirty-one clinicians (nurses, doctors and social workers) working with a wide range of patients participated in interviews, of whom 27 completed two questionnaire cycles. Results Consensus was gained on 75 items that define specialist palliative care and distinguish it from non-specialist palliative care. Consensus was gained that specialist palliative care clinicians have advanced knowledge of identifying dying, skills to assess and manage complex symptoms to improve quality of life, have advanced communication skills and perform distinct clinical practices (e.g. working with the whole family as the unit of care and providing support in complex bereavement). Non-specialist palliative care involves discussions around futile or burdensome treatments, and care for people who are dying. Conclusions Areas of connection were identified: clinicians from disease-specific specialties should be more involved in leading discussions on futile or burdensome treatment and providing care to people in their last months and days of life, in collaboration with specialists in palliative care when required. What is known about the topic? At present there is no evidence-based definition or agreement about what constitutes specialist palliative care (as opposed to palliative care delivered by non-specialists) in the Australian Capital Territory. An agreed definition is needed to effectively determine the workforce required and its clinical skill mix, and to clarify roles and expectations to mitigate risks in not adequately providing services to patients with life-limiting conditions. What does this paper add? This paper offers, for the first time, an evidence-based definition that distinguishes specialist palliative care from non-specialist palliative care. End of life care and bereavement support are not just the remit of specialist palliative care clinicians. Clinicians from beyond specialist palliative care should lead discussions about futile or burdensome treatment. What are the implications for practitioners? The findings of this study can facilitate implementation of palliative care strategies by enabling practitioners and patients to distinguish who should be delivering what care.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK; and Faculty of Health Sciences, Australian Catholic University, Canberra, ACT 2600, Australia; and Corresponding author.
| | | | - Imogen Mitchell
- Medical School, Australian National University, Florey Building, 54 Mills Road, Canberra, ACT 2601, Australia. ; and Canberra Hospital, Building 4, Level 2, Garran, ACT 2605, Australia
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Rai S, Brown R, van Haren F, Neeman T, Rajamani A, Sundararajan K, Mitchell I. Long-term follow-up for Psychological stRess in Intensive CarE (PRICE) survivors: study protocol for a multicentre, prospective observational cohort study in Australian intensive care units. BMJ Open 2019; 9:e023310. [PMID: 30782702 PMCID: PMC6352815 DOI: 10.1136/bmjopen-2018-023310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/17/2022] Open
Abstract
INTRODUCTION There are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating the effects of psychological morbidity in intensive care survivors on their family members. The aims of this study are to describe and compare the long-term psychological outcomes of intubated and non-intubated ICU survivors and their family members in an Australian ICU setting. METHODS AND ANALYSIS This will be a prospective observational cohort study across four ICUs in Australia. The study aims to recruit 150 (75 intubated and 75 non-intubated) adult ICU survivors and 150 family members of the survivors from 2015 to 2018. Long-term psychological outcomes and effects on health-related quality of life (HRQoL) will be evaluated at 3 and 12 months follow-up using validated and published screening tools. The primary objective is to compare the prevalence of affective symptoms in intubated and non-intubated survivors of intensive care and their families and its effects on HRQoL. The secondary objective is to explore dyadic relations of psychological outcomes in patients and their family members. ETHICS AND DISSEMINATION The study has been approved by the relevant human research ethics committees (HREC) of Australian Capital Territory (ACT) Health (ETH.11.14.315), New South Wales (HREC/16/HNE/64), South Australia (HREC/15/RAH/346). The results of this study will be published in a peer-reviewed medical journal and presented to the local intensive care community and other stakeholders. TRIAL REGISTRATION NUMBER ACTRN12615000880549; Pre-results.
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Affiliation(s)
- Sumeet Rai
- Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Frank van Haren
- Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Arvind Rajamani
- Intensive Care Unit, Nepean Hospital, Penrith, New South Wales, Australia
- Discipline of Critical Care, Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Imogen Mitchell
- Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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Gunasekaran B, Scott C, Ducharlet K, Marco D, Mitchell I, Weil J. Recognising and managing dying patients in the acute hospital setting: can we do better? Intern Med J 2019; 49:119-122. [DOI: 10.1111/imj.14177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/03/2018] [Accepted: 06/13/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Kathryn Ducharlet
- Department of Nephrology; St Vincent’s Hospital; Victoria Australia
- Department of Medicine; St Vincent’s Hospital; Victoria Australia
| | - David Marco
- Centre for Palliative Care; Victoria Australia
- Melbourne School of Psychological Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - Imogen Mitchell
- Intensive Care Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
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Adey D, An FP, Balantekin AB, Band HR, Bishai M, Blyth S, Cao D, Cao GF, Cao J, Chan YL, Chang JF, Chang Y, Chen HS, Chen SM, Chen Y, Chen YX, Cheng J, Cheng ZK, Cherwinka JJ, Chu MC, Chukanov A, Cummings JP, Deng FS, Ding YY, Diwan MV, Dolgareva M, Dwyer DA, Edwards WR, Gonchar M, Gong GH, Gong H, Gu WQ, Guo L, Guo XH, Guo YH, Guo Z, Hackenburg RW, Hans S, He M, Heeger KM, Heng YK, Higuera A, Hsiung YB, Hu BZ, Hu JR, Hu T, Hu ZJ, Huang HX, Huang XT, Huang YB, Huber P, Huo W, Hussain G, Jaffe DE, Jen KL, Ji XL, Ji XP, Johnson RA, Jones D, Kang L, Kettell SH, Koerner LW, Kohn S, Kramer M, Langford TJ, Lebanowski L, Lee J, Lee JHC, Lei RT, Leitner R, Leung JKC, Li C, Li F, Li HL, Li QJ, Li S, Li SC, Li SJ, Li WD, Li XN, Li XQ, Li YF, Li ZB, Liang H, Lin CJ, Lin GL, Lin S, Lin SK, Lin YC, Ling JJ, Link JM, Littenberg L, Littlejohn BR, Liu JC, Liu JL, Liu Y, Liu YH, Loh CW, Lu C, Lu HQ, Lu JS, Luk KB, Ma XB, Ma XY, Ma YQ, Malyshkin Y, Marshall C, Martinez Caicedo DA, McDonald KT, McKeown RD, Mitchell I, Mora Lepin L, Napolitano J, Naumov D, Naumova E, Ochoa-Ricoux JP, Olshevskiy A, Pan HR, Park J, Patton S, Pec V, Peng JC, Pinsky L, Pun CSJ, Qi FZ, Qi M, Qian X, Qiu RM, Raper N, Ren J, Rosero R, Roskovec B, Ruan XC, Steiner H, Sun JL, Tang W, Taychenachev D, Treskov K, Tse WH, Tull CE, Viren B, Vorobel V, Wang CH, Wang J, Wang M, Wang NY, Wang RG, Wang W, Wang W, Wang X, Wang YF, Wang Z, Wang Z, Wang ZM, Wei HY, Wei LH, Wen LJ, Whisnant K, White CG, Wise T, Wong HLH, Wong SCF, Worcester E, Wu Q, Wu WJ, Xia DM, Xing ZZ, Xu JL, Xue T, Yang CG, Yang H, Yang L, Yang MS, Yang MT, Yang YZ, Ye M, Yeh M, Young BL, Yu HZ, Yu ZY, Yue BB, Zeng S, Zhan L, Zhang C, Zhang CC, Zhang FY, Zhang HH, Zhang JW, Zhang QM, Zhang R, Zhang XF, Zhang XT, Zhang YM, Zhang YM, Zhang YX, Zhang YY, Zhang ZJ, Zhang ZP, Zhang ZY, Zhao J, Zheng P, Zhou L, Zhuang HL, Zou JH. Measurement of the Electron Antineutrino Oscillation with 1958 Days of Operation at Daya Bay. Phys Rev Lett 2018; 121:241805. [PMID: 30608728 DOI: 10.1103/physrevlett.121.241805] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Indexed: 06/09/2023]
Abstract
We report a measurement of electron antineutrino oscillation from the Daya Bay Reactor Neutrino Experiment with nearly 4 million reactor ν[over ¯]_{e} inverse β decay candidates observed over 1958 days of data collection. The installation of a flash analog-to-digital converter readout system and a special calibration campaign using different source enclosures reduce uncertainties in the absolute energy calibration to less than 0.5% for visible energies larger than 2 MeV. The uncertainty in the cosmogenic ^{9}Li and ^{8}He background is reduced from 45% to 30% in the near detectors. A detailed investigation of the spent nuclear fuel history improves its uncertainty from 100% to 30%. Analysis of the relative ν[over ¯]_{e} rates and energy spectra among detectors yields sin^{2}2θ_{13}=0.0856±0.0029 and Δm_{32}^{2}=(2.471_{-0.070}^{+0.068})×10^{-3} eV^{2} assuming the normal hierarchy, and Δm_{32}^{2}=-(2.575_{-0.070}^{+0.068})×10^{-3} eV^{2} assuming the inverted hierarchy.
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Affiliation(s)
- D Adey
- Institute of High Energy Physics, Beijing
| | - F P An
- Institute of Modern Physics, East China University of Science and Technology, Shanghai
| | | | - H R Band
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - M Bishai
- Brookhaven National Laboratory, Upton, New York 11973
| | - S Blyth
- Department of Physics, National Taiwan University, Taipei
- National United University, Miao-Li
| | - D Cao
- Nanjing University, Nanjing
| | - G F Cao
- Institute of High Energy Physics, Beijing
| | - J Cao
- Institute of High Energy Physics, Beijing
| | - Y L Chan
- Chinese University of Hong Kong, Hong Kong
| | - J F Chang
- Institute of High Energy Physics, Beijing
| | - Y Chang
- National United University, Miao-Li
| | - H S Chen
- Institute of High Energy Physics, Beijing
| | - S M Chen
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Y Chen
- Shenzhen University, Shenzhen
| | - Y X Chen
- North China Electric Power University, Beijing
| | | | - Z K Cheng
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | | | - M C Chu
- Chinese University of Hong Kong, Hong Kong
| | - A Chukanov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | | | - F S Deng
- University of Science and Technology of China, Hefei
| | - Y Y Ding
- Institute of High Energy Physics, Beijing
| | - M V Diwan
- Brookhaven National Laboratory, Upton, New York 11973
| | - M Dolgareva
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - D A Dwyer
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - W R Edwards
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - M Gonchar
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - G H Gong
- Department of Engineering Physics, Tsinghua University, Beijing
| | - H Gong
- Department of Engineering Physics, Tsinghua University, Beijing
| | - W Q Gu
- Brookhaven National Laboratory, Upton, New York 11973
| | - L Guo
- Department of Engineering Physics, Tsinghua University, Beijing
| | - X H Guo
- Beijing Normal University, Beijing
| | - Y H Guo
- Department of Nuclear Science and Technology, School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an
| | - Z Guo
- Department of Engineering Physics, Tsinghua University, Beijing
| | | | - S Hans
- Brookhaven National Laboratory, Upton, New York 11973
| | - M He
- Institute of High Energy Physics, Beijing
| | - K M Heeger
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - Y K Heng
- Institute of High Energy Physics, Beijing
| | - A Higuera
- Department of Physics, University of Houston, Houston, Texas 77204
| | - Y B Hsiung
- Department of Physics, National Taiwan University, Taipei
| | - B Z Hu
- Department of Physics, National Taiwan University, Taipei
| | - J R Hu
- Institute of High Energy Physics, Beijing
| | - T Hu
- Institute of High Energy Physics, Beijing
| | - Z J Hu
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - H X Huang
- China Institute of Atomic Energy, Beijing
| | | | - Y B Huang
- Institute of High Energy Physics, Beijing
| | - P Huber
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - W Huo
- University of Science and Technology of China, Hefei
| | - G Hussain
- Department of Engineering Physics, Tsinghua University, Beijing
| | - D E Jaffe
- Brookhaven National Laboratory, Upton, New York 11973
| | - K L Jen
- Institute of Physics, National Chiao-Tung University, Hsinchu
| | - X L Ji
- Institute of High Energy Physics, Beijing
| | - X P Ji
- Brookhaven National Laboratory, Upton, New York 11973
| | - R A Johnson
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221
| | - D Jones
- Department of Physics, College of Science and Technology, Temple University, Philadelphia, Pennsylvania 19122
| | - L Kang
- Dongguan University of Technology, Dongguan
| | - S H Kettell
- Brookhaven National Laboratory, Upton, New York 11973
| | - L W Koerner
- Department of Physics, University of Houston, Houston, Texas 77204
| | - S Kohn
- Department of Physics, University of California, Berkeley, California 94720
| | - M Kramer
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - T J Langford
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - L Lebanowski
- Department of Engineering Physics, Tsinghua University, Beijing
| | - J Lee
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - J H C Lee
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - R T Lei
- Dongguan University of Technology, Dongguan
| | - R Leitner
- Charles University, Faculty of Mathematics and Physics, Prague
| | - J K C Leung
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - C Li
- Shandong University, Jinan
| | - F Li
- Institute of High Energy Physics, Beijing
| | - H L Li
- Shandong University, Jinan
| | - Q J Li
- Institute of High Energy Physics, Beijing
| | - S Li
- Dongguan University of Technology, Dongguan
| | - S C Li
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - S J Li
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - W D Li
- Institute of High Energy Physics, Beijing
| | - X N Li
- Institute of High Energy Physics, Beijing
| | - X Q Li
- School of Physics, Nankai University, Tianjin
| | - Y F Li
- Institute of High Energy Physics, Beijing
| | - Z B Li
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - H Liang
- University of Science and Technology of China, Hefei
| | - C J Lin
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - G L Lin
- Institute of Physics, National Chiao-Tung University, Hsinchu
| | - S Lin
- Dongguan University of Technology, Dongguan
| | - S K Lin
- Department of Physics, University of Houston, Houston, Texas 77204
| | - Y-C Lin
- Department of Physics, National Taiwan University, Taipei
| | - J J Ling
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J M Link
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - L Littenberg
- Brookhaven National Laboratory, Upton, New York 11973
| | - B R Littlejohn
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - J C Liu
- Institute of High Energy Physics, Beijing
| | - J L Liu
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - Y Liu
- Shandong University, Jinan
| | | | | | - C Lu
- Joseph Henry Laboratories, Princeton University, Princeton, New Jersey 08544
| | - H Q Lu
- Institute of High Energy Physics, Beijing
| | - J S Lu
- Institute of High Energy Physics, Beijing
| | - K B Luk
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - X B Ma
- North China Electric Power University, Beijing
| | - X Y Ma
- Institute of High Energy Physics, Beijing
| | - Y Q Ma
- Institute of High Energy Physics, Beijing
| | - Y Malyshkin
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - C Marshall
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - D A Martinez Caicedo
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - K T McDonald
- Joseph Henry Laboratories, Princeton University, Princeton, New Jersey 08544
| | - R D McKeown
- California Institute of Technology, Pasadena, California 91125
- College of William and Mary, Williamsburg, Virginia 23187
| | - I Mitchell
- Department of Physics, University of Houston, Houston, Texas 77204
| | - L Mora Lepin
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - J Napolitano
- Department of Physics, College of Science and Technology, Temple University, Philadelphia, Pennsylvania 19122
| | - D Naumov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - E Naumova
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - J P Ochoa-Ricoux
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - A Olshevskiy
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - H-R Pan
- Department of Physics, National Taiwan University, Taipei
| | - J Park
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - S Patton
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - V Pec
- Charles University, Faculty of Mathematics and Physics, Prague
| | - J C Peng
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801
| | - L Pinsky
- Department of Physics, University of Houston, Houston, Texas 77204
| | - C S J Pun
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - F Z Qi
- Institute of High Energy Physics, Beijing
| | - M Qi
- Nanjing University, Nanjing
| | - X Qian
- Brookhaven National Laboratory, Upton, New York 11973
| | - R M Qiu
- North China Electric Power University, Beijing
| | - N Raper
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J Ren
- China Institute of Atomic Energy, Beijing
| | - R Rosero
- Brookhaven National Laboratory, Upton, New York 11973
| | - B Roskovec
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - X C Ruan
- China Institute of Atomic Energy, Beijing
| | - H Steiner
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - J L Sun
- China General Nuclear Power Group, Shenzhen
| | - W Tang
- Brookhaven National Laboratory, Upton, New York 11973
| | - D Taychenachev
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - K Treskov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - W-H Tse
- Chinese University of Hong Kong, Hong Kong
| | - C E Tull
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - B Viren
- Brookhaven National Laboratory, Upton, New York 11973
| | - V Vorobel
- Charles University, Faculty of Mathematics and Physics, Prague
| | - C H Wang
- National United University, Miao-Li
| | - J Wang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - M Wang
- Shandong University, Jinan
| | - N Y Wang
- Beijing Normal University, Beijing
| | - R G Wang
- Institute of High Energy Physics, Beijing
| | - W Wang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
- College of William and Mary, Williamsburg, Virginia 23187
| | - W Wang
- Nanjing University, Nanjing
| | - X Wang
- College of Electronic Science and Engineering, National University of Defense Technology, Changsha
| | - Y F Wang
- Institute of High Energy Physics, Beijing
| | - Z Wang
- Institute of High Energy Physics, Beijing
| | - Z Wang
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Z M Wang
- Institute of High Energy Physics, Beijing
| | - H Y Wei
- Brookhaven National Laboratory, Upton, New York 11973
| | - L H Wei
- Institute of High Energy Physics, Beijing
| | - L J Wen
- Institute of High Energy Physics, Beijing
| | | | - C G White
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - T Wise
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - H L H Wong
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - S C F Wong
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - E Worcester
- Brookhaven National Laboratory, Upton, New York 11973
| | - Q Wu
- Shandong University, Jinan
| | - W J Wu
- Institute of High Energy Physics, Beijing
| | - D M Xia
- Chongqing University, Chongqing
| | - Z Z Xing
- Institute of High Energy Physics, Beijing
| | - J L Xu
- Institute of High Energy Physics, Beijing
| | - T Xue
- Department of Engineering Physics, Tsinghua University, Beijing
| | - C G Yang
- Institute of High Energy Physics, Beijing
| | - H Yang
- Nanjing University, Nanjing
| | - L Yang
- Dongguan University of Technology, Dongguan
| | - M S Yang
- Institute of High Energy Physics, Beijing
| | | | - Y Z Yang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - M Ye
- Institute of High Energy Physics, Beijing
| | - M Yeh
- Brookhaven National Laboratory, Upton, New York 11973
| | - B L Young
- Iowa State University, Ames, Iowa 50011
| | - H Z Yu
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - Z Y Yu
- Institute of High Energy Physics, Beijing
| | - B B Yue
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - S Zeng
- Institute of High Energy Physics, Beijing
| | - L Zhan
- Institute of High Energy Physics, Beijing
| | - C Zhang
- Brookhaven National Laboratory, Upton, New York 11973
| | - C C Zhang
- Institute of High Energy Physics, Beijing
| | - F Y Zhang
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - H H Zhang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J W Zhang
- Institute of High Energy Physics, Beijing
| | - Q M Zhang
- Department of Nuclear Science and Technology, School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an
| | | | - X F Zhang
- Institute of High Energy Physics, Beijing
| | - X T Zhang
- Institute of High Energy Physics, Beijing
| | - Y M Zhang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - Y M Zhang
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Y X Zhang
- China General Nuclear Power Group, Shenzhen
| | - Y Y Zhang
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - Z J Zhang
- Dongguan University of Technology, Dongguan
| | - Z P Zhang
- University of Science and Technology of China, Hefei
| | - Z Y Zhang
- Institute of High Energy Physics, Beijing
| | - J Zhao
- Institute of High Energy Physics, Beijing
| | - P Zheng
- Dongguan University of Technology, Dongguan
| | - L Zhou
- Institute of High Energy Physics, Beijing
| | - H L Zhuang
- Institute of High Energy Physics, Beijing
| | - J H Zou
- Institute of High Energy Physics, Beijing
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Venkatesh B, Mehta S, Angus DC, Finfer S, Machado FR, Marshall J, Mitchell I, Peake S, Zimmerman JL. Women in Intensive Care study: a preliminary assessment of international data on female representation in the ICU physician workforce, leadership and academic positions. Crit Care 2018; 22:211. [PMID: 30196796 PMCID: PMC6130077 DOI: 10.1186/s13054-018-2139-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 05/03/2018] [Accepted: 07/27/2018] [Indexed: 11/12/2022] Open
Abstract
Background Despite increasing female enrolment into medical schools, persistent gender gaps exist in the physician workforce. There are limited published data on female representation in the critical care medicine workforce. Methods To obtain a global perspective, societies (n = 84; 79,834 members (40,363 physicians, 39,471 non-physicians)) registered with the World Federation of Societies of Intensive and Critical Care Medicine were surveyed. Longitudinal data on female trainee and specialist positions between 2006-2017 were obtained from Australia and New Zealand. Data regarding leadership and academic faculty representation were also collected from national training bodies and other organisations of critical care medicine. Results Of the 84 societies, 23 had a registered membership of greater than 500 members. Responses were received from 27 societies (n = 55,996), mainly high-income countries, covering 70.1% of the membership. Amongst the physician workforce, the gender distribution was available from six (22%) participating societies—mean proportion of females 37 ± 11% (range 26–50%). Longitudinal data from Australia and New Zealand between 2006 and 2017 demonstrate rising proportions of female trainees and specialists. Female trainee and specialist numbers increased from 26 to 37% and from 13 to 22% respectively. Globally, female representation in leadership positions was presidencies of critical care organisations (0–41%), representation on critical care medicine boards and councils (8–50%) and faculty representation at symposia (7–34%). Significant gaps in knowledge exist: data from low and middle-income countries, the age distribution and the time taken to enter and complete training. Conclusions Despite limited information globally, available data suggest that females are under-represented in training programmes, specialist positions, academic faculty and leadership roles in intensive care. There are significant gaps in data on female participation in the critical care workforce. Further data from intensive care organisations worldwide are required to understand the demographics, challenges and barriers to their professional progress. Electronic supplementary material The online version of this article (10.1186/s13054-018-2139-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bala Venkatesh
- Intensive Care, Wesley and Princess Alexandra Hospitals, Brisbane, QLD, Australia. .,College of Intensive Care Medicine, Prahran, VIC, Australia. .,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Derek C Angus
- The Clinical Research, Investigation, and Systems Modeling of Acute illness [CRISMA] Center, Pittsburgh, PA, USA.,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Royal North Shore Hospital, Sydney, NSW, Australia
| | - Flavia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Sao Paulo, SP, Brazil
| | - John Marshall
- Department of Surgery and Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Imogen Mitchell
- Australian National University Medical School, Canberra, ACT, Australia
| | - Sandra Peake
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Janice L Zimmerman
- World Federation of Societies of Intensive and Critical Care Medicine, Houston, Texas, USA.,Societies of Intensive and Critical Care Medicine, Houston Methodist Hospital, Houston, TX, USA
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Batten M, Nguyen B, Burke B, Harryanto H, Mitchell I, Davis A. End-of-life care of oncology inpatients: Are we getting it right? Asia Pac J Clin Oncol 2018; 14:e528-e534. [DOI: 10.1111/ajco.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Monique Batten
- Australian National University Medical School; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Bella Nguyen
- Department of Medical Oncology; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Brandon Burke
- Intensive Care Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Hilman Harryanto
- The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Imogen Mitchell
- Australian National University Medical School; The Canberra Hospital; Canberra Australian Capital Territory Australia
- Intensive Care Unit; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Alison Davis
- Australian National University Medical School; The Canberra Hospital; Canberra Australian Capital Territory Australia
- Department of Medical Oncology; The Canberra Hospital; Canberra Australian Capital Territory Australia
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Brock C, Marzano V, Green M, Wang J, Neeman T, Mitchell I, Bissett B. Defining new barriers to mobilisation in a highly active intensive care unit - have we found the ceiling? An observational study. Heart Lung 2018; 47:380-385. [PMID: 29748138 DOI: 10.1016/j.hrtlng.2018.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/03/2018] [Accepted: 04/08/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mobilisation of intensive care (ICU) patients attenuates ICU-acquired weakness, but the prevalence is low (12-54%). Better understanding of barriers and enablers may inform practice. OBJECTIVES To identify barriers to mobilisation and factors associated with successful mobilisation in our medical /surgical /trauma ICU where mobilisation is well-established. METHODS 4-week prospective study of frequency and intensity of mobilisation, clinical factors and barriers (extracted from electronic database). Generalized linear mixed models were used to describe associations between demographics, clinical factors and successful mobilisation. RESULTS 202 patients accounted for 742 patient days. Patients mobilised on 51% of patient days. Most frequent barriers were drowsiness (18%), haemodynamic/respiratory contraindications (17%), and medical orders (14%). Predictors of successful mobilisation included high Glasgow Coma Score (OR = 1.44, 95%CI=[1.29-1.60]), and male sex (OR = 2.29, 95%CI=[1.40-3.75]) but not age (OR = 1.05, 95%CI=[1.01-1.08]). CONCLUSIONS Our major barriers (drowsiness, haemodynamic/respiratory contraindications) may be unavoidable, indicating an upper limit of feasible mobilisation therapy in ICU.
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Affiliation(s)
- Christopher Brock
- Australian National University, Medical School, Acton, ACT, Australia
| | - Vince Marzano
- The Canberra Hospital, Intensive Care Unit, Garran, ACT, Australia
| | - Margot Green
- The Canberra Hospital, Intensive Care Unit, Garran, ACT, Australia
| | - Jiali Wang
- Australian National University, Statistical Consulting Unit, Acton, ACT, Australia
| | - Teresa Neeman
- Australian National University, Statistical Consulting Unit, Acton, ACT, Australia
| | - Imogen Mitchell
- Australian National University, Medical School, Acton, ACT, Australia; The Canberra Hospital, Intensive Care Unit, Garran, ACT, Australia
| | - Bernie Bissett
- The Canberra Hospital, Intensive Care Unit, Garran, ACT, Australia; Discipline of Physiotherapy, University of Canberra, Faculty of Health, Bruce, ACT, Australia.
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Hoffman KR, Loong B, Mitchell I, Van Haren F. Discrepancy between factors associated with long-term outcome in very old patients referred to the intensive care unit, and prevalence of treatment limitations. Anaesth Intensive Care 2018; 46:344-346. [PMID: 29716502] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - I Mitchell
- Dean Medical School, Australian National University, Canberra, Australian Capital Territory
| | - Fmp Van Haren
- Adjunct Professor, University of Canberra; Associate Professor, Australian National University; Adjunct Associate Professor, University of New South Wales, Sydney, New South Wales
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Rebel A, Marzano V, Green M, Johnston K, Wang J, Neeman T, Mitchell I, Bissett B. Mobilisation is feasible in intensive care patients receiving vasoactive therapy: An observational study. Aust Crit Care 2018; 32:139-146. [PMID: 29703636 DOI: 10.1016/j.aucc.2018.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/01/2017] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy. OBJECTIVES To describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events. METHODS Retrospective cohort study of patients undergoing vasoactive therapy in a 31-bed tertiary ICU (October-December, 2016). Details of vasoactive drug dosage, mobilisation, and adverse events were extracted from databases, including mobilisation intensity (ICU Mobility Scale [IMS]). Two generalised linear mixed models were used: first, to describe factors associated with mobilisation and second, to describe factors associated with adverse events during mobilisation, adjusting for age, gender, and acute physiology and chronic health evaluation II score as co-variates. RESULTS In 119 patients undergoing vasoactive therapy on 371 cumulative vasoactive days, 195 mobilisation episodes occurred (37.5% of vasoactive days). Low (76.8%) and moderate (13.7%) dose vasoactive therapies were associated with a higher probability of mobilisation relative to high (9.4%) dose therapy (odds ratio = 5.50, 95% confidence interval = 2.23-13.59 and odds ratio = 2.50, 95% confidence interval = 0.95-6.59, respectively). For patients who mobilised on vasoactive therapy (n = 72), maximum mobilisation intensity was low (IMS = 1-2) in 31%, moderate (IMS = 3-5) in 51%, and high (IMS = 6-10) in 18% of vasoactive days. While no serious adverse events occurred, there were 14 occurrences of reversible hypotension requiring transient escalation of vasoactive therapy (7.3%), associated with lower mean arterial pressure (p = 0.001). CONCLUSION In our ICU, patients mobilised on approximately one-third of vasoactive days. Clinicians should anticipate a higher risk of hypotension during mobilisation in patients receiving vasoactive therapy, which may require transient escalation of vasoactive therapy.
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Affiliation(s)
- Anneke Rebel
- Discipline of Physiotherapy, University of Canberra, Australia
| | | | - Margot Green
- Canberra Hospital, ACT Health, Canberra, Australia
| | | | - Jiali Wang
- Statistical Consulting Unit, Australian National University, Canberra, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, Australia
| | - Imogen Mitchell
- Canberra Hospital, ACT Health, Canberra, Australia; Medical School, Australian National University, Canberra, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Australia; Canberra Hospital, ACT Health, Canberra, Australia.
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Abstract
The ability of human breast carcinomas to convert pregnenolone to progesterone and dehydroepiandrosterone to Δ4-androstene-3,17-dione (Δ4) was investigated as a potential aid for prognosis, and the following observations were recorded. 1. Neither the amounts of progesterone or Δ4 synthesized nor Δ4/progesterone ratios correlated with tumour size or lymph node involvement. 2. Δ4 synthesis was lower in carcinomas from patients who had recurrences within 2 years of mastectomy than in carcinomas from those who remained free of metastases. 3. Life table analysis of the results indicated that these parameters appeared unlikely to be useful aids for prognosis.
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Di Martino L, Tarquini A, Mitchell I, Deshpande N. Effects of Opiates and Naloxone on Certain Enzymes of Carbohydrate Metabolism in Human Breast Carcinomas. Tumori 2018; 68:397-401. [PMID: 6294937 DOI: 10.1177/030089168206800507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of administration of opiates and naloxone on the activities of PFK, 6PGDH and α-GPDH and α-GPDH/6PGDH ratios in human breast carcinomas were investigated in patients awaiting mastectomy. Injection of naloxone or fentanyl into an antecubital vein resulted in a statistically significant reduction in the activity of α-GPDH. Fentanyl was also effective in reducing the activity of 6PGDH. Injection of morphine into a branch of the internal mammary artery during mastectomy failed to induce changes in the activities of any of the enzymes but injection of naloxone resulted in a significant rise in the activity of 6PGDH. It is postulated that these alterations in the activities might not be associated with the binding of these drugs to opiate receptor proteins in the carcinoma. Furthermore opiate agonists or antagonists might not produce the required changes in the activities of any of the enzymes.
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An F, Balantekin A, Band H, Bishai M, Blyth S, Cao D, Cao G, Cao J, Chan Y, Chang J, Chang Y, Chen H, Chen S, Chen Y, Chen Y, Cheng J, Cheng Z, Cherwinka J, Chu M, Chukanov A, Cummings J, Ding Y, Diwan M, Dolgareva M, Dove J, Dwyer D, Edwards W, Gill R, Gonchar M, Gong G, Gong H, Grassi M, Gu W, Guo L, Guo X, Guo Y, Guo Z, Hackenburg R, Hans S, He M, Heeger K, Heng Y, Higuera A, Hsiung Y, Hu B, Hu T, Huang H, Huang X, Huang Y, Huber P, Huo W, Hussain G, Jaffe D, Jen K, Ji X, Ji X, Jiao J, Johnson R, Jones D, Kang L, Kettell S, Khan A, Koerner L, Kohn S, Kramer M, Kwok M, Langford T, Lau K, Lebanowski L, Lee J, Lee J, Lei R, Leitner R, Leung J, Li C, Li D, Li F, Li G, Li Q, Li S, Li S, Li W, Li X, Li X, Li Y, Li Z, Liang H, Lin C, Lin G, Lin S, Lin S, Lin YC, Ling J, Link J, Littenberg L, Littlejohn B, Liu J, Liu J, Loh C, Lu C, Lu H, Lu J, Luk K, Ma X, Ma X, Ma Y, Malyshkin Y, Martinez Caicedo D, McDonald K, McKeown R, Mitchell I, Nakajima Y, Napolitano J, Naumov D, Naumova E, Ochoa-Ricoux J, Olshevskiy A, Pan HR, Park J, Patton S, Pec V, Peng J, Pinsky L, Pun C, Qi F, Qi M, Qian X, Qiu R, Raper N, Ren J, Rosero R, Roskovec B, Ruan X, Steiner H, Sun J, Tang W, Taychenachev D, Treskov K, Tsang K, Tse WH, Tull C, Viaux N, Viren B, Vorobel V, Wang C, Wang M, Wang N, Wang R, Wang W, Wang X, Wang Y, Wang Z, Wang Z, Wang Z, Wei H, Wen L, Whisnant K, White C, Wise T, Wong H, Wong S, Worcester E, Wu CH, Wu Q, Wu W, Xia D, Xia J, Xing Z, Xu J, Xu Y, Xue T, Yang C, Yang H, Yang L, Yang M, Yang M, Yang Y, Ye M, Ye Z, Yeh M, Young B, Yu Z, Zeng S, Zhan L, Zhang C, Zhang C, Zhang H, Zhang J, Zhang Q, Zhang R, Zhang X, Zhang Y, Zhang Y, Zhang Y, Zhang Z, Zhang Z, Zhang Z, Zhao J, Zhou L, Zhuang H, Zou J. Cosmogenic neutron production at Daya Bay. Int J Clin Exp Med 2018. [DOI: 10.1103/physrevd.97.052009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Siiteri O, Mitchell I, Robertson S. Quick sepsis-related organ failure assessment unlikely to aid in the identification of retrieval patients at risk of an adverse outcome. Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.076] [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: 10/17/2022] Open
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Marzano V, Wang J, Neeman T, Green M, Mitchell I, Bissett B. Walking for the weekend – Is there a weekend effect for mobilisation practices in ICU? An observational study. Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.040] [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: 10/17/2022] Open
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Martin GP, Aveling EL, Campbell A, Tarrant C, Pronovost PJ, Mitchell I, Dankers C, Bates D, Dixon-Woods M. Making soft intelligence hard: a multi-site qualitative study of challenges relating to voice about safety concerns. BMJ Qual Saf 2018; 27:710-717. [PMID: 29459365 PMCID: PMC6109252 DOI: 10.1136/bmjqs-2017-007579] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 11/06/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 12/02/2022]
Abstract
Background Healthcare organisations often fail to harvest and make use of the ‘soft intelligence’ about safety and quality concerns held by their own personnel. We aimed to examine the role of formal channels in encouraging or inhibiting employee voice about concerns. Methods Qualitative study involving personnel from three academic hospitals in two countries. Interviews were conducted with 165 participants from a wide range of occupational and professional backgrounds, including senior leaders and those from the sharp end of care. Data analysis was based on the constant comparative method. Results Leaders reported that they valued employee voice; they identified formal organisational channels as a key route for the expression of concerns by employees. Formal channels and processes were designed to ensure fairness, account for all available evidence and achieve appropriate resolution. When processed through these formal systems, concerns were destined to become evidenced, formal and tractable to organisational intervention. But the way these systems operated meant that some concerns were never voiced. Participants were anxious about having to process their suspicions and concerns into hard evidentiary facts, and they feared being drawn into official procedures designed to allocate consequence. Anxiety about evidence and process was particularly relevant when the intelligence was especially ‘soft’—feelings or intuitions that were difficult to resolve into a coherent, compelling reconstruction of an incident or concern. Efforts to make soft intelligence hard thus risked creating ‘forbidden knowledge’: dangerous to know or share. Conclusions The legal and bureaucratic considerations that govern formal channels for the voicing of concerns may, perversely, inhibit staff from speaking up. Leaders responsible for quality and safety should consider complementing formal mechanisms with alternative, informal opportunities for listening to concerns.
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Affiliation(s)
- Graham P Martin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emma-Louise Aveling
- TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Anne Campbell
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Imogen Mitchell
- Australian National University Medical School, Canberra, Australia
| | - Christian Dankers
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Patients who come to the intensive care unit are amongst the sickest patients in our hospitals. Patients can be admitted to the intensive care unit unexpectedly (following accidents or sudden onset of illness) or as unplanned but not necessarily truly 'unexpected' admissions. These patients often have significant underlying chronic health issues, including metastatic cancer, advanced cardiac, respiratory, renal, or hepatic failure, or frailty, with a high likelihood of death in the ensuing months. Using the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program, a prospective single-day observational study across 46 Australian hospitals in 2014 and 2015, we found that less than 9% of intensive care unit patients (51/577) had an advance directive available. From these results, we provide two suggestions to increase intensive care's understanding of patients' end-of-life wishes. First, systematically target 'high risk of dying' patient groups for goals of care conversations in the outpatient setting. Such groups include those where one would not be 'surprised' if they died within a year. Second, as a society, more conversations about end-of-life wishes are needed.
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Affiliation(s)
- Mhr Anstey
- Intensivist, Intensive Care Unit, Sir Charles Gairdner Hospital, Adjunct Researcher, Curtin University School of Public Health, Perth, Western Australia
| | - N Watts
- Post Doctoral Research Fellow, Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales
| | - N Orford
- Intensive Care Specialist, Intensive Care, University Hospital, Geelong, Victoria
| | - I M Seppelt
- Senior Staff Specialist, Intensive Care, Nepean Hospital, Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales
| | - I Mitchell
- Director, Intensive Care Unit, Canberra Hospital, Associate Professor, ANU Medical School, Canberra, Australian Capital Territory
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Bucknall TK, Harvey G, Considine J, Mitchell I, Rycroft-Malone J, Graham ID, Mohebbi M, Watts J, Hutchinson AM. Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis. Implement Sci 2017; 12:85. [PMID: 28693596 PMCID: PMC5504605 DOI: 10.1186/s13012-017-0617-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/14/2017] [Accepted: 06/29/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Vital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. Yet, if physiological signs of deterioration are missed, misinterpreted or mismanaged, then critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. Although evidence demonstrates the benefit of early recognition and management of deteriorating patients, failure to escalate care and manage deteriorating patients remains a relatively frequent occurrence in hospitals. METHODS/DESIGN A pragmatic cluster-randomised controlled trial design will be used to measure clinical effectiveness and cost of a facilitation intervention to improve nurses' vital sign measurement, interpretation, treatment and escalation of care for patients with abnormal vital signs. A cost consequence analysis will evaluate the intervention cost and effectiveness, and a process evaluation will determine how the implementation of the intervention contributes to outcomes. We will compare clinical outcomes and costs from standard implementation of clinical practice guidelines (CPGs) to facilitated implementation of CPGs. The primary outcome will be adherence to the CPGs by nurses, as measured by escalation of care as per organisational policy. The study will be conducted in four Australian major metropolitan teaching hospitals. In each hospital, eight to ten wards will be randomly allocated to intervention and control groups. Control wards will receive standard implementation of CPGs, while intervention wards will receive standard CPG implementation plus facilitation, using facilitation methods and processes tailored to the ward context. The intervention will be administered to all nursing staff at the ward level for 6 months. At each hospital, two types of facilitators will be provided: a hospital-level facilitator as the lead; and two ward-level facilitators for each ward. DISCUSSION This study uses an innovative, networked approach to facilitation to enable uptake of CPGs. Findings will inform the intervention utility and knowledge translation measurement approaches. If successful, the study methodology and intervention has potential for translation to other health care standards. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616000544471p.
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Affiliation(s)
- Tracey K Bucknall
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Faculty of Health, Geelong, VIC, 3220, Australia. .,Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, SA, 5005, Australia.,Alliance Manchester Business School, University of Manchester, Manchester, M15 6PB, UK
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Faculty of Health, Geelong, VIC, 3220, Australia.,Eastern Health, 5 Arnold St, Box Hill, 3125, VIC, Australia
| | - Imogen Mitchell
- Office of the Dean, Australian National University Medical School, Acton, ACT, 0200, Australia
| | - Jo Rycroft-Malone
- School of Healthcare Sciences, Bangor Institute for Health & Medical Research, Bangor University, Ffriddoedd Road, Bangor, LL572EF, UK
| | - Ian D Graham
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Faculty of Health, Geelong, VIC, 3220, Australia.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 51 Smyth, Ottawa, ON, K1H 8M5, Canada
| | | | - Jennifer Watts
- Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Alison M Hutchinson
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Faculty of Health, Geelong, VIC, 3220, Australia.,Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
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An FP, Balantekin AB, Band HR, Bishai M, Blyth S, Cao D, Cao GF, Cao J, Chan YL, Chang JF, Chang Y, Chen HS, Chen QY, Chen SM, Chen YX, Chen Y, Cheng J, Cheng ZK, Cherwinka JJ, Chu MC, Chukanov A, Cummings JP, Ding YY, Diwan MV, Dolgareva M, Dove J, Dwyer DA, Edwards WR, Gill R, Gonchar M, Gong GH, Gong H, Grassi M, Gu WQ, Guo L, Guo XH, Guo YH, Guo Z, Hackenburg RW, Hans S, He M, Heeger KM, Heng YK, Higuera A, Hsiung YB, Hu BZ, Hu T, Huang EC, Huang HX, Huang XT, Huang YB, Huber P, Huo W, Hussain G, Jaffe DE, Jen KL, Ji XP, Ji XL, Jiao JB, Johnson RA, Jones D, Kang L, Kettell SH, Khan A, Kohn S, Kramer M, Kwan KK, Kwok MW, Langford TJ, Lau K, Lebanowski L, Lee J, Lee JHC, Lei RT, Leitner R, Leung JKC, Li C, Li DJ, Li F, Li GS, Li QJ, Li S, Li SC, Li WD, Li XN, Li XQ, Li YF, Li ZB, Liang H, Lin CJ, Lin GL, Lin S, Lin SK, Lin YC, Ling JJ, Link JM, Littenberg L, Littlejohn BR, Liu JL, Liu JC, Loh CW, Lu C, Lu HQ, Lu JS, Luk KB, Ma XY, Ma XB, Ma YQ, Malyshkin Y, Martinez Caicedo DA, McDonald KT, McKeown RD, Mitchell I, Nakajima Y, Napolitano J, Naumov D, Naumova E, Ngai HY, Ochoa-Ricoux JP, Olshevskiy A, Pan HR, Park J, Patton S, Pec V, Peng JC, Pinsky L, Pun CSJ, Qi FZ, Qi M, Qian X, Qiu RM, Raper N, Ren J, Rosero R, Roskovec B, Ruan XC, Steiner H, Stoler P, Sun JL, Tang W, Taychenachev D, Treskov K, Tsang KV, Tull CE, Viaux N, Viren B, Vorobel V, Wang CH, Wang M, Wang NY, Wang RG, Wang W, Wang X, Wang YF, Wang Z, Wang Z, Wang ZM, Wei HY, Wen LJ, Whisnant K, White CG, Whitehead L, Wise T, Wong HLH, Wong SCF, Worcester E, Wu CH, Wu Q, Wu WJ, Xia DM, Xia JK, Xing ZZ, Xu JL, Xu Y, Xue T, Yang CG, Yang H, Yang L, Yang MS, Yang MT, Yang YZ, Ye M, Ye Z, Yeh M, Young BL, Yu ZY, Zeng S, Zhan L, Zhang C, Zhang CC, Zhang HH, Zhang JW, Zhang QM, Zhang R, Zhang XT, Zhang YM, Zhang YX, Zhang YM, Zhang ZJ, Zhang ZY, Zhang ZP, Zhao J, Zhou L, Zhuang HL, Zou JH. Evolution of the Reactor Antineutrino Flux and Spectrum at Daya Bay. Phys Rev Lett 2017; 118:251801. [PMID: 28696753 DOI: 10.1103/physrevlett.118.251801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Indexed: 06/07/2023]
Abstract
The Daya Bay experiment has observed correlations between reactor core fuel evolution and changes in the reactor antineutrino flux and energy spectrum. Four antineutrino detectors in two experimental halls were used to identify 2.2 million inverse beta decays (IBDs) over 1230 days spanning multiple fuel cycles for each of six 2.9 GW_{th} reactor cores at the Daya Bay and Ling Ao nuclear power plants. Using detector data spanning effective ^{239}Pu fission fractions F_{239} from 0.25 to 0.35, Daya Bay measures an average IBD yield σ[over ¯]_{f} of (5.90±0.13)×10^{-43} cm^{2}/fission and a fuel-dependent variation in the IBD yield, dσ_{f}/dF_{239}, of (-1.86±0.18)×10^{-43} cm^{2}/fission. This observation rejects the hypothesis of a constant antineutrino flux as a function of the ^{239}Pu fission fraction at 10 standard deviations. The variation in IBD yield is found to be energy dependent, rejecting the hypothesis of a constant antineutrino energy spectrum at 5.1 standard deviations. While measurements of the evolution in the IBD spectrum show general agreement with predictions from recent reactor models, the measured evolution in total IBD yield disagrees with recent predictions at 3.1σ. This discrepancy indicates that an overall deficit in the measured flux with respect to predictions does not result from equal fractional deficits from the primary fission isotopes ^{235}U, ^{239}Pu, ^{238}U, and ^{241}Pu. Based on measured IBD yield variations, yields of (6.17±0.17) and (4.27±0.26)×10^{-43} cm^{2}/fission have been determined for the two dominant fission parent isotopes ^{235}U and ^{239}Pu. A 7.8% discrepancy between the observed and predicted ^{235}U yields suggests that this isotope may be the primary contributor to the reactor antineutrino anomaly.
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Affiliation(s)
- F P An
- Institute of Modern Physics, East China University of Science and Technology, Shanghai
| | | | - H R Band
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - M Bishai
- Brookhaven National Laboratory, Upton, New York 11973
| | - S Blyth
- Department of Physics, National Taiwan University, Taipei
- National United University, Miao-Li
| | - D Cao
- Nanjing University, Nanjing
| | - G F Cao
- Institute of High Energy Physics, Beijing
| | - J Cao
- Institute of High Energy Physics, Beijing
| | - Y L Chan
- Chinese University of Hong Kong, Hong Kong
| | - J F Chang
- Institute of High Energy Physics, Beijing
| | - Y Chang
- National United University, Miao-Li
| | - H S Chen
- Institute of High Energy Physics, Beijing
| | | | - S M Chen
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Y X Chen
- North China Electric Power University, Beijing
| | - Y Chen
- Shenzhen University, Shenzhen
| | | | - Z K Cheng
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | | | - M C Chu
- Chinese University of Hong Kong, Hong Kong
| | - A Chukanov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | | | - Y Y Ding
- Institute of High Energy Physics, Beijing
| | - M V Diwan
- Brookhaven National Laboratory, Upton, New York 11973
| | - M Dolgareva
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - J Dove
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801
| | - D A Dwyer
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - W R Edwards
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - R Gill
- Brookhaven National Laboratory, Upton, New York 11973
| | - M Gonchar
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - G H Gong
- Department of Engineering Physics, Tsinghua University, Beijing
| | - H Gong
- Department of Engineering Physics, Tsinghua University, Beijing
| | - M Grassi
- Institute of High Energy Physics, Beijing
| | - W Q Gu
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - L Guo
- Department of Engineering Physics, Tsinghua University, Beijing
| | - X H Guo
- Beijing Normal University, Beijing
| | - Y H Guo
- Department of Nuclear Science and Technology, School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an
| | - Z Guo
- Department of Engineering Physics, Tsinghua University, Beijing
| | | | - S Hans
- Brookhaven National Laboratory, Upton, New York 11973
| | - M He
- Institute of High Energy Physics, Beijing
| | - K M Heeger
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - Y K Heng
- Institute of High Energy Physics, Beijing
| | - A Higuera
- Department of Physics, University of Houston, Houston, Texas 77204
| | - Y B Hsiung
- Department of Physics, National Taiwan University, Taipei
| | - B Z Hu
- Department of Physics, National Taiwan University, Taipei
| | - T Hu
- Institute of High Energy Physics, Beijing
| | - E C Huang
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801
| | - H X Huang
- China Institute of Atomic Energy, Beijing
| | | | - Y B Huang
- Institute of High Energy Physics, Beijing
| | - P Huber
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - W Huo
- University of Science and Technology of China, Hefei
| | - G Hussain
- Department of Engineering Physics, Tsinghua University, Beijing
| | - D E Jaffe
- Brookhaven National Laboratory, Upton, New York 11973
| | - K L Jen
- Institute of Physics, National Chiao-Tung University, Hsinchu
| | - X P Ji
- Department of Engineering Physics, Tsinghua University, Beijing
- School of Physics, Nankai University, Tianjin
| | - X L Ji
- Institute of High Energy Physics, Beijing
| | | | - R A Johnson
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221
| | - D Jones
- Department of Physics, College of Science and Technology, Temple University, Philadelphia, Pennsylvania 19122
| | - L Kang
- Dongguan University of Technology, Dongguan
| | - S H Kettell
- Brookhaven National Laboratory, Upton, New York 11973
| | - A Khan
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - S Kohn
- Department of Physics, University of California, Berkeley, California 94720
| | - M Kramer
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - K K Kwan
- Chinese University of Hong Kong, Hong Kong
| | - M W Kwok
- Chinese University of Hong Kong, Hong Kong
| | - T J Langford
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - K Lau
- Department of Physics, University of Houston, Houston, Texas 77204
| | - L Lebanowski
- Department of Engineering Physics, Tsinghua University, Beijing
| | - J Lee
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - J H C Lee
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - R T Lei
- Dongguan University of Technology, Dongguan
| | - R Leitner
- Charles University, Faculty of Mathematics and Physics, Prague
| | - J K C Leung
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - C Li
- Shandong University, Jinan
| | - D J Li
- University of Science and Technology of China, Hefei
| | - F Li
- Institute of High Energy Physics, Beijing
| | - G S Li
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - Q J Li
- Institute of High Energy Physics, Beijing
| | - S Li
- Dongguan University of Technology, Dongguan
| | - S C Li
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - W D Li
- Institute of High Energy Physics, Beijing
| | - X N Li
- Institute of High Energy Physics, Beijing
| | - X Q Li
- School of Physics, Nankai University, Tianjin
| | - Y F Li
- Institute of High Energy Physics, Beijing
| | - Z B Li
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - H Liang
- University of Science and Technology of China, Hefei
| | - C J Lin
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - G L Lin
- Institute of Physics, National Chiao-Tung University, Hsinchu
| | - S Lin
- Dongguan University of Technology, Dongguan
| | - S K Lin
- Department of Physics, University of Houston, Houston, Texas 77204
| | - Y-C Lin
- Department of Physics, National Taiwan University, Taipei
| | - J J Ling
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J M Link
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - L Littenberg
- Brookhaven National Laboratory, Upton, New York 11973
| | - B R Littlejohn
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - J L Liu
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai Laboratory for Particle Physics and Cosmology, Shanghai
| | - J C Liu
- Institute of High Energy Physics, Beijing
| | | | - C Lu
- Joseph Henry Laboratories, Princeton University, Princeton, New Jersey 08544
| | - H Q Lu
- Institute of High Energy Physics, Beijing
| | - J S Lu
- Institute of High Energy Physics, Beijing
| | - K B Luk
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - X Y Ma
- Institute of High Energy Physics, Beijing
| | - X B Ma
- North China Electric Power University, Beijing
| | - Y Q Ma
- Institute of High Energy Physics, Beijing
| | - Y Malyshkin
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - D A Martinez Caicedo
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - K T McDonald
- Joseph Henry Laboratories, Princeton University, Princeton, New Jersey 08544
| | - R D McKeown
- California Institute of Technology, Pasadena, California 91125
- College of William and Mary, Williamsburg, Virginia 23187
| | - I Mitchell
- Department of Physics, University of Houston, Houston, Texas 77204
| | - Y Nakajima
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - J Napolitano
- Department of Physics, College of Science and Technology, Temple University, Philadelphia, Pennsylvania 19122
| | - D Naumov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - E Naumova
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - H Y Ngai
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - J P Ochoa-Ricoux
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - A Olshevskiy
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - H-R Pan
- Department of Physics, National Taiwan University, Taipei
| | - J Park
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061
| | - S Patton
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - V Pec
- Charles University, Faculty of Mathematics and Physics, Prague
| | - J C Peng
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801
| | - L Pinsky
- Department of Physics, University of Houston, Houston, Texas 77204
| | - C S J Pun
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong
| | - F Z Qi
- Institute of High Energy Physics, Beijing
| | - M Qi
- Nanjing University, Nanjing
| | - X Qian
- Brookhaven National Laboratory, Upton, New York 11973
| | - R M Qiu
- North China Electric Power University, Beijing
| | - N Raper
- Sun Yat-Sen (Zhongshan) University, Guangzhou
- Department of Physics, Applied Physics, and Astronomy, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - J Ren
- China Institute of Atomic Energy, Beijing
| | - R Rosero
- Brookhaven National Laboratory, Upton, New York 11973
| | - B Roskovec
- Charles University, Faculty of Mathematics and Physics, Prague
| | - X C Ruan
- China Institute of Atomic Energy, Beijing
| | - H Steiner
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - P Stoler
- Department of Physics, Applied Physics, and Astronomy, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - J L Sun
- China General Nuclear Power Group, Shenzhen
| | - W Tang
- Brookhaven National Laboratory, Upton, New York 11973
| | - D Taychenachev
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - K Treskov
- Joint Institute for Nuclear Research, Dubna, Moscow Region
| | - K V Tsang
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - C E Tull
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - N Viaux
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago
| | - B Viren
- Brookhaven National Laboratory, Upton, New York 11973
| | - V Vorobel
- Charles University, Faculty of Mathematics and Physics, Prague
| | - C H Wang
- National United University, Miao-Li
| | - M Wang
- Shandong University, Jinan
| | - N Y Wang
- Beijing Normal University, Beijing
| | - R G Wang
- Institute of High Energy Physics, Beijing
| | - W Wang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
- College of William and Mary, Williamsburg, Virginia 23187
| | - X Wang
- College of Electronic Science and Engineering, National University of Defense Technology, Changsha
| | - Y F Wang
- Institute of High Energy Physics, Beijing
| | - Z Wang
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Z Wang
- Institute of High Energy Physics, Beijing
| | - Z M Wang
- Institute of High Energy Physics, Beijing
| | - H Y Wei
- Department of Engineering Physics, Tsinghua University, Beijing
| | - L J Wen
- Institute of High Energy Physics, Beijing
| | | | - C G White
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616
| | - L Whitehead
- Department of Physics, University of Houston, Houston, Texas 77204
| | - T Wise
- Wright Laboratory and Department of Physics, Yale University, New Haven, Connecticut 06520
| | - H L H Wong
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
- Department of Physics, University of California, Berkeley, California 94720
| | - S C F Wong
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - E Worcester
- Brookhaven National Laboratory, Upton, New York 11973
| | - C-H Wu
- Institute of Physics, National Chiao-Tung University, Hsinchu
| | - Q Wu
- Shandong University, Jinan
| | - W J Wu
- Institute of High Energy Physics, Beijing
| | - D M Xia
- Chongqing University, Chongqing
| | - J K Xia
- Institute of High Energy Physics, Beijing
| | - Z Z Xing
- Institute of High Energy Physics, Beijing
| | - J L Xu
- Institute of High Energy Physics, Beijing
| | - Y Xu
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - T Xue
- Department of Engineering Physics, Tsinghua University, Beijing
| | - C G Yang
- Institute of High Energy Physics, Beijing
| | - H Yang
- Nanjing University, Nanjing
| | - L Yang
- Dongguan University of Technology, Dongguan
| | - M S Yang
- Institute of High Energy Physics, Beijing
| | | | - Y Z Yang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - M Ye
- Institute of High Energy Physics, Beijing
| | - Z Ye
- Department of Physics, University of Houston, Houston, Texas 77204
| | - M Yeh
- Brookhaven National Laboratory, Upton, New York 11973
| | - B L Young
- Iowa State University, Ames, Iowa 50011
| | - Z Y Yu
- Institute of High Energy Physics, Beijing
| | - S Zeng
- Institute of High Energy Physics, Beijing
| | - L Zhan
- Institute of High Energy Physics, Beijing
| | - C Zhang
- Brookhaven National Laboratory, Upton, New York 11973
| | - C C Zhang
- Institute of High Energy Physics, Beijing
| | - H H Zhang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - J W Zhang
- Institute of High Energy Physics, Beijing
| | - Q M Zhang
- Department of Nuclear Science and Technology, School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an
| | | | - X T Zhang
- Institute of High Energy Physics, Beijing
| | - Y M Zhang
- Department of Engineering Physics, Tsinghua University, Beijing
| | - Y X Zhang
- China General Nuclear Power Group, Shenzhen
| | - Y M Zhang
- Sun Yat-Sen (Zhongshan) University, Guangzhou
| | - Z J Zhang
- Dongguan University of Technology, Dongguan
| | - Z Y Zhang
- Institute of High Energy Physics, Beijing
| | - Z P Zhang
- University of Science and Technology of China, Hefei
| | - J Zhao
- Institute of High Energy Physics, Beijing
| | - L Zhou
- Institute of High Energy Physics, Beijing
| | - H L Zhuang
- Institute of High Energy Physics, Beijing
| | - J H Zou
- Institute of High Energy Physics, Beijing
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Skinner S, Assen K, Mitchell I. WHAT DOES MAINSTREAM MEDIA SAY ABOUT ENZYME REPLACEMENT THERAPIES? Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.073] [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: 11/12/2022] Open
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Wong S, Paes B, Li A, Mitchell I, Lanctôt KL. RESPIRATORY ILLNESS AND RESPIRATORY SYNCYTIAL VIRUS (RSV)-RELATED HOSPITALIZATION (RSVH) IN INFANTS WITH CONGENITAL AIRWAY ANOMALIES (CAA) IN THE CARESS REGISTRY (2005-2015). Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.078] [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: 11/13/2022] Open
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