المؤلفون: Marc L. Seal, Gabriel Dabscheck, Francesca Lami, Belinda Barton, Katrina Williams, Jonathan M. Payne, Karin S. Walsh, Michael Kean, Jennifer Lorenzo, Melissa Rouel, Alice Maier, Kathryn N. North, Caroline Rae, Timothy J. Silk, Natalie A. Pride, Anita K. Chisholm, Kristina M Haebich, Vicki Anderson, Mayuresh S. Korgaonkar

المصدر: BMJ Open

مصطلحات موضوعية: Male, congenital, hereditary, and neonatal diseases and abnormalities, Neurofibromatosis 1, Adolescent, Autism Spectrum Disorder, Child Behavior, behavioral disciplines and activities, Nervous System, 050105 experimental psychology, 03 medical and health sciences, 0302 clinical medicine, Magnetic resonance imaging, Child Development, Cognition, Social cognition, mental disorders, Social functioning, medicine, Protocol, Humans, 0501 psychology and cognitive sciences, Prospective Studies, Autistic Disorder, Child, Social Behavior, business.industry, 05 social sciences, Neuropsychology, Paediatrics, General Medicine, medicine.disease, Child development, Cognitive test, Cross-Sectional Studies, Phenotype, Autism spectrum disorder, Research Design, Child, Preschool, Autism, Female, business, 030217 neurology & neurosurgery, Cohort study, Clinical psychology, Neurofibromatosis type 1

الوصف: IntroductionChildren with the single-gene disorder neurofibromatosis type 1 (NF1) appear to be at an increased risk for autism spectrum disorder (ASD) and exhibit a unique social-cognitive phenotype compared with children with idiopathic ASD. A complete framework is required to better understand autism in NF1, from neurobiological levels through to behavioural and functional outcomes. The primary aims of this study are to establish the frequency of ASD in children with NF1, examine the social cognitive phenotype, investigate the neuropsychological processes contributing to ASD symptoms and poor social functioning in children with NF1, and to investigate novel structural and functional neurobiological markers of ASD and social dysfunction in NF1. The secondary aim of this study is to compare the neuropsychological and neurobiological features of ASD in children with NF1 to a matched group of patients with idiopathic ASD.Methods and analysisThis is an international, multisite, prospective, cross-sectional cohort study of children with NF1, idiopathic ASD and typically developing (TD) controls. Participants will be 200 children with NF1 (3–15 years of age), 70 TD participants (3–15 years) and 35 children with idiopathic ASD (7–15 years). Idiopathic ASD and NF1 cases will be matched on age, sex and intelligence. All participants will complete cognitive testing and parents will rate their child’s behaviour on standardised questionnaires. Neuroimaging will be completed by a subset of participants aged 7 years and older. Children with NF1 that screen at risk for ASD on the parent-rated Social Responsiveness Scale 2nd Edition will be invited back to complete the Autism Diagnostic Observation Scale 2nd Edition and Autism Diagnostic Interview-Revised to determine whether they fulfil ASD diagnostic criteria.Ethics and disseminationThis study has hospital ethics approval and the results will be disseminated through peer-reviewed publications and international conferences.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9e2ce932142cdd9fabdbdb2a0e5aa7d9Test
http://europepmc.org/articles/PMC6773330Test

المؤلفون: Jean Antonelli, Guro Huby, Timothy S. Walsh, Kalliopi Kydonaki, Janet Hanley

المصدر: BMJ Open
2019, ' Challenges and barriers to optimising sedation in intensive care : a qualitative study in eight Scottish intensive care units ', BMJ Open, vol. 9, no. 5, 024549 . https://doi.org/10.1136/bmjopen-2018-024549Test

مصطلحات موضوعية: PROTOCOL, MECHANICALLY VENTILATED PATIENTS, Quality management, Critical Care, Sedation, Exploratory research, Conscious Sedation, Critical Care Nursing, ANALGESIA, 03 medical and health sciences, 0302 clinical medicine, Nursing, Intensive care, Physicians, medicine, Humans, 030212 general & internal medicine, INTERRUPTION, Research ethics, business.industry, Research, Intensive Care, General Medicine, Focus Groups, SLEEP, Focus group, Quality Improvement, Physical Therapists, Intensive Care Units, Scotland, Health, quality In health care, Thematic analysis, medicine.symptom, DELIRIUM, business, CRITICALLY-ILL PATIENTS, 030217 neurology & neurosurgery, qualitative research, Qualitative research

الوصف: ObjectivesVarious strategies to promote light sedation are highly recommended in recent guidelines, as deep sedation is associated with suboptimum patient outcomes. Yet, the challenges met by clinicians in delivering high-quality analgosedation is rarely addressed. As part of the evaluation of a cluster-randomised quality improvement trial in eight Scottish intensive care units (ICUs), we aimed to understand the challenges to optimising sedation in the Scottish ICU settings prior to the trial. This article reports on the findings.DesignA qualitative exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period.Setting and participants: Eight Scottish ICUs. Nurses, physiotherapists and doctors working in each ICU volunteered to participate. FG were recorded and verbatim transcribed and inserted in NVivo V.10 for analysis. Qualitative thematic analysis was undertaken to develop emergent themes from the patterns identified in relation to sedation practice. Ethical approval was secured by Scotland A Research ethics committee.ResultsThree themes emerged from the inductive analysis: (a) a recent shift in sedation practice, (b) uncertainty in decision-making and (c) system-level factors including the ICU environment, organisational factors and educational gaps. Clinicians were challenged daily to manage agitated or difficult-to-sedate patients in the era of a progressive mantra of ‘just sedate less’ imposed by the pain–agitation–delirium guidelines.ConclusionsThe current implementation of guidelines does not support behaviour change strategies to allow a patient-focused approach to sedation management, which obstructs optimum sedation–analgesia management. Recognition of the various challenges when mandating less sedation needs to be considered and novel sedation–analgesia strategies should allow a system-level approach to improve sedation–analgesia quality.DESIST registration numberNCT01634451

وصف الملف: PDF; application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1370b0e03a90e98a62d2c32c34401cdfTest
http://europepmc.org/articles/PMC6538047Test

المؤلفون: Natalie Pattison, Sally Humphreys, Timothy S. Walsh, Bronwen Connolly, Philip Hopkins, Nishkantha Arulkumaran, Geraldine O’Gara, Paul Dark

المصدر: Pattison, N, Arulkumaran, N, O'gara, G, Connolly, B, Humphreys, S, Walsh, T, Hopkins, P & Dark, P 2019, ' Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure ', BMJ Open, vol. 9, no. 12, pp. e030815 . https://doi.org/10.1136/bmjopen-2019-030815Test
BMJ Open

مصطلحات موضوعية: Patient Consent, Critical Care, barriers, critical care trials, 03 medical and health sciences, 0302 clinical medicine, Nursing, Intensive care, Health care, access to research, Humans, Medicine, 030212 general & internal medicine, Qualitative Research, Original Research, Clinical Trials as Topic, business.industry, Patient Selection, Resource constraints, Intensive Care, 030208 emergency & critical care medicine, General Medicine, United Kingdom, Clinical trial, Patient recruitment, Intensive Care Units, qualitative synthesis, facilitators, Thematic analysis, business, normalising research, Qualitative research

الوصف: Conducting clinical trials in critical care is integral to improving patient care. Unique practical and ethical considerations exist in this patient population that make patient recruitment challenging, including narrow recruitment timeframes and obtaining patient consent often in time-critical situations. Units currently vary significantly in their ability to recruit according to infrastructure and level of research activity.AimTo identify variability in the research infrastructure of UK intensive care units and their ability to conduct research and recruit patients into clinical trials.DesignWe evaluated factors related to intensive care patient enrolment into clinical trials in the UK. This consisted of a qualitative synthesis carried out with two datasets of in-depth interviews (distinct participants across the two datasets) conducted with 27 intensive care consultants (n=9), research nurses (n=17) and trial coordinators (n=1) from 27 units across the UK. Primary and secondary analyses of two datasets (one dataset had been analysed previously) were undertaken in the thematic analysis.FindingsThe synthesis yielded an overarching core theme of normalising research, characterised by motivations for promoting research and fostering research-active cultures within resource constraints, with six themes under this to explain the factors influencing critical care research capacity: organisational, human, study, practical resources, clinician and patient/family factors. There was a strong sense of integrating research in routine clinical practice, and recommendations are outlined.ConclusionsThe central and transferable tenet of normalising research advocates the importance of developing a culture where research is inclusive alongside clinical practice in routine patient care and is a requisite for all healthcare individuals from organisational to direct patient contact level.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::436ee3880013ba5043574fd232558e8eTest
https://doi.org/10.1136/bmjopen-2019-030815Test

المؤلفون: Robert J. Lee, Christopher J. Weir, Jean Antonelli, Janet Hanley, Kimmo Uutelo, Petra Peltola, Kirsty Everingham, Timothy S. Walsh, Kalliopi Kydonaki, Jacqueline Stephen

المصدر: BMJ Open
Walsh, T S, Kydonaki, K, Antonelli, J, Stephen, J, Lee, R J, Everingham, K, Hanley, J, Uutelo, K, Peltola, P, Weir, C J 2016, ' Rationale, design and methodology of a trial evaluating three strategies designed to improve sedation quality in intensive care units (DESIST study) ', BMJ Open, vol. 6, no. 3, pp. e010148 . https://doi.org/10.1136/bmjopen-2015-010148Test

مصطلحات موضوعية: Male, medicine.medical_specialty, Quality management, Critical Care, Sedation, Psychological intervention, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Cluster Analysis, Humans, Hypnotics and Sedatives, Medicine, 030212 general & internal medicine, Adverse effect, Intensive care medicine, Monitoring, Physiologic, PAIN MANAGEMENT, business.industry, Research, Process Assessment, Health Care, Intensive Care, clinical trial, 030208 emergency & critical care medicine, General Medicine, Quality Improvement, Respiration, Artificial, Focus group, Clinical trial, Intensive Care Units, Scotland, sedation, Sample size determination, Emergency medicine, Female, Analgesia, medicine.symptom, business

الوصف: OBJECTIVES: To describe the rationale, design and methodology for a trial of three novel interventions developed to improve sedation-analgesia quality in adult intensive care units (ICUs).PARTICIPANTS AND SETTING: 8 clusters, each a Scottish ICU. All mechanically ventilated sedated patients were potentially eligible for inclusion in data analysis.DESIGN: Cluster randomised design in 8 ICUs, with ICUs randomised after 45 weeks baseline data collection to implement one of four intervention combinations: a web-based educational programme (2 ICUs); education plus regular sedation quality feedback using process control charts (2 ICUs); education plus a novel sedation monitoring technology (2 ICUs); or all three interventions. ICUs measured sedation-analgesia quality, relevant drug use and clinical outcomes, during a 45-week preintervention and 45-week postintervention period separated by an 8-week implementation period. The intended sample size was >100 patients per site per study period.MAIN OUTCOME MEASURES: The primary outcome was the proportion of 12 h care periods with optimum sedation-analgesia, defined as the absence of agitation, unnecessary deep sedation, poor relaxation and poor ventilator synchronisation. Secondary outcomes were proportions of care periods with each of these four components of optimum sedation and rates of sedation-related adverse events. Sedative and analgesic drug use, and ICU and hospital outcomes were also measured.ANALYTIC APPROACH: Multilevel generalised linear regression mixed models will explore the effects of each intervention taking clustering into account, and adjusting for age, gender and APACHE II score. Sedation-analgesia quality outcomes will be explored at ICU level and individual patient level. A process evaluation using mixed methods including quantitative description of intervention implementation, focus groups and direct observation will provide explanatory information regarding any effects observed.CONCLUSIONS: The DESIST study uses a novel design to provide system-level evaluation of three contrasting complex interventions on sedation-analgesia quality. Recruitment is complete and analysis ongoing.TRIAL REGISTRATION NUMBER: NCT01634451.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::24d44b4a98313de24b76b02ba3b6c53fTest
https://doi.org/10.1136/bmjopen-2015-010148Test