1
|
Cook TM, Kane AD, Armstrong RA, Kursumovic E, Soar J. Peri-operative cardiac arrest due to suspected anaphylaxis as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:498-505. [PMID: 38205586 DOI: 10.1111/anae.16229] [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] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest. Among 59 cases reported as possible anaphylaxis, 33 (56%) were judged to be so by the review panel with high or moderate confidence. Causes in excluded cases included: isolated severe hypotension; bronchospasm; and oesophageal intubation. Severe bronchospasm leading to cardiac arrest was uncommon, but notably in one case led to a reported flat capnograph. In the baseline survey, anaesthetists estimated anaphylaxis as the cause of 10% of cases of peri-operative cardiac arrests and to be among the four most common causes. In a year-long registry of peri-operative cardiac arrest, suspected anaphylaxis was the seventh most common cause accounting for 4% of reports. Initial management was most often with low-dose intravenous adrenaline, and this was without complications. Both the NAP7 baseline survey and case registry provided evidence of reluctance to starting chest compressions when systolic blood pressure had fallen to below 50 mmHg and occasionally even when it was unrecordable. All 33 patients were resuscitated successfully but one patient later died. The one death occurred in a relatively young patient in whom chest compressions were delayed. Overall, peri-operative anaphylaxis leading to cardiac arrest occurred with a similar frequency and patterns of presentation, location, initial rhythm and suspected triggers in NAP7 as in the 6th National Audit Project (NAP6). Outcomes in NAP7 were generally better than for equivalent cases in NAP6.
Collapse
Affiliation(s)
- T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
- Royal College of Anaesthetists, London, UK
| | - R A Armstrong
- Royal College of Anaesthetists, London, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Royal College of Anaesthetists, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
2
|
Dodd A, Turner PJ, Soar J, Savic L. Emergency treatment of peri-operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists. Anaesthesia 2024; 79:535-541. [PMID: 38205901 DOI: 10.1111/anae.16206] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 01/12/2024]
Abstract
Peri-operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri-operative anaphylaxis highlights the importance of early intravenous adrenaline and fluid resuscitation and provides guidance on the treatment of refractory anaphylaxis and immediate follow-up. This algorithm is endorsed by the Royal College of Anaesthetists, Association of Anaesthetists, British Society of Allergy and Clinical Immunology and Clinical Immunology Professional Network of the British Society for Immunology. This document was produced by the Perioperative Allergy Network steering committee in collaboration with the Resuscitation Council UK.
Collapse
Affiliation(s)
- A Dodd
- Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - P J Turner
- Department of Paediatric Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - L Savic
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
3
|
Armstrong RA, Cook TM, Kunst G, Kane AD, Kursumovic E, Lucas DN, Nickols G, Soar J, Mouton R. Cardiac arrest in vascular surgical patients receiving anaesthetic care: an analysis from the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists. Anaesthesia 2024; 79:506-513. [PMID: 38173364 DOI: 10.1111/anae.16208] [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] [Accepted: 11/14/2023] [Indexed: 01/05/2024]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK. We report the results of the vascular surgery cohort from the 12-month case registry, from 16 June 2021 to 15 June 2022. Anaesthesia for vascular surgery accounted for 2% of UK anaesthetic caseload and included 69 (8%) reported peri-operative cardiac arrests, giving an estimated incidence of 1 in 670 vascular anaesthetics (95%CI 1 in 520-830). The high-risk nature of the vascular population is reflected by the proportion of patients who were ASA physical status 4 (30, 43%) or 5 (19, 28%); the age of patients (80% aged > 65 y); and that most cardiac arrests (57, 83%) occurred during non-elective surgery. The most common vascular surgical procedures among patients who had a cardiac arrest were: aortic surgery (38, 55%); lower-limb revascularisation (13, 19%); and lower-limb amputation (8, 12%). Among patients having vascular surgery and who had a cardiac arrest, 28 (41%) presented with a ruptured abdominal aortic aneurysm. There were 48 (70%) patients who had died at the time of reporting to NAP7 and 11 (16%) were still in hospital, signifying poorer outcomes compared with the non-vascular surgical cohort. The most common cause of cardiac arrest was major haemorrhage (39, 57%), but multiple other causes reflected the critical illness of the patients and the complexity of surgery. This is the first analysis of the incidence, management and outcomes of peri-operative cardiac arrest during vascular anaesthesia in the UK.
Collapse
Affiliation(s)
- R A Armstrong
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Severn Deanery, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of Bristol, Bristol, UK
| | - G Kunst
- Department of Anaesthesia, Kings College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - A D Kane
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - E Kursumovic
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - G Nickols
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - R Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
- University of Bristol, Bristol, UK
| |
Collapse
|
4
|
Cook T, Oglesby F, Soar J. NAP7 and airway management: as important as life and death. Anaesthesia 2024; 79:548-549. [PMID: 38319863 DOI: 10.1111/anae.16246] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/08/2024]
Affiliation(s)
- T Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - J Soar
- Southmead Hospital, Bristol, UK
| |
Collapse
|
5
|
Lucas DN, Kursumovic E, Cook TM, Kane AD, Armstrong RA, Plaat F, Soar J. Cardiac arrest in obstetric patients receiving anaesthetic care: results from the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:514-523. [PMID: 38214067 DOI: 10.1111/anae.16204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/13/2024]
Abstract
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest. Additional inclusion criteria for obstetric anaesthesia were: cardiac arrest associated with neuraxial block performed by an anaesthetist outside the operating theatre (labour epidural analgesia); and cardiac arrest associated with remifentanil patient-controlled analgesia. There were 28 cases of cardiac arrest in obstetric patients, representing 3% of all cardiac arrests reported to NAP7, giving an incidence of 7.9 per 100,000 (95%CI 5.4-11.4 per 100,000). Obstetric patients were approximately four times less likely to have a cardiac arrest during anaesthesia care than patients having non-obstetric surgery. The single leading cause of peri-operative cardiac arrest in obstetric patients was haemorrhage, with underestimated severity and inadequate early resuscitation being contributory factors. When taken together, anaesthetic causes, high neuraxial block and bradyarrhythmia associated with spinal anaesthesia were the leading causes overall. Two patients had a cardiac arrest related to labour neuraxial analgesia. There were no cardiac arrests related to failed airway management or remifentanil patient-controlled analgesia.
Collapse
Affiliation(s)
- D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, UK
| | - E Kursumovic
- Royal College of Anaesthetists, London, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of Bristol, Bristol, UK
| | - A D Kane
- Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - R A Armstrong
- Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - F Plaat
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
6
|
Cook TM, Oglesby F, Kane AD, Armstrong RA, Kursumovic E, Soar J. Airway and respiratory complications during anaesthesia and associated with peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:368-379. [PMID: 38031494 DOI: 10.1111/anae.16187] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied complications of the airway and respiratory system during anaesthesia care including peri-operative cardiac arrest. Among 24,721 surveyed cases, airway and respiratory complications occurred commonly (n = 421 and n = 264, respectively). The most common airway complications were: laryngospasm (157, 37%); airway failure (125, 30%); and aspiration (27, 6%). Emergency front of neck airway was rare (1 in 8370, 95%CI 1 in 2296-30,519). The most common respiratory complications were: severe ventilation difficulty (97, 37%); hyper/hypocapnia (63, 24%); and hypoxaemia (62, 23%). Among 881 reports to NAP7 and 358 deaths, airway and respiratory complications accounted for 113 (13%) peri-operative cardiac arrests and 32 (9%) deaths, with hypoxaemia as the most common primary cause. Airway and respiratory cases had higher and lower survival rates than other causes of cardiac arrest, respectively. Patients with obesity, young children (particularly infants) and out-of-hours care were overrepresented in reports. There were six cases of unrecognised oesophageal intubation with three resulting in cardiac arrest. Of these cases, failure to correctly interpret capnography was a recurrent theme. Cases of emergency front of neck airway (6, approximately 1 in 450,000) and pulmonary aspiration (11, approximately 1 in 25,000) leading to cardiac arrest were rare. Overall, these data, while distinct from the 4th National Audit Project, suggest that airway management is likely to have become safer in the last decade, despite the surgical population having become more challenging for anaesthetists.
Collapse
Affiliation(s)
- T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
| | - F Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- Royal College of Anaesthetists, London, UK
| | - R A Armstrong
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Royal College of Anaesthetists, London, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Royal College of Anaesthetists, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
7
|
Cook TM, Kane AD, Bouch C, Armstrong RA, Kursumovic E, Soar J. Independent sector and peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:380-388. [PMID: 38173350 DOI: 10.1111/anae.16175] [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] [Accepted: 10/17/2023] [Indexed: 01/05/2024]
Abstract
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest including those that occurred in the independent healthcare sector, which provides around 1 in 6 NHS-funded care episodes. In total, 174 (39%) of 442 independent hospitals contacted agreed to participate. A survey examining provider preparedness for cardiac arrest had a response rate of 23 (13%), preventing useful analysis. An activity survey with 1912 responses (from a maximum of 45% of participating hospitals) showed that, compared with the NHS caseload, the independent sector caseload was less comorbid, with fewer patients at the extremes of age or who were severely obese, and with a large proportion of elective orthopaedic surgery undertaken during weekday working hours. The survey suggested suboptimal compliance rates with monitoring recommendations. Seventeen reports of independent sector peri-operative cardiac arrest comprised 2% of NAP7 reports and underreporting is likely. These patients were lower risk than NHS cases, reflecting the sector's case mix, but included cases of haemorrhage, anaphylaxis, cardiac arrhythmia and pulmonary embolus. Good and poor quality care were seen, the latter including delayed recognition and treatment of patient deterioration, and poor care delivery. Independent sector outcomes were similar to those in the NHS, though due to the case mix, improved outcomes might be anticipated. Assessment of quality of care was less often favourable for independent sector reports than NHS reports, though assessments were often uncertain, reflecting poor quality reports. Overall, NAP7 is unable to determine whether peri-operative care relating to cardiac arrest is more, equally or less safe than in the NHS.
Collapse
Affiliation(s)
- T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- Royal College of Anaesthetists, London, UK
| | - C Bouch
- Department of Anaesthesia and Critical Care Medicine, Leicester Royal Infirmary, Leicester, UK
| | - R A Armstrong
- Royal College of Anaesthetists, London, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Royal College of Anaesthetists, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
8
|
Moppett IK, Kane AD, Armstrong RA, Kursumovic E, Soar J, Cook TM. Peri-operative cardiac arrest in the older frail patient as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024. [PMID: 38556808 DOI: 10.1111/anae.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 04/02/2024]
Abstract
Frailty increases peri-operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri-operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of Anaesthetists, we described the characteristics of older patients living with frailty undergoing anaesthesia and surgery, and those reported to the peri-operative cardiac arrest case registry. In the activity survey, 1676 (26%) of 6466 patients aged > 65 y were reported as frail (Clinical Frailty Scale score ≥ 5). Increasing age and frailty were both associated with increasing comorbidities and the proportion of surgery undertaken as an emergency. Except in patients who were terminally ill (Clinical Frailty Scale score 9), increasing frailty was associated with an increased proportion of complex or major surgery. The rate of use of invasive arterial blood pressure monitoring was associated with frailty only until Clinical Frailty Scale score 5, and then plateaued or fell. Of 881 cardiac arrests reported to the 7th National Audit Project, 156 (18%) were in patients aged > 65 y and living with frailty, with an estimated incidence of 1 in 1204 (95%CI 1 in 1027-1412) and a mortality rate of 1 in 2020 (95%CI 1 in 1642-2488), approximately 2.6-fold higher than in adults who were not frail. Hip fracture, emergency laparotomy, emergency vascular surgery and urological surgery were the most common surgical procedures in older patients living with frailty who had a cardiac arrest. We report a high burden of frailty within the surgical population, requiring complex, urgent surgery, and the extent of poorer outcomes of peri-operative cardiac arrest compared with patients of the same age not living with frailty.
Collapse
Affiliation(s)
- I K Moppett
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia and Critical Care, Academic Unit of Injury, Rehabilitation and Inflammation, University of Nottingham, Nottingham, UK
| | - A D Kane
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - R A Armstrong
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - E Kursumovic
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of Bristol, Bristol, UK
| |
Collapse
|
9
|
Oglesby FC, Scholefield BR, Cook TM, Smith JH, Pappachan VJ, Kane AD, Armstrong RA, Kursumovic E, Soar J. Peri-operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024. [PMID: 38369586 DOI: 10.1111/anae.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/20/2024]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri-operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2-3.3 per 10,000). The incidence of peri-operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non-cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri-operative cardiac arrest.
Collapse
Affiliation(s)
- F C Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - B R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
| | - J H Smith
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - V J Pappachan
- Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- National Institute for Health and Care Research Biomedical Research Centre, University of Southampton, Southampton, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- Hull York Medical School, Hull, UK
| | - R A Armstrong
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
10
|
Nolan JP, Soar J, Kane AD, Moppett IK, Armstrong RA, Kursumovic E, Cook TM. Peri-operative decisions about cardiopulmonary resuscitation among adults as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:186-192. [PMID: 37991058 DOI: 10.1111/anae.16179] [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] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
Current guidance recommends that, in most circumstances, cardiopulmonary resuscitation should be attempted when cardiac arrest occurs during anaesthesia, and when a patient has a pre-existing 'do not attempt cardiopulmonary resuscitation' recommendation, this should be suspended. How this guidance is translated into everyday clinical practice in the UK is currently unknown. Here, as part of the 7th National Audit Project of the Royal College of Anaesthetists, we have: assessed the rates of pre-operative 'do not attempt cardiopulmonary resuscitation' recommendations via an activity survey of all cases undertaken by anaesthetists over four days in each participating site; and analysed our one-year case registry of peri-operative cardiac arrests to understand the rates of cardiac arrest in patients who had 'do not attempt cardiopulmonary resuscitation' decisions pre-operatively. In the activity survey, among 20,717 adults (aged > 18 y) undergoing surgery, 595 (3%) had a 'do not attempt cardiopulmonary resuscitation' recommendation pre-operatively, of which less than a third (175, 29%) were suspended. Of the 881 peri-operative cardiac arrest reports, 54 (6%) patients had a 'do not attempt cardiopulmonary resuscitation' recommendation made pre-operatively and of these 38 (70%) had a clinical frailty scale score ≥ 5. Just under half (25, 46%) of these 'do not attempt cardiopulmonary resuscitation' recommendations were formally suspended at the time of anaesthesia and surgery. One in five of these patients with a 'do not attempt cardiopulmonary resuscitation' recommendation who had a cardiac arrest survived to leave hospital and of the seven patients with documented modified Rankin Scale scores before and after cardiac arrest, four remained the same and three had worse scores. Very few patients who had a pre-existing 'do not attempt cardiopulmonary resuscitation' recommendation had a peri-operative cardiac arrest, and when cardiac arrest did occur, return of spontaneous circulation was achieved in 57%, although > 50% of these patients subsequently died before discharge from hospital.
Collapse
Affiliation(s)
- J P Nolan
- Warwick Clinical Trials Unit, University of Warwick, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - A D Kane
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - I K Moppett
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
- University of Nottingham, Nottingham, UK
| | - R A Armstrong
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
- Severn Deanery, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of Bristol, Bristol, UK
| |
Collapse
|
11
|
Shrimpton AJ, Brown V, Vassallo J, Nolan JP, Soar J, Hamilton F, Cook TM, Bzdek BR, Reid JP, Makepeace CH, Deutsch J, Ascione R, Brown JM, Benger JR, Pickering AE. A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation. Anaesthesia 2024; 79:156-167. [PMID: 37921438 PMCID: PMC10952244 DOI: 10.1111/anae.16162] [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] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.
Collapse
Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - V. Brown
- Critical Care, South Western Ambulance Service NHS Foundation TrustUK
- Great Western Air Ambulance CharityBristolUK
| | - J. Vassallo
- Institute of Naval MedicineGosportUK
- Academic Department of Military Emergency MedicineRoyal Centre for Defence MedicineBirminghamUK
| | - J. P. Nolan
- University of Warwick, Warwick Medical SchoolCoventryUK
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - J. Soar
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - F. Hamilton
- MRC Integrative Epidemiology UnitUniversity of BristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - C. H. Makepeace
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - J. Deutsch
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - R. Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- University Hospital Bristol Weston NHS TrustBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - J. R. Benger
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - A. E. Pickering
- Department of AnaesthesiaUniversity Hospitals Bristol and WestonBristolUK
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| |
Collapse
|
12
|
Kane AD, Cook TM, Armstrong RA, Kursumovic E, Davies MT, Agarwal S, Nolan JP, Smith JH, Moppett IK, Oglesby FC, Cortes L, Taylor C, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Varney L, Soar J. The incidence of potentially serious complications during non-obstetric anaesthetic practice in the United Kingdom: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2024; 79:43-53. [PMID: 37944508 DOI: 10.1111/anae.16155] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 11/12/2023]
Abstract
Complications and critical incidents arising during anaesthesia due to patient, surgical or anaesthetic factors, may cause harm themselves or progress to more severe events, including cardiac arrest or death. As part of the 7th National Audit Project of the Royal College of Anaesthetists, we studied a prospective national cohort of unselected patients. Anaesthetists recorded anonymous details of all cases undertaken over 4 days at their site through an online survey. Of 416 hospital sites invited to participate, 352 (85%) completed the survey. Among 24,172 cases, 1922 discrete potentially serious complications were reported during 1337 (6%) cases. Obstetric cases had a high reported major haemorrhage rate and were excluded from further analysis. Of 20,996 non-obstetric cases, 1705 complications were reported during 1150 (5%) cases. Circulatory events accounted for most complications (616, 36%), followed by airway (418, 25%), metabolic (264, 15%), breathing (259, 15%), and neurological (41, 2%) events. A single complication was reported in 851 (4%) cases, two complications in 166 (1%) cases and three or more complications in 133 (1%) cases. In non-obstetric elective surgery, all complications were 'uncommon' (10-100 per 10,000 cases). Emergency (urgent and immediate priority) surgery accounted for 3454 (16%) of non-obstetric cases but 714 (42%) of complications with severe hypotension, major haemorrhage, severe arrhythmias, septic shock, significant acidosis and electrolyte disturbances all being 'common' (100-1000 per 10,000 cases). Based on univariate analysis, complications were associated with: younger age; higher ASA physical status; male sex; increased frailty; urgency and extent of surgery; day of the week; and time of day. These data represent the rates of potentially serious complications during routine anaesthesia care and may be valuable for risk assessment and patient consent.
Collapse
|
13
|
Armstrong RA, Soar J, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Cook TM. Peri-operative cardiac arrest: epidemiology and clinical features of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:18-30. [PMID: 37972476 DOI: 10.1111/anae.16156] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. Here we report the results of the 12-month registry, from 16 June 2021 to 15 June 2022, focusing on epidemiology and clinical features. We reviewed 881 cases of peri-operative cardiac arrest, giving an incidence of 3 in 10,000 anaesthetics (95%CI 3.0-3.5 per 10,000). Incidence varied with patient and surgical factors. Compared with denominator survey activity, patients with cardiac arrest: included more males (56% vs. 42%); were older (median (IQR) age 60.5 (40.5-80.5) vs. 50.5 (30.5-70.5) y), although the age distribution was bimodal, with infants and patients aged > 66 y overrepresented; and were notably more comorbid (73% ASA physical status 3-5 vs. 27% ASA physical status 1-2). The surgical case-mix included more weekend (14% vs. 11%), out-of-hours (19% vs. 10%), non-elective (65% vs. 30%) and major/complex cases (60% vs. 28%). Cardiac arrest was most prevalent in orthopaedic trauma (12%), lower gastrointestinal surgery (10%), cardiac surgery (9%), vascular surgery (8%) and interventional cardiology (6%). Specialities with the highest proportion of cases relative to denominator activity were: cardiac surgery (9% vs. 1%); cardiology (8% vs. 1%); and vascular surgery (8% vs. 2%). The most common causes of cardiac arrest were: major haemorrhage (17%); bradyarrhythmia (9%); and cardiac ischaemia (7%). Patient factors were judged a key cause of cardiac arrest in 82% of cases, anaesthesia in 40% and surgery in 35%.
Collapse
|
14
|
Armstrong RA, Cook TM, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Soar J. Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:31-42. [PMID: 37972480 DOI: 10.1111/anae.16157] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12-month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri-operative cardiac arrest, the initial rhythm was non-shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non-elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri-operative cardiac arrest in UK practice for the first time.
Collapse
|
15
|
Kane AD, Davies MT, Armstrong RA, Kursumovic E, Soar J, Cook TM. Observed gaps in UK anaesthetic monitoring practice. Anaesthesia 2024; 79:93-95. [PMID: 37855065 DOI: 10.1111/anae.16147] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Affiliation(s)
- A D Kane
- James Cook University Hospital, Middlesbrough, UK
| | | | | | - E Kursumovic
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Soar
- Southmead Hospital, Bristol, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| |
Collapse
|
16
|
Kursumovic E, Soar J, Nolan JP, Plaat F, Kane AD, Armstrong RA, Davies MT, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Patel B, Pappachan VJ, Scholefield BR, Smith JH, Varney L, Cook TM. Organisation of UK hospitals and anaesthetic departments in the treatment of peri-operative cardiac arrest: an analysis from the 7th National Audit Project (NAP7) local co-ordinator baseline survey. Anaesthesia 2023; 78:1442-1452. [PMID: 37920932 DOI: 10.1111/anae.16153] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 11/04/2023]
Abstract
We report the results of the Royal College of Anaesthetists' 7th National Audit Project organisational baseline survey sent to every NHS anaesthetic department in the UK to assess preparedness for treating peri-operative cardiac arrest. We received 199 responses from 277 UK anaesthetic departments, representing a 72% response rate. Adult and paediatric anaesthetic care was provided by 188 (95%) and 165 (84%) hospitals, respectively. There was no paediatric intensive care unit on-site in 144 (87%) hospitals caring for children, meaning transfer of critically ill children is required. Remote site anaesthesia is provided in 182 (92%) departments. There was a departmental resuscitation lead in 113 (58%) departments, wellbeing lead in 106 (54%) and departmental staff wellbeing policy in 81 (42%). A defibrillator was present in every operating theatre suite and in all paediatric anaesthesia locations in 193 (99%) and 149 (97%) departments, respectively. Advanced airway equipment was not available in: every theatre suite in 13 (7%) departments; all remote locations in 103 (57%) departments; and all paediatric anaesthesia locations in 23 (15%) departments. Anaesthetic rooms were the default location for induction of anaesthesia in adults and children in 148 (79%) and 121 (79%) departments, respectively. Annual updates in chest compressions and in defibrillation were available in 149 (76%) and 130 (67%) departments, respectively. Following a peri-operative cardiac arrest, debriefing and peer support programmes were available in 154 (79%) and 57 (29%) departments, respectively. While it is likely many UK hospitals are very well prepared to treat anaesthetic emergencies including cardiac arrest, the survey suggests this is not universal.
Collapse
|
17
|
Kursumovic E, Cook TM, Lucas DN, Davies MT, Martin S, Kane AD, Armstrong RA, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Beecham E, Cordingley J, Dorey J, Finney SJ, Kunst G, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Wain EC, Soar J. The 7th National Audit Project (NAP7) baseline survey of individual anaesthetists: preparedness for and experiences of peri-operative cardiac arrest. Anaesthesia 2023; 78:1453-1464. [PMID: 37920919 DOI: 10.1111/anae.16154] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri-operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In-date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists, respectively. There were 8994 (84%) respondents who were confident in leading a peri-operative cardiac arrest, with males more confident than females, but only 5985 (56%) were confident in leading a debrief and 7340 (68%) communicating with next of kin. In the previous two years, 4806 (46%) respondents had managed at least one peri-operative cardiac arrest, of which 321 (7%) and 189 (4%) of these events involved a child or an obstetric patient, respectively. Respondents estimated the most common causes of peri-operative cardiac arrest to be hypovolaemia, hypoxaemia and cardiac ischaemia, with haemorrhage coming fifth. However, the most common reported causes for the most recently attended peri-operative cardiac arrest were haemorrhage; (927, 20%); anaphylaxis (474, 10%); and cardiac ischaemia (397, 9%). Operating lists or shifts were paused or stopped after 1330 (39%) cardiac arrests and 1693 (38%) respondents attended a debrief, with 'hot' debriefs most common. Informal wellbeing support was relatively common (2458, 56%) and formal support was uncommon (472, 11%). An impact on future care delivery was reported by 196 (4%) anaesthetists, most commonly a negative psychological impact. Management of a peri-operative cardiac arrest during their career was reported by 8654 (85%) respondents. The overall impact on professional life was more often judged positive (2630, 30%) than negative (1961, 23%), but impact on personal life was more often negative.
Collapse
|
18
|
Xu S, Deo RC, Soar J, Barua PD, Faust O, Homaira N, Jaffe A, Kabir AL, Acharya UR. Automated detection of airflow obstructive diseases: A systematic review of the last decade (2013-2022). Comput Methods Programs Biomed 2023; 241:107746. [PMID: 37660550 DOI: 10.1016/j.cmpb.2023.107746] [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: 04/02/2023] [Revised: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Obstructive airway diseases, including asthma and Chronic Obstructive Pulmonary Disease (COPD), are two of the most common chronic respiratory health problems. Both of these conditions require health professional expertise in making a diagnosis. Hence, this process is time intensive for healthcare providers and the diagnostic quality is subject to intra- and inter- operator variability. In this study we investigate the role of automated detection of obstructive airway diseases to reduce cost and improve diagnostic quality. METHODS We investigated the existing body of evidence and applied Preferred Reporting Items for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search records in IEEE, Google scholar, and PubMed databases. We identified 65 papers that were published from 2013 to 2022 and these papers cover 67 different studies. The review process was structured according to the medical data that was used for disease detection. We identified six main categories, namely air flow, genetic, imaging, signals, and miscellaneous. For each of these categories, we report both disease detection methods and their performance. RESULTS We found that medical imaging was used in 14 of the reviewed studies as data for automated obstructive airway disease detection. Genetics and physiological signals were used in 13 studies. Medical records and air flow were used in 9 and 7 studies, respectively. Most papers were published in 2020 and we found three times more work on Machine Learning (ML) when compared to Deep Learning (DL). Statistical analysis shows that DL techniques achieve higher Accuracy (ACC) when compared to ML. Convolutional Neural Network (CNN) is the most common DL classifier and Support Vector Machine (SVM) is the most widely used ML classifier. During our review, we discovered only two publicly available asthma and COPD datasets. Most studies used private clinical datasets, so data size and data composition are inconsistent. CONCLUSIONS Our review results indicate that Artificial Intelligence (AI) can improve both decision quality and efficiency of health professionals during COPD and asthma diagnosis. However, we found several limitations in this review, such as a lack of dataset consistency, a limited dataset and remote monitoring was not sufficiently explored. We appeal to society to accept and trust computer aided airflow obstructive diseases diagnosis and we encourage health professionals to work closely with AI scientists to promote automated detection in clinical practice and hospital settings.
Collapse
Affiliation(s)
- Shuting Xu
- School of Mathematics Physics and Computing, University of Southern Queensland, Springfield Central, QLD 4300, Australia; Cogninet Australia, Sydney, NSW 2010, Australia
| | - Ravinesh C Deo
- School of Mathematics Physics and Computing, University of Southern Queensland, Springfield Central, QLD 4300, Australia
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Australia
| | - Prabal Datta Barua
- Cogninet Australia, Sydney, NSW 2010, Australia; School of Business, University of Southern Queensland, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia; Australian International Institute of Higher Education, Sydney, NSW 2000, Australia; School of Science Technology, University of New England, Australia; School of Biosciences, Taylor's University, Malaysia; School of Computing, SRM Institute of Science and Technology, India; School of Science and Technology, Kumamoto University, Japan; Sydney School of Education and Social Work, University of Sydney, Australia.
| | - Oliver Faust
- School of Computing and Information Science, Anglia Ruskin University Cambridge Campus, UK
| | - Nusrat Homaira
- School of Clinical Medicine, University of New South Wales, Australia; Sydney Children's Hospital, Sydney, Australia; James P. Grant School of Public Health, Dhaka, Bangladesh
| | - Adam Jaffe
- School of Clinical Medicine, University of New South Wales, Australia; Sydney Children's Hospital, Sydney, Australia
| | | | - U Rajendra Acharya
- School of Mathematics Physics and Computing, University of Southern Queensland, Springfield Central, QLD 4300, Australia; School of Science and Technology, Kumamoto University, Japan
| |
Collapse
|
19
|
Ekanayake SKDM, Ward AE, Heart D, Valery P, Soar J. Improving primary care referral to specialist services: a protocol for a 10-year global systematic review in the Australian context. BMJ Open 2023; 13:e068927. [PMID: 37643858 PMCID: PMC10465904 DOI: 10.1136/bmjopen-2022-068927] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Barriers to accessing specialist services impart a significant burden on patient outcomes and experience as well as a cost and administrative burden on health systems due to healthcare wastage and inefficiencies. This paper outlines the planned protocol for a systematic review relating to how health systems perform with regard to patient access to specialist care, and the efficacy of interventions aimed at improving this. METHODS AND ANALYSIS Systematic review of the literature will be carried out on publications retrieved by searching the following electronic literature databases: EBSCOhost Megafile Ultimate (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Ultimate, APA Psychological Abstracts (PsycINFO), HealthSource), PubMed (Medical Literature Analysis and Retrieval System Online (MEDLINE)), Elsevier Bibliographic Database (Scopus), Excerpta Medica Database (EMBASE), Web of Science and The Cochrane Library. Articles published over a 10-year period (2012-2022) will be analysed to determine; current accessibility and availability problems faced by primary care services when referring patients to specialist care, and the effectiveness of interventions to improve primary care access to specialist services. Grey literature publications (ie, government reports, policy statements and issues papers, conference proceedings) will not be analysed in this review. Articles not published in English, Spanish or Portuguese will not be included. Two independent reviewers will conduct the initial screening, disagreements will be resolved by a third independent reviewer, following which data extraction and selection of eligible sources will be carried out. Selected articles will be categorised on study design, setting and participants. Methodological quality and heterogeneity will subsequently be assessed using the Mixed Methods Appraisal Tool. A descriptive approach will be used to review and synthesise the findings. ETHICS AND DISSEMINATION This study does not require ethics committee review as it solely focuses on analysing published literature. Findings will be published and disseminated through a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022354890.
Collapse
Affiliation(s)
- Siyaguna Kosgamage Dilum Manthinda Ekanayake
- School of Nursing and Midwifery, University of Southern Queensland, Darling Heights, Queensland, Australia
- Population Health, Cancer and Chronic Disease Group QIMR-Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Aletha E Ward
- Faculty of Health, Sciences and Engineering, University of Southern Queensland - Ipswich Campus, Ipswich, Queensland, Australia
| | - Diane Heart
- Faculty of Health, Sciences and Engineering, University of Southern Queensland - Ipswich Campus, Ipswich, Queensland, Australia
| | - Patricia Valery
- Population Health, Cancer and Chronic Disease Group QIMR-Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Darling Heights, Queensland, Australia
| |
Collapse
|
20
|
Ishra R, Khanam R, Soar J, Sharif S. Food hygiene knowledge and behaviour among domestic food handlers during COVID 19 pandemic in Bangladesh. Food Control 2023; 153:109945. [PMID: 38620164 PMCID: PMC10303748 DOI: 10.1016/j.foodcont.2023.109945] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 04/17/2024]
Abstract
The COVID-19 pandemic reshaped every aspect of life, including food safety. Understanding food safety behaviour at home is necessary for developing effective strategies to mitigate foodborne disease during and after this pandemic. This study administered a cross-sectional survey among 503 domestic food handlers to examine the food handlers' food safety concerns during the pandemic and pandemic-related knowledge and hygiene behaviour (PRKHB) in Bangladesh. The results found that only 35.8% of respondents in this study were more concerned about food safety because of the COVID-19 pandemic. Although the results found a good PRKHB among 95.8% of urban food handlers, overall, 62% showed a poor level of PRKHB. Only 38.8% reported washing their hands after returning home or preparing meals every time. The regression model found that food safety concerns positively related to the PRKHB, and participants who lived in rural areas had a negative association with the PRKHB. The study also explored sociodemographic variations and significant differences observed between urban and rural areas. Meticulous educational campaigns and targeted messages to the food handlers on food safety risks, food handling practices and hand hygiene are necessary to minimise the foodborne disease burden in this region.
Collapse
Affiliation(s)
- Rakia Ishra
- University of Southern Queensland, Toowoomba, Qld, 4350, Australia
| | - Rasheda Khanam
- University of Southern Queensland, Toowoomba, Qld, 4350, Australia
| | - Jeffrey Soar
- University of Southern Queensland, Toowoomba, Qld, 4350, Australia
| | - Saif Sharif
- University of Southern Queensland, Toowoomba, Qld, 4350, Australia
| |
Collapse
|
21
|
Kane AD, Lucas DN, Soar J, Plaat F, Cook TM. NAP7 and obstetric activity: important and measured. Anaesthesia 2023. [PMID: 37020328 DOI: 10.1111/anae.16022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Affiliation(s)
- A D Kane
- James Cook University Hospital, Middlesbrough, UK
| | - D N Lucas
- London North West University Healthcare NHS Trust, London, UK
| | - J Soar
- Southmead Hospital, Bristol, UK
| | - F Plaat
- Queen Charlotte's and Chelsea Hospital, London, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| |
Collapse
|
22
|
Hossain E, Rana R, Higgins N, Soar J, Barua PD, Pisani AR, Turner K. Natural Language Processing in Electronic Health Records in relation to healthcare decision-making: A systematic review. Comput Biol Med 2023; 155:106649. [PMID: 36805219 DOI: 10.1016/j.compbiomed.2023.106649] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 10/03/2022] [Revised: 01/04/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Natural Language Processing (NLP) is widely used to extract clinical insights from Electronic Health Records (EHRs). However, the lack of annotated data, automated tools, and other challenges hinder the full utilisation of NLP for EHRs. Various Machine Learning (ML), Deep Learning (DL) and NLP techniques are studied and compared to understand the limitations and opportunities in this space comprehensively. METHODOLOGY After screening 261 articles from 11 databases, we included 127 papers for full-text review covering seven categories of articles: (1) medical note classification, (2) clinical entity recognition, (3) text summarisation, (4) deep learning (DL) and transfer learning architecture, (5) information extraction, (6) Medical language translation and (7) other NLP applications. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULT AND DISCUSSION EHR was the most commonly used data type among the selected articles, and the datasets were primarily unstructured. Various ML and DL methods were used, with prediction or classification being the most common application of ML or DL. The most common use cases were: the International Classification of Diseases, Ninth Revision (ICD-9) classification, clinical note analysis, and named entity recognition (NER) for clinical descriptions and research on psychiatric disorders. CONCLUSION We find that the adopted ML models were not adequately assessed. In addition, the data imbalance problem is quite important, yet we must find techniques to address this underlining problem. Future studies should address key limitations in studies, primarily identifying Lupus Nephritis, Suicide Attempts, perinatal self-harmed and ICD-9 classification.
Collapse
Affiliation(s)
- Elias Hossain
- School of Engineering & Physical Sciences, North South University, Dhaka 1229, Bangladesh.
| | - Rajib Rana
- School of Mathematics, Physics and Computing, University of Southern Queensland, Springfield Central QLD 4300, Australia
| | - Niall Higgins
- School of Management and Enterprise, University of Southern Queensland, Darling Heights QLD 4350, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4000, Australia; Metro North Mental Health, Herston QLD 4029, Australia
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Springfield Central QLD 4300, Australia
| | - Prabal Datta Barua
- School of Business, University of Southern Queensland, Springfield Central QLD 4300, Australia
| | - Anthony R Pisani
- Center for the Study and Prevention of Suicide, University of Rochester, Rochester, NY, United States
| | - Kathryn Turner
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4000, Australia
| |
Collapse
|
23
|
Kane AD, Soar J, Armstrong RA, Kursumovic E, Davies MT, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Cook TM. Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2023; 78:701-711. [PMID: 36857758 DOI: 10.1111/anae.15989] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.
Collapse
Affiliation(s)
- A D Kane
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - R A Armstrong
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - E Kursumovic
- Royal College of Anaesthetists, Red Lion Square, UK.,Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - M T Davies
- Department of Critical Care and Anaesthesia, North West Anglia NHS Trust, UK
| | - F C Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - L Cortes
- Royal College of Anaesthetists, Red Lion Square, UK
| | - C Taylor
- Royal College of Anaesthetists, Red Lion Square, UK
| | - I K Moppett
- Royal College of Anaesthetists, Red Lion Square, UK.,University of Nottingham, UK
| | - S Agarwal
- Department of Anaesthesia, Manchester University Hospitals Foundation Trust, Manchester, UK
| | - J Cordingley
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - J Dorey
- Royal College of Anaesthetists, Red Lion Square, UK
| | - S J Finney
- Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK
| | - G Kunst
- Department of Cardiovascular Anaesthesia, Kings College London, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, UK
| | - G Nickols
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - R Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - J P Nolan
- Resuscitation Medicine, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - B Patel
- Royal College of Anaesthetists, Red Lion Square, UK
| | - V J Pappachan
- Southampton Children's Hospital, NIHR Biomedical Research Centre, Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - F Plaat
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - B R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - J H Smith
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - L Varney
- Department of Anaesthesia, University College London Hospitals, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,University of Bristol, UK
| | | |
Collapse
|
24
|
Thorne C, Kimani P, Hampshire S, Hamilton-Bower I, Begum-Ali S, Benson-Clarke A, Couper K, Yeung J, Lockey A, Perkins G, Soar J. The nationwide impact of COVID-19 on life support courses. A retrospective evaluation by Resuscitation Council UK. Resusc Plus 2023; 13:100366. [PMID: 36816597 PMCID: PMC9922585 DOI: 10.1016/j.resplu.2023.100366] [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] [Indexed: 02/15/2023] Open
Abstract
Aim To determine the impact of the COVID-19 pandemic on Resuscitation Council UK Advanced Life Support (ALS) and Immediate Life Support (ILS) course numbers and outcomes. Methods We conducted a before-after study using course data from the Resuscitation Council UK Learning Management System between January 2018 and December 2021, using 23 March 2020 as the cut-off between pre- and post-pandemic periods. Demographics and outcomes were analysed using chi-squared tests and regression models. Results There were 90,265 ALS participants (51,464 pre-; 38,801 post-) and 368,140 ILS participants (225,628 pre-; 142,512 post-). There was a sharp decline in participants on ALS/ILS courses due to COVID-19. ALS participant numbers rebounded to exceed pre-pandemic levels, whereas ILS numbers recovered to a lesser degree with increased uptake of e-learning versions. Mean ALS course participants reduced from 20.0 to 14.8 post-pandemic (P < 0.001).Post-pandemic there were small but statistically significant decreases in ALS Cardiac Arrest Simulation Test pass rates (from 82.1 % to 80.1 % (OR = 0.90, 95 % CI = 0.86-0.94, P < 0.001)), ALS MCQ score (from 86.6 % to 86.0 % (mean difference = -0.35, 95 % CI -0.44 to -0.26, P < 0.001)), and overall ALS course results (from 95.2 %to 94.7 %, OR = 0.92, CI = 0.85-0.99, P = 0.023). ILS course outcomes were similar post-pandemic (from 99.4 % to 99.4 %, P = 0.037). Conclusion COVID-19 caused a sharp decline in the number of participants on ALS/ILS courses and an accelerated uptake of e-learning versions, with the average ALS course size reducing significantly. The small reduction in performance on ALS courses requires further research to clarify the contributing factors.
Collapse
Affiliation(s)
- C.J. Thorne
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK,North Bristol NHS Trust, Bristol BS10 5NB, UK,Corresponding author at: North Bristol NHS Trust, Bristol BS10 5NB, UK.
| | - P.K. Kimani
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Hampshire
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK
| | - I. Hamilton-Bower
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK
| | - S. Begum-Ali
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK
| | - A. Benson-Clarke
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK
| | - K. Couper
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK,Critical Care Unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J. Yeung
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK,Critical Care Unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A. Lockey
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK,Calderdale & Huddersfield NHS Foundation Trust, Halifax, United Kingdom,School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - G.D. Perkins
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK,Critical Care Unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J. Soar
- Resuscitation Council UK, Tavistock House North, Tavistock Square, London WC1H 9HR, UK,North Bristol NHS Trust, Bristol BS10 5NB, UK
| |
Collapse
|
25
|
Wu RMX, Wang Y, Shafiabady N, Zhang H, Yan W, Gou J, Shi Y, Liu B, Gide E, Kang C, Zhang Z, Shen B, Li X, Fan J, He X, Soar J, Zhao H, Sun L, Huo W, Wang Y. Using multi-focus group method as an effective tool for eliciting business system requirements: Verified by a case study. PLoS One 2023; 18:e0281603. [PMID: 36897871 PMCID: PMC10027421 DOI: 10.1371/journal.pone.0281603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023] Open
Abstract
This research aims to explore the multi-focus group method as an effective tool for systematically eliciting business requirements for business information system (BIS) projects. During the COVID-19 crisis, many businesses plan to transform their businesses into digital businesses. Business managers face a critical challenge: they do not know much about detailed system requirements and what they want for digital transformation requirements. Among many approaches used for understanding business requirements, the focus group method has been used to help elicit BIS needs over the past 30 years. However, most focus group studies about research practices mainly focus on a particular disciplinary field, such as social, biomedical, and health research. Limited research reported using the multi-focus group method to elicit business system requirements. There is a need to fill this research gap. A case study is conducted to verify that the multi-focus group method might effectively explore detailed system requirements to cover the Case Study business's needs from transforming the existing systems into a visual warning system. The research outcomes verify that the multi-focus group method might effectively explore the detailed system requirements to cover the business's needs. This research identifies that the multi-focus group method is especially suitable for investigating less well-studied, no previous evidence, or unstudied research topics. As a result, an innovative visual warning system was successfully deployed based on the multi-focus studies for user acceptance testing in the Case Study mine in Feb 2022. The main contribution is that this research verifies the multi-focus group method might be an effective tool for systematically eliciting business requirements. Another contribution is to develop a flowchart for adding to Systems Analysis & Design course in information system education, which may guide BIS students step by step on using the multi-focus group method to explore business system requirements in practice.
Collapse
Affiliation(s)
- Robert M X Wu
- School of Engineering and Technology, Central Queensland University, Sydney, Australia
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Yongwen Wang
- Shanxi Fenxi Mining Industry (Group) Co. Ltd, China
| | - Niusha Shafiabady
- Faculty of Science and Technology (Sydney Campus), Charles Darwin University, Darwin, Australia
| | - Huan Zhang
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Wanjun Yan
- Shanxi Fenxi Mining Industry (Group) Co. Ltd, China
| | - Jinwen Gou
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Yong Shi
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Bao Liu
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Ergun Gide
- School of Engineering and Technology, Central Queensland University, Sydney, Australia
| | - Changlong Kang
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Zhongwu Zhang
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Bo Shen
- GENEW Technologies Co. Ltd, China
| | | | - Jianfeng Fan
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Xiangqian He
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Australia
| | - Haijun Zhao
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Lei Sun
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Wenying Huo
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Ya Wang
- Shanxi Kailain Technology Co. Ltd, China
| |
Collapse
|
26
|
Kane AD, Armstrong RA, Kursumovic E, Cook TM, Oglesby FC, Cortes L, Moppett IK, Moonesinghe SR, Agarwal S, Bouch DC, Cordingley J, Davies MT, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Samuel K, Scholefield BR, Smith JH, Varney L, Vindrola‐Padros C, Martin S, Wain EC, Kendall SW, Ward S, Drake S, Lourtie J, Taylor C, Soar J. Methods of the 7 th National Audit Project (NAP7) of the Royal College of Anaesthetists: peri-operative cardiac arrest. Anaesthesia 2022; 77:1376-1385. [PMID: 36111390 PMCID: PMC9826156 DOI: 10.1111/anae.15856] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
Abstract
Cardiac arrest in the peri-operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri-operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large-scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri-operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three-part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri-operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri-operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri-operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri-operative period began with the World Health Organization 'sign-in' checklist or first hands-on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri-operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies.
Collapse
|
27
|
Ramakrishnan M, Gregor S, Shrestha A, Soar J. Achieving Industry-aligned Education through Digital-Commons: A Case Study. Journal of Computer Information Systems 2022. [DOI: 10.1080/08874417.2022.2115955] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | | | - Anup Shrestha
- University of Southern Queensland, Toowoomba, Australia
| | - Jeffrey Soar
- University of Southern Queensland, Toowoomba, Australia
| |
Collapse
|
28
|
Kaplan E, Altunisik E, Ekmekyapar Firat Y, Datta Barua P, Dogan S, Baygin M, Burak Demir F, Tuncer T, Palmer E, Tan RS, Yu P, Soar J, Fujita H, Rajendra Acharya U. Novel nested patch-based feature extraction model for automated Parkinson's Disease symptom classification using MRI images. Comput Methods Programs Biomed 2022; 224:107030. [PMID: 35878484 DOI: 10.1016/j.cmpb.2022.107030] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) is a common neurological disorder with variable clinical manifestations and magnetic resonance imaging (MRI) findings. We propose a handcrafted image classification model that can accurately (i) classify different PD stages, (ii) detect comorbid dementia, and (iii) discriminate PD-related motor symptoms. METHODS Selected image datasets from three PD studies were used to develop the classification model. Our proposed novel automated system was developed in four phases: (i) texture features are extracted from the non-fixed size patches. In the feature extraction phase, a pyramid histogram-oriented gradient (PHOG) image descriptor is used. (ii) In the feature selection phase, four feature selectors: neighborhood component analysis (NCA), Chi2, minimum redundancy maximum relevancy (mRMR), and ReliefF are used to generate four feature vectors. (iii) Two classifiers: k-nearest neighbor (kNN) and support vector machine (SVM) are used in the classification step. A ten-fold cross-validation technique is used to validate the results. (iv) Eight predicted vectors are generated using four selected feature vectors and two classifiers. Finally, iterative majority voting (IMV) is used to attain general classification results. Therefore, this model is named nested patch-PHOG-multiple feature selectors and multiple classifiers-IMV (NP-PHOG-MFSMCIMV). RESULTS Our presented NP-PHOG-MFSMCIMV model achieved 99.22, 98.70, and 99.53% accuracies for the collected PD stages, PD dementia, and PD symptoms classification datasets, respectively. SIGNIFICANCE The obtained accuracies (over 98% for all states) demonstrated the performance of developed NP-PHOG-MFSMCIMV model in automated PD state classification.
Collapse
Affiliation(s)
- Ela Kaplan
- Department of Radiology, Adıyaman Training and Research Hospital, Turkey
| | - Erman Altunisik
- Department of Neurology, Adiyaman University Medicine Faculty, Adiyaman, Turkey
| | | | - Prabal Datta Barua
- School of Business (Information Systems), University of Southern Queensland, Toowoomba, QLD 4350, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Sengul Dogan
- Department of Digital Forensics Engineering, College of Technology, Firat University, Elazig, Turkey
| | - Mehmet Baygin
- Department of Computer Engineering, College of Engineering, Ardahan University, Ardahan, Turkey
| | - Fahrettin Burak Demir
- Department of Software Engineering, Faculty of Engineering and Natural Sciences, Bandirma Onyedi Eylul University, Bandirma, Turkey
| | - Turker Tuncer
- Department of Digital Forensics Engineering, College of Technology, Firat University, Elazig, Turkey
| | - Elizabeth Palmer
- Centre of Clinical Genetics, Sydney Children's Hospitals Network, Randwick 2031, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine Randwick, Faculty of Medicine and Health, UNSW, Randwick, NSW 2031, Australia
| | - Ru-San Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Ping Yu
- School of Computing and Information Technology, University of Wollongong, Wollongong NSW 2522, Australia
| | - Jeffrey Soar
- School of Business (Information Systems), University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Hamido Fujita
- Faculty of Information Technology, HUTECH University of Technology, Ho Chi Minh City, Viet Nam; Andalusian Research Institute in Data Science and Computational Intelligence, University of Granada, Granada, Spain; Regional Research Center, Iwate Prefectural University, Iwate, Japan
| | - U Rajendra Acharya
- School of Business (Information Systems), University of Southern Queensland, Toowoomba, QLD 4350, Australia; Ngee Ann Polytechnic, Department of Electronics and Computer Engineering, 599489, Singapore; Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore; Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung, Taiwan; International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto, Japan.
| |
Collapse
|
29
|
Wu RMX, Zhang Z, Yan W, Fan J, Gou J, Liu B, Gide E, Soar J, Shen B, Fazal-e-Hasan S, Liu Z, Zhang P, Wang P, Cui X, Peng Z, Wang Y. A comparative analysis of the principal component analysis and entropy weight methods to establish the indexing measurement. PLoS One 2022; 17:e0262261. [PMID: 35085274 PMCID: PMC8802816 DOI: 10.1371/journal.pone.0262261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As the world's largest coal producer, China was accounted for about 46% of global coal production. Among present coal mining risks, methane gas (called gas in this paper) explosion or ignition in an underground mine remains ever-present. Although many techniques have been used, gas accidents associated with the complex elements of underground gassy mines need more robust monitoring or warning systems to identify risks. This paper aimed to determine which single method between the PCA and Entropy methods better establishes a responsive weighted indexing measurement to improve coal mining safety. METHODS Qualitative and quantitative mixed research methodologies were adopted for this research, including analysis of two case studies, correlation analysis, and comparative analysis. The literature reviewed the most-used multi-criteria decision making (MCDM) methods, including subjective methods and objective methods. The advantages and disadvantages of each MCDM method were briefly discussed. One more round literature review was conducted to search publications between 2017 and 2019 in CNKI. Followed two case studies, correlation analysis and comparative analysis were then conducted. Research ethics was approved by the Shanxi Coking Coal Group Research Committee. RESULTS The literature searched a total of 25,831publications and found that the PCA method was the predominant method adopted, and the Entropy method was the second most widely adopted method. Two weighting methods were compared using two case studies. For the comparative analysis of Case Study 1, the PCA method appeared to be more responsive than the Entropy. For Case Study 2, the Entropy method is more responsive than the PCA. As a result, both methods were adopted for different cases in the case study mine and finally deployed for user acceptance testing on 5 November 2020. CONCLUSIONS The findings and suggestions were provided as further scopes for further research. This research indicated that no single method could be adopted as the better option for establishing indexing measurement in all cases. The practical implication suggests that comparative analysis should always be conducted on each case and determine the appropriate weighting method to the relevant case. This research recommended that the PCA method was a dimension reduction technique that could be handy for identifying the critical variables or factors and effectively used in hazard, risk, and emergency assessment. The PCA method might also be well-applied for developing predicting and forecasting systems as it was sensitive to outliers. The Entropy method might be suitable for all the cases requiring the MCDM. There is also a need to conduct further research to probe the causal reasons why the PCA and Entropy methods were applied to each case and not the other way round. This research found that the Entropy method provides higher accuracy than the PCA method. This research also found that the Entropy method demonstrated to assess the weights of the higher dimension dataset was higher sensitivity than the lower dimensions. Finally, the comprehensive analysis indicates a need to explore a more responsive method for establishing a weighted indexing measurement for warning applications in hazard, risk, and emergency assessments.
Collapse
Affiliation(s)
- Robert M. X. Wu
- School of Engineering and Technology, Central Queensland University,
Sydney, Australia
- Shanxi Normal University, Xi’an, China
| | | | - Wanjun Yan
- Shanxi Fenxi Mining Zhongxing Coal Industry Co., Ltd, Lvliang,
China
| | | | - Jinwen Gou
- Shanxi Fenxi Mining Zhongxing Coal Industry Co., Ltd, Lvliang,
China
| | - Bao Liu
- Shanxi Fenxi Mining Zhongxing Coal Industry Co., Ltd, Lvliang,
China
| | - Ergun Gide
- School of Engineering and Technology, Central Queensland University,
Sydney, Australia
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Ipswich,
Australia
| | - Bo Shen
- GENEW Technologies Co. Ltd, ShenZhen, China
| | - Syed Fazal-e-Hasan
- Peter Faber Business School, Australian Catholic University, Blacktown,
Australia
| | - Zengquan Liu
- Shanxi Fenxi Mining Zhongxing Coal Industry Co., Ltd, Lvliang,
China
| | - Peng Zhang
- Shanxi Fenxi Mining Zhongxing Coal Industry Co., Ltd, Lvliang,
China
| | - Peilin Wang
- Shanxi Kailain Technology Co. Ltd, Shanxi, China
| | | | - Zhanfei Peng
- Shanxi Kailain Technology Co. Ltd, Shanxi, China
| | - Ya Wang
- Shanxi Kailain Technology Co. Ltd, Shanxi, China
| |
Collapse
|
30
|
Loh HW, Hong W, Ooi CP, Chakraborty S, Barua PD, Deo RC, Soar J, Palmer EE, Acharya UR. Application of Deep Learning Models for Automated Identification of Parkinson's Disease: A Review (2011-2021). Sensors (Basel) 2021; 21:s21217034. [PMID: 34770340 PMCID: PMC8587636 DOI: 10.3390/s21217034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022]
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disorder affecting over 6 million people globally. Although there are symptomatic treatments that can increase the survivability of the disease, there are no curative treatments. The prevalence of PD and disability-adjusted life years continue to increase steadily, leading to a growing burden on patients, their families, society and the economy. Dopaminergic medications can significantly slow down the progression of PD when applied during the early stages. However, these treatments often become less effective with the disease progression. Early diagnosis of PD is crucial for immediate interventions so that the patients can remain self-sufficient for the longest period of time possible. Unfortunately, diagnoses are often late, due to factors such as a global shortage of neurologists skilled in early PD diagnosis. Computer-aided diagnostic (CAD) tools, based on artificial intelligence methods, that can perform automated diagnosis of PD, are gaining attention from healthcare services. In this review, we have identified 63 studies published between January 2011 and July 2021, that proposed deep learning models for an automated diagnosis of PD, using various types of modalities like brain analysis (SPECT, PET, MRI and EEG), and motion symptoms (gait, handwriting, speech and EMG). From these studies, we identify the best performing deep learning model reported for each modality and highlight the current limitations that are hindering the adoption of such CAD tools in healthcare. Finally, we propose new directions to further the studies on deep learning in the automated detection of PD, in the hopes of improving the utility, applicability and impact of such tools to improve early detection of PD globally.
Collapse
Affiliation(s)
- Hui Wen Loh
- School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
| | - Wanrong Hong
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW 2010, Australia
| | - Chui Ping Ooi
- School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
| | - Subrata Chakraborty
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Prabal Datta Barua
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW 2010, Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
- School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Ravinesh C Deo
- School of Sciences, University of Southern Queensland, Springfield, QLD 4300, Australia
| | - Jeffrey Soar
- School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Elizabeth E Palmer
- Centre of Clinical Genetics, Sydney Children's Hospitals Network, Randwick, NSW 2031, Australia
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - U Rajendra Acharya
- School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
- School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia
- School of Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413, Taiwan
- Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto 860-8555, Japan
| |
Collapse
|
31
|
Kursumovic E, Cook TM, Vindrola-Padros C, Kane AD, Armstrong RA, Waite O, Soar J. The impact of COVID-19 on anaesthesia and critical care services in the UK: a serial service evaluation. Anaesthesia 2021; 76:1167-1175. [PMID: 34005837 PMCID: PMC8222939 DOI: 10.1111/anae.15512] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/02/2022]
Abstract
Between October 2020 and January 2021, we conducted three national surveys to track anaesthetic, surgical and critical care activity during the second COVID‐19 pandemic wave in the UK. We surveyed all NHS hospitals where surgery is undertaken. Response rates, by round, were 64%, 56% and 51%. Despite important regional variations, the surveys showed increasing systemic pressure on anaesthetic and peri‐operative services due to the need to support critical care pandemic demands. During Rounds 1 and 2, approximately one in eight anaesthetic staff were not available for anaesthetic work. Approximately one in five operating theatres were closed and activity fell in those that were open. Some mitigation was achieved by relocation of surgical activity to other locations. Approximately one‐quarter of all surgical activity was lost, with paediatric and non‐cancer surgery most impacted. During January 2021, the system was largely overwhelmed. Almost one‐third of anaesthesia staff were unavailable, 42% of operating theatres were closed, national surgical activity reduced to less than half, including reduced cancer and emergency surgery. Redeployed anaesthesia staff increased the critical care workforce by 125%. Three‐quarters of critical care units were so expanded that planned surgery could not be safely resumed. At all times, the greatest resource limitation was staff. Due to lower response rates from the most pressed regions and hospitals, these results may underestimate the true impact. These findings have important implications for understanding what has happened during the COVID‐19 pandemic, planning recovery and building a system that will better respond to future waves or new epidemics.
Collapse
Affiliation(s)
- E Kursumovic
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Royal College of Anaesthetists, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath.,of Anaesthesia, University of Bristol, Bristol, UK
| | - C Vindrola-Padros
- Department of Targeted Intervention, University College London, London, UK.,NIAA Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - A D Kane
- Royal College of Anaesthetists, London, UK.,Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - R A Armstrong
- Royal College of Anaesthetists, London, UK.,Department of Anaesthesia, Severn Deanery, UK
| | - O Waite
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
32
|
Kane AD, Armstrong RA, Kursumovic E, Cook TM, Soar J. The 7th UK National Audit Project (NAP7). The challenges of defining, studying and learning from peri-operative cardiac arrest. Anaesthesia 2021; 76:1026-1030. [PMID: 33982281 DOI: 10.1111/anae.15509] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A D Kane
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - R A Armstrong
- Department of Anaesthesia, Severn Deanery, Bristol, UK
| | - E Kursumovic
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Anaesthesia, University of Bristol, Bristol, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
33
|
Hawkes CA, Brown T, Noor U, Carlyon J, Davidson N, Soar J, Perkins GD, Smyth MA, Lockey A. Characteristics of Restart a Heart 2019 event locations in the UK. Resusc Plus 2021; 6:100132. [PMID: 34223389 PMCID: PMC8244288 DOI: 10.1016/j.resplu.2021.100132] [Citation(s) in RCA: 5] [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: 12/30/2020] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Restart a Heart (RSAH) is an annual CPR mass training initiative delivered predominantly by ambulance services in the UK. The aim of this study was to identify to what extent voluntary participation in the 2019 initiative delivered training to the population with the highest need. Methods A cross-sectional observational study of location characteristics for RSAH training events conducted by UK ambulance services. Descriptive statistics were used to analyse event and area characteristics. National cardiac arrest registry data were used to establish proportions of training coverage in “hot spot” areas with above national median incidence of cardiac arrest and below median bystander CPR rates. The significance of observed differences were tested using chi-square for proportions and t-test for means. Results Twelve of 14 UK ambulance services participated, training 236,318 people. Most of the events (82%) were held in schools, and schoolchildren comprised most participants (81%). RSAH events were held in areas that were less densely populated (p < 0.001), were more common in affluent areas (p < 0.001), and had a significantly lower proportion of black residents (p < 0.05) and higher proportion of white residents (p < 0.05). Events were held in 28% of known “hot spot” areas in England. Conclusion With mandatory CPR training for school children in England, Scotland and Wales there is an opportunity to re-focus RSAH resources to deliver training for all age groups in OHCA “hot spots”, communities with higher proportions of black residents, and areas of deprivation. In Northern Ireland, we recommend targeting schools in areas with similar characteristics.
Collapse
Affiliation(s)
- C A Hawkes
- University of Warwick, Warwick Clinical Trials Unit, Gibbet Hill, Coventry, CV4 7AL, UK
| | - T Brown
- University of Warwick, Warwick Clinical Trials Unit, Gibbet Hill, Coventry, CV4 7AL, UK
| | - U Noor
- University of Warwick, Warwick Clinical Trials Unit, Gibbet Hill, Coventry, CV4 7AL, UK
| | - J Carlyon
- Resuscitation Council UK 5th Floor Tavistock House North, Tavistock Square, London, WC1H 9H, UK.,Yorkshire Ambulance Service, Trust Headquarters, Brindley Way, Wakefield 41 Business Park, Wakefield, WF2 0XQ, UK
| | | | - J Soar
- Resuscitation Council UK 5th Floor Tavistock House North, Tavistock Square, London, WC1H 9H, UK.,North Bristol NHS Trust Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - G D Perkins
- University of Warwick, Warwick Clinical Trials Unit, Gibbet Hill, Coventry, CV4 7AL, UK.,University Hospitals Birmingham, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK
| | - M A Smyth
- University of Warwick, Warwick Clinical Trials Unit, Gibbet Hill, Coventry, CV4 7AL, UK.,West Midlands Ambulance Service University NHS Foundation Trust, Trust Headquarters, Millennium Point, Waterfront Business Park, Waterfront Way, Brierley Hill, West Midlands, DY5 1LX, UK
| | - A Lockey
- Resuscitation Council UK 5th Floor Tavistock House North, Tavistock Square, London, WC1H 9H, UK.,Calderdale and Huddersfield NHS Foundation Trust, Salterhebble, Halifax, West Yorkshire HX3 0PW, UK
| | | |
Collapse
|
34
|
Nolan JP, Orzechowska I, Harrison DA, Soar J, Perkins GD, Shankar-Hari M. Changes in temperature management and outcome after out-of-hospital cardiac arrest in United Kingdom intensive care units following publication of the targeted temperature management trial. Resuscitation 2021; 162:304-311. [PMID: 33819502 DOI: 10.1016/j.resuscitation.2021.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/19/2022]
Abstract
AIM To investigate how the publication of the targeted temperature management (TTM) trial in December 2013 affected the trends in temperature management and outcome following admission to UK intensive care units (ICUs) after out-of-hospital cardiac arrest (OHCA). METHODS We used a national ICU database of 1,181,405 consecutive admissions to 235 adult ICUs. OHCA admissions mechanically ventilated in the first 24 h in the ICU were divided into a pre-TTM trial cohort of patients admitted before publication of the TTM trial (January 2010-December 2013) and post-TTM cohort of patients admitted after TTM trial publication (January 2014-December 2017). The primary outcome variables were lowest temperature in the first 24 h in ICU and survival to hospital discharge. RESULTS The lowest temperature recorded in the first-24 h of admission was significantly higher in the post-TTM cohort (n = 18,106) than in the pre-TTM cohort (n = 12,162) (mean 34.7 (±1.6) versus 33.6 °C (±1.8); absolute difference 1.12 °C (95% CI 1.08-1.16). The post-TTM cohort had a greater prevalence of fever (>38.0 °C) (24.8% vs 14.7%; (odds ratio (OR) 1.91 (95% CI 1.80-2.03); p < 0.001)) and higher unadjusted in-hospital mortality (63.7% vs 61.6%). In a multilevel model, accounting for time trend and including site as a random effect, neither the step change in acute hospital mortality following publication of the TTM trial result (OR 1.04, 95% CI 0.95-1.15; p = 0.37), nor the change in slope (from OR 1.00 per year, 95% CI 0.97-1.04, to 1.04 per year, 95% CI 1.02-1.07; p = 0.059), was statistically significant. Adjusted analyses were limited by the models' dependence on temperature and temperature-related variables. CONCLUSIONS The lowest temperature recorded in the first-24 h of admission in OHCA patients was higher in the post-TTM cohort compared with the pre-TTM cohort. There has been an increase in the proportion of patients with fever (>38 °C) in the first 24 h. Although crude mortality was slightly higher in the post-TTM cohort, an analysis accounting for time trend and variation between critical care units, found no significant change associated with the TTM publication.
Collapse
Affiliation(s)
- J P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK; Royal United Hospitals NHS Foundation Trust, Bath, BA1 3NG, UK.
| | - I Orzechowska
- Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - D A Harrison
- Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - J Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK; Heartlands Hospital, University Hospitals Birmingham, Birmingham, B9 5SS, UK
| | - M Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, London, UK; Peter Gorer Department of Immunobiology, King's College London, UK
| |
Collapse
|
35
|
Nolan JP, Ornato JP, Parr MJA, Perkins GD, Soar J. Resuscitation highlights in 2020. Resuscitation 2021; 162:1-10. [PMID: 33577963 DOI: 10.1016/j.resuscitation.2021.01.037] [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: 01/31/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2020. The number of papers submitted to the Journal in 2020 increased by 25% on the previous year.MethodsHand-searching by the editors of all papers published in Resuscitation during 2020. Papers were selected based on then general interest and novelty and were categorised into general themes.ResultsA total of 103 papers were selected for brief mention in this review.ConclusionsResuscitation science continues to evolve rapidly and incorporate all links in the chain of survival.
Collapse
Affiliation(s)
- J P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, UK.
| | - J P Ornato
- Department of Emergency Medicine, Virginia Commonwealth University Health, Richmond, VA, USA.
| | - M J A Parr
- Intensive Care, Liverpool and Macquarie University Hospitals, University of New South Wales and Macquarie University, Sydney, Australia.
| | - G D Perkins
- Critical Care Medicine, University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, CV4 7AL, UK.
| | - J Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| |
Collapse
|
36
|
Li Y, Li Y, Wang Y, Ma G, Liu X, Li Y, Soar J. Application of zeolitic imidazolate frameworks (ZIF-8)/ionic liquid composites modified nano-carbon paste electrode as sensor for electroanalytical sensing of 1-hydroxypyrene. Microchem J 2020. [DOI: 10.1016/j.microc.2020.105433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
37
|
Bargshady G, Zhou X, Deo RC, Soar J, Whittaker F, Wang H. The modeling of human facial pain intensity based on Temporal Convolutional Networks trained with video frames in HSV color space. Appl Soft Comput 2020. [DOI: 10.1016/j.asoc.2020.106805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
38
|
Yusif S, Hafeez-Baig A, Soar J, Teik DOL. PLS-SEM path analysis to determine the predictive relevance of e-Health readiness assessment model. Health Technol 2020. [DOI: 10.1007/s12553-020-00484-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
39
|
Bargshady G, Zhou X, Deo RC, Soar J, Whittaker F, Wang H. Ensemble neural network approach detecting pain intensity from facial expressions. Artif Intell Med 2020; 109:101954. [PMID: 34756219 DOI: 10.1016/j.artmed.2020.101954] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 01/21/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
This paper reports on research to design an ensemble deep learning framework that integrates fine-tuned, three-stream hybrid deep neural network (i.e., Ensemble Deep Learning Model, EDLM), employing Convolutional Neural Network (CNN) to extract facial image features, detect and accurately classify the pain. To develop the approach, the VGGFace is fine-tuned and integrated with Principal Component Analysis and employed to extract features in images from the Multimodal Intensity Pain database at the early phase of the model fusion. Subsequently, a late fusion, three layers hybrid CNN and recurrent neural network algorithm is developed with their outputs merged to produce image-classified features to classify pain levels. The EDLM model is then benchmarked by means of a single-stream deep learning model including several competing models based on deep learning methods. The results obtained indicate that the proposed framework is able to outperform the competing methods, applied in a multi-level pain detection database to produce a feature classification accuracy that exceeds 89 %, with a receiver operating characteristic of 93 %. To evaluate the generalization of the proposed EDLM model, the UNBC-McMaster Shoulder Pain dataset is used as a test dataset for all of the modelling experiments, which reveals the efficacy of the proposed method for pain classification from facial images. The study concludes that the proposed EDLM model can accurately classify pain and generate multi-class pain levels for potential applications in the medical informatics area, and should therefore, be explored further in expert systems for detecting and classifying the pain intensity of patients, and automatically evaluating the patients' pain level accurately.
Collapse
Affiliation(s)
- Ghazal Bargshady
- School of Management and Enterprise, University of Southern Queensland, Springfield, Qld 4300, Australia.
| | - Xujuan Zhou
- School of Management and Enterprise, University of Southern Queensland, Springfield, Qld 4300, Australia.
| | - Ravinesh C Deo
- School of Sciences, University of Southern Queensland, Springfield, Qld 4300, Australia.
| | - Jeffrey Soar
- School of Management and Enterprise, University of Southern Queensland, Springfield, Qld 4300, Australia.
| | - Frank Whittaker
- School of Management and Enterprise, University of Southern Queensland, Springfield, Qld 4300, Australia.
| | - Hua Wang
- Victoria University, Melbourne, Australia.
| |
Collapse
|
40
|
Yusif S, Hafeez-Baig A, Soar J. Change management and adoption of health information technology (HIT)/eHealth in public hospitals in Ghana: A qualitative study. ACI 2020. [DOI: 10.1016/j.aci.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Ghana, as with other developing countries, there are several health information technology (HIT) initiatives as interventions to improve healthcare delivery. HIT implementation undoubtedly results in change. However, most studies relating to HIT implementation readiness have constantly neglected the role of change in successfully implementing HIT. This study intends to identify factors affecting successful change management as part of preparation towards successfully implementing HIT in public hospital in Ghana. To carry out this study, we conducted in-depth interviews with a matrix of HIT senior managers and thematically analyzed the data. The data was transcribed and uploaded into a Nvivo 11 software for analysis using thematic analysis techniques. Five (5) themes were discovered. They are: 1) Stakeholder participation; 2) Proof of experience in similar project; 3) Availability of committed change agents/all-levels-change representatives; 4) Clearly articulated change implementation strategy; and 5) Training and improvement mechanism (post-implementation). A fresh call is made for more attention to be paid to change as part of preparatory measures towards the adoption of HIT in Ghana using the five cardinal approaches identified as a guide.
Collapse
|
41
|
Nolan JP, Monsieurs KG, Bossaert L, Böttiger BW, Greif R, Lott C, Madar J, Olasveengen TM, Roehr CC, Semeraro F, Soar J, Van de Voorde P, Zideman DA, Perkins GD. European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation 2020; 153:45-55. [PMID: 32525022 PMCID: PMC7276132 DOI: 10.1016/j.resuscitation.2020.06.001] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person’s presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.
Collapse
Affiliation(s)
- J P Nolan
- Resuscitation Medicine, University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG UK.
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - L Bossaert
- University of Antwerp, Antwerp, Belgium; European Resuscitation Council (ERC), Niel, Belgium
| | - B W Böttiger
- Anaesthesiology and Intensive Care Medicine, Director of Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - R Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, 3010 Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - C Lott
- Department of Anaesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - J Madar
- University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH UK; Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - T M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - C C Roehr
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), Medical Sciences Division, University of Oxford. Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF UK
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - J Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - P Van de Voorde
- Emergency Medicine - Clinical Head, Ghent University Hospital and University of Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium; Emergency Dispatch Centre, 112 West/East-Flanders, Federal Dept Health, Belgium
| | - D A Zideman
- Anaesthesia and Pre-Hospital Emergency Medicine, Thames Valley Air Ambulance, Stokenchurch House, Stokenchurch, HP14 3SX, UK
| | - G D Perkins
- Critical Care Medicine, University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, CV4 7AL, UK
| | | |
Collapse
|
42
|
Soar J, Lott C, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. Erweiterte lebensrettende Maßnahmen bei Erwachsenen. Notf Rett Med 2020; 23:248-250. [PMID: 32536800 PMCID: PMC7284666 DOI: 10.1007/s10049-020-00720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
43
|
Olasveengen T, Castrén M, Handley A, Kuzovlev A, Monsieurs KG, Perkins G, Raffay V, Ristagno G, Semeraro F, Smyth M, Soar J, Svavarsdóttir H. Basismaßnahmen zur Wiederbelebung Erwachsener. Notf Rett Med 2020; 23:246-247. [PMID: 32536799 PMCID: PMC7284673 DOI: 10.1007/s10049-020-00719-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. Olasveengen
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - M. Castrén
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - A. Handley
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - A. Kuzovlev
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - K. G. Monsieurs
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - G. Perkins
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - V. Raffay
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - G. Ristagno
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - F. Semeraro
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - M. Smyth
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - J. Soar
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| | - H. Svavarsdóttir
- European Resuscitation Council VZW, Emile Vanderveldelaan 35, 2845 Niel, Belgien
| |
Collapse
|
44
|
Abstract
Purpose
This paper aims to validate an initially developed e-Health readiness assessment model.
Design/methodology/approach
The authors thematically analysed an initial qualitative data collected and used the outcome to develop survey instruments for this study. To collect the quantitative data, the authors used the drop and collect survey approach given the research setting. The quantitative data was analysed using factor and regression analyses of SPSS 23 in which hypotheses formulated were tested.
Findings
The results suggest that the model [R2 = 0.971; F (5, 214) = 1414.303], which is made up of readiness assessment factors (constructs) and measuring tools explain about 97% of the variance of the overall health information technology/e-Health adoption readiness at Komfo Anokye Teaching Hospital. The measuring tools were reliable for assessing the composite variables (constructs): technology readiness; operational resource readiness; organizational and cultural readiness; regulatory and policy readiness; and core readiness, which have significant influence on eHealth adoption readiness assessment..
Originality/value
This study has successfully validated empirically developed eHealth readiness assessment model with complete reliable indicators given that existing eHealth readiness assessment models have not been effective due to a general lack of standard indicators for measuring assessment factors. The study also contributes to the growing research on the adoption of information technology/systems in health-care environment using the Technology–Organization–Environment framework.
Collapse
|
45
|
Perkins GD, Morley PT, Nolan JP, Soar J, Berg K, Olasveengen T, Wyckoff M, Greif R, Singletary N, Castren M, de Caen A, Wang T, Escalante R, Merchant RM, Hazinski M, Kloeck D, Heriot G, Couper K, Neumar R. International Liaison Committee on Resuscitation: COVID-19 consensus on science, treatment recommendations and task force insights. Resuscitation 2020; 151:145-147. [PMID: 32371027 PMCID: PMC7194051 DOI: 10.1016/j.resuscitation.2020.04.035] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/02/2022]
Abstract
Consensus on Science and Treatment recommendations aim to balance the benefits of early resuscitation with the potential for harm to care providers during the COVID-19 pandemic. Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols. During the current COVID-19 pandemic lay rescuers should consider compressions and public-access defibrillation. Lay rescuers who are willing, trained and able to do so, should consider providing rescue breaths to infants and children in addition to chest compressions. Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation and may consider defibrillation before donning personal protective equipment for aerosol generating procedures.
Collapse
Affiliation(s)
- G D Perkins
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium.
| | - P T Morley
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - J P Nolan
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - J Soar
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - K Berg
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - T Olasveengen
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - M Wyckoff
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - R Greif
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - N Singletary
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - M Castren
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - A de Caen
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - T Wang
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - R Escalante
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - R M Merchant
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - M Hazinski
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - D Kloeck
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - G Heriot
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - K Couper
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - R Neumar
- International Liaison Committee on Resuscitation, Emile Vanderveldelaan 35, 2845 Niel, Belgium
| |
Collapse
|
46
|
Nolan J, Berg R, Andersen L, Soar J. Reply to comment on update of in-hospital Utstein guidelines. Resuscitation 2020; 149:244. [DOI: 10.1016/j.resuscitation.2020.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
|
47
|
Yusif S, Hafeez-Baig A, Soar J. An Exploratory Study of the Readiness of Public Healthcare Facilities in Developing Countries to Adopt Health Information Technology (HIT)/e-Health: the Case of Ghana. J Healthc Inform Res 2020; 4:189-214. [DOI: 10.1007/s41666-020-00070-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
|
48
|
Soar J, Yu L, Al-Hakim L. Older People’s Needs and Opportunities for Assistive Technologies. Lecture Notes in Computer Science 2020. [PMCID: PMC7313296 DOI: 10.1007/978-3-030-51517-1_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Older adults experience a disconnect between their needs and adoption of technologies that have potential to assist and to support more independent living. This paper reviewed research that links people’s needs with opportunities for assistive technologies. It searched 13 databases identifying 923 papers with 34 papers finally included for detailed analysis. The research papers identified needs in the fields of health, leisure, living, safety, communication, family relationship and social involvement. Amongst these, support for activities of daily living category was of most interest. In specific sub-categories, the next most reported need was assistive technology to support walking and mobility followed by smart cooking/kitchen technology and assistive technology for social contacts with family member/other people. The research aimed to inform a program of research into improving the adoption of technologies where they can ameliorate identified needs of older people.
Collapse
|
49
|
Abstract
Purpose
Although an increasing number of organisations implement the Information Technology Infrastructure Library® (ITIL®) with the aim to improve provision of information technology services to their customers, a significant number of ITIL implementations do not achieve the expected outcomes. The organisational change strategies of organisations during ITIL implementation initiatives may have an effect on success, but empirical research on this topic is scarce. The paper aims to discuss these issues.
Design/methodology/approach
A multiple case study methodology comprising successful ITIL implementations in eight large Australian organisations is used. A socio-technical systems approach represented by Leavitt’s Diamond is adopted as a lens to shed light on the attributes of effective organisational change strategies for successful ITIL implementation.
Findings
This paper identifies organisational change strategies employed by organisations that have effected a successful ITIL implementation. The authors identified that the ITIL implementation required changes to the four components of the socio-technical work system (STS) identified in Leavitt’s Diamond. Changes to one STS component affected other STS components when implementing ITIL; and that effort applied to the STS components did not need to be equal, but appropriate to the requirements of the ITIL implementation and the organisation.
Research limitations/implications
The sample size of eight ITIL implementation cases studied may limit the generalisation of findings.
Practical implications
This research provides IT service management researchers and ITIL practitioners, for the first time, information about organisational change strategies as applied to successful ITIL implementations.
Originality/value
This research has developed novel insights into organisational change strategies and ITIL implementation that had not previously been explored.
Collapse
|
50
|
Ali O, Shrestha A, Soar J, Wamba SF. Cloud computing-enabled healthcare opportunities, issues, and applications: A systematic review. International Journal of Information Management 2018. [DOI: 10.1016/j.ijinfomgt.2018.07.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|