The quality of staff-patient interactions underpins the overall quality of patient experience and can affect other important outcomes. However no studies have been identified that comprehensively ...explore both the quality and quantity of interactions in general hospital settings.
To quantify and characterise the quality of staff-patient interactions and to identify factors associated with negative interaction ratings.
Data were gathered at two acute English NHS hospitals between March and April 2015. Six wards for adult patients participated including medicine for older people (n=4), urology (n=1) and orthopaedics (n=1).
Eligible patients on participating wards were randomly selected for observation. Staff-patient interactions were observed using the Quality of Interactions Schedule. 120h of care were observed with each 2h observation session determined from a balanced random schedule (Monday-Friday, 08:00-22:00h). Multilevel logistic regression models were used to determine factors associated with negative interactions.
1554 interactions involving 133 patients were observed. The median length of interaction was 36s with a mean of 6 interactions per patient per hour. Seventy three percent of interactions were categorized as positive, 17% neutral and 10% negative. Forty percent of patients had at least one negative interaction (95% confidence interval 32% to 49%). Interactions initiated by the patient (adjusted Odds Ratio OR 5.30), one way communication (adjusted OR 10.70), involving two or more staff (adjusted OR 5.86 for 2 staff, 6.46 for 3+ staff), having a higher total number of interactions (adjusted OR 1.09 per unit increase), and specific types of interaction content were associated with increased odds of negative interaction (p<0.05). In the full multivariable model there was no significant association with staff characteristics, skill mix or staffing levels. Patient agitation at the outset of interaction was associated with increased odds of negative interaction in a reduced model. There was no significant association with gender, age or cognitive impairment. There was substantially more variation at ward level (variance component 1.76) and observation session level (3.49) than at patient level (0.09).
These findings present a unique insight into the quality and quantity of staff-patient interactions in acute care. While a high proportion of interactions were positive, findings indicate that there is scope for improvement. Future research should focus on further exploring factors associated with negative interactions, such as workload and ward culture.
Glucocorticoids, also known as steroids, are a class of anti-inflammatory drugs utilised widely in clinical practice for a variety of conditions. They are associated with a range of side effects ...including abnormalities of glucose metabolism. Multiple guidelines have been published to illustrate best management of glucocorticoid-induced hyperglycaemia and diabetes in a variety of settings. This article discusses current best clinical practice including diagnosis, investigations and ongoing management of glucocorticoid-induced dysglycaemia in both in- and outpatient settings.
In ophthalmology, optical coherence tomography (OCT) is a widely used imaging modality, allowing visualisation of the structures of the eye with objective and quantitative cross-sectional ...three-dimensional (3D) volumetric scans. Due to the quantity of data generated from OCT scans and the time taken for an ophthalmologist to inspect for various disease pathology features, automated image analysis in the form of deep neural networks has seen success for the classification and segmentation of OCT layers and quantification of features. However, existing high-performance deep learning approaches rely on huge training datasets with high-quality annotations, which are challenging to obtain in many clinical applications. The collection of annotations from less experienced clinicians has the potential to alleviate time constraints from more senior clinicians, allowing faster data collection of medical image annotations; however, with less experience, there is the possibility of reduced annotation quality. In this study, we evaluate the quality of diabetic macular edema (DME) intraretinal fluid (IRF) biomarker image annotations on OCT B-scans from five clinicians with a range of experience. We also assess the effectiveness of annotating across multiple sessions following a training session led by an expert clinician. Our investigation shows a notable variance in annotation performance, with a correlation that depends on the clinician’s experience with OCT image interpretation of DME, and that having multiple annotation sessions has a limited effect on the annotation quality.
The outbreak of COVID-19 has brought renewed attention to past narratives of disease outbreaks. What do the Black Death and COVID-19 have in common? How we tell outbreak stories is shaped by ...political, cultural, social, and historical contexts. It is deeply rhetorical. The general public relies on experts (scientists, historians, and government officials) to provide credible information, but uncertainties during an outbreak can make it difficult to provide definitive answers quickly. Experts need to be conscious about the contexts in which their statements would be received. Regarding the Black Death, historians of medicine have relied heavily on a single medieval account of the outbreak, which confirmed their preconceptions about Mongol violence, allowing them to present the Black Death as an instance of biological warfare. Looking at other medieval accounts, however, makes clear that this narrative of Mongol biological warfare is false. Similarly, modern outbreak narratives also tend to use militarized language, which results in othering peoples and cultures where a disease might have originated. Given the contemporary political tensions between China and the United States, narratives about the origin of the SARS-CoV-2 virus and its transmission have led to a transnational infodemic of misinformation as well as discrimination and violence against people of Asian descent. In light of this long-running pattern, we argue for more interdisciplinary collaborations between the experts whose work is used to build outbreak narratives to adopt more critical rhetorical approaches in communicating with the public.
Aim
To cross‐culturally adapt and determine the preliminary psychometric properties of the English version of the LwLTC Scale in people living with long‐term conditions in the UK.
Design
...Cross‐cultural adaptation and cross‐sectional study.
Methods
Forty‐nine patients with five long‐term conditions were included in the pilot study. Patients completed the English version of the LwLTC Scale and a bespoke questionnaire related to the scale. Feasibility/acceptability, internal consistency and construct validity were analysed.
Results
59.2% of participants were female, with an average age of 65.9 (SD = 12.30). Cronbach's alpha coefficient ranged between 0.50 and 0.84. Content validity showed that the English version of the LwLTC Scale was useful even negative items were identified.
Conclusion
These preliminary psychometric properties are satisfactory and promising. Further psychometric analyses are needed to verify them in a larger and more representative sample size during the main validation study, which is now in process.
The Black Sea Slave Trade Weiss, Gillian
The American historical review,
06/2023, Letnik:
128, Številka:
2
Journal Article
Recenzirano
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
19.
The Risk of Birth Barker, Hannah
Journal of global slavery,
06/2021, Letnik:
6, Številka:
2
Journal Article
Recenzirano
Abstract
Why did fifteenth-century Genoese slaveholders insure the lives of enslaved pregnant women? I argue that their assessment of the risks associated with childbirth reflected their views on the ...connection between slavery, property, and lineage. Genoese slaveholders saw the reproductive labor of enslaved women as a potential contribution to their lineage as well as their property. Because their children by enslaved women might become their heirs, Genoese slaveholders were inclined to worry about and seek protection against the risk of maternal mortality. In the context of the commercial revolution and the rise of third-party insurance, they developed life insurance for enslaved pregnant women to complement the fines already required of those who illegally impregnated enslaved women and thereby endangered their lives.
Barker focuses on global economic inequality and health. Inequalities can occur both between and within countries and can affect a large variety of population groups. Inequalities in health can lead ...to losses in productivity and tax payments as well as leading to higher welfare payments and healthcare costs and therefore can be costly to societies. The impact to the individual is also costly as diseases of poverty, such as tuberculosis, make it difficult for individuals to improve their personal economic condition in addition to the impact upon their health related quality of life. To truly address health inequity across the globe, a health in all policy approach should be utilized and there is a moral imperative for global actors and nation states to work towards health, not only within nations, but also globally.
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