scholarly journals 1308 Investigating the Use of a Novel Pre-Hospital Triage Tool for Acute Abdominal Surgical Emergencies – A Two-Phase Single Centre Cohort Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Misbert ◽  
M Hughes ◽  
J Burke ◽  
C Schofield ◽  
A Young
Keyword(s):  
Cohort Study ◽  
Abdominal Pain ◽  
Surgical Intervention ◽  
Phase 1 ◽  
Gastrointestinal Perforation ◽  
Ambulance Service ◽  
Emergency Laparotomy ◽  
Phase 2 ◽  
Single Centre ◽  
Two Phase

Abstract Background Despite the recent improvements in mortality in patients undergoing emergency laparotomy(EL) within the UK, delay to theatre continues to be associated with increased mortality. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting. Method A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020. Results Phase 1: 45 patients were coded through NELA and confirmed through operation note review as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80% (n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED, of which 69 initially treated by the ambulance service. 30% (n = 21) of these patients had an initial NEWS2 of 3 or above. Sensitivity of a NEWS2 score of >/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95% (95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98% (95%CI, 87-99). Conclusions A NEWS2 score of >/3 predicts the need for emergency surgical intervention including laparotomy for gastrointestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.

scholarly journals EP.FRI.753 Investigating the use of a novel pre-hospital triage tool for acute abdominal surgical emergencies – a two-phase single centre cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Emily Misbert ◽  
Michael Hughes ◽  
Joshua Burke ◽  
Claire Schofield ◽  
Alistair Young
Keyword(s):  
Cohort Study ◽  
Abdominal Pain ◽  
Surgical Intervention ◽  
Phase 1 ◽  
Hospital Setting ◽  
Ambulance Service ◽  
Emergency Laparotomy ◽  
Phase 2 ◽  
Single Centre ◽  
Two Phase

Abstract Aims Despite recent improvements, delay to theatre in emergency laparotomy(EL) continues to be associated with increased mortality in the UK. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting. Methods A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020.  Results Phase 1: 45 patients were coded through NELA and confirmed through operation note as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80%(n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED resus of which 69 were initially treated by the ambulance service. 30%(n = 21) of these patients had an initial NEWS2 of 3 or above. The sensitivity of a NEWS2 score of >/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95%(95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98%(95%CI, 87-99).  Conclusion A NEWS2 score of >/3 predicts the need for emergency surgical intervention including laparotomy for gastroinestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.

Endometrial Adenocarcinoma in SurePath™ Cervical Samples: Cytological Features Revisited

2016 ◽  
Vol 60 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Nalini Gupta ◽  
John Crossley ◽  
Nick Dudding ◽  
John H.F. Smith
Keyword(s):  
Phase 1 ◽  
Endometrial Adenocarcinoma ◽  
Nuclear Chromatin ◽  
Phase 2 ◽  
Cervical Lesions ◽  
Two Phase ◽  
Endometrial Cells ◽  
Phase Study ◽  
Cytological Features ◽  
Liquid Based Cytology

Objective: The cytomorphological criteria of malignant endometrial lesions in cervical samples are less well described than those of cervical lesions. We wished to investigate if there were features in SurePath™ liquid-based cytology samples that would facilitate more accurate differentiation between benign and malignant endometrial cells. Study Design: This was a two-phase study, with a review of all SurePath™ samples reported as endometrial adenocarcinoma (n = 42) evaluating 12 cytological features in the first phase. In phase 2 (test set), all initial cases plus an additional 83 cases were reviewed using these 12 cytological features to predict the outcome. Results: Out of 12 cytological features evaluated in phase 1 (training set), nuclear chromatin pattern, apoptotic bodies and tingible body macrophages were found to be the most significant features determining malignant histological outcome. These 12 cytological features were re-evaluated in phase 2 (n = 125). Of 125 cases, 54 had a benign and 71 had a malignant or premalignant histological outcome, with a positive predictive value of 56.8%. Conclusion: Granular nuclear chromatin, tingible body macrophages and apoptosis in the background are the most significant factors in determining whether endometrial cells present in cervical samples represent malignancy or are benign. Using these features, relatively accurate predictions of endometrial pathology can be made.

scholarly journals Developing a realist theory of psychosocial rehabilitation: the Clubhouse model

2021 ◽  
Author(s):  
Christina Mutschler ◽  
Jen Rouse ◽  
Kelly McShane ◽  
Criss Habal-Brosek
Keyword(s):  
Phase 1 ◽  
Psychosocial Rehabilitation ◽  
Theory Development ◽  
Realist Evaluation ◽  
Self Determination ◽  
Phase 2 ◽  
Two Phase ◽  
Realist Theory ◽  
Clubhouse Model ◽  
Two Phases

Background Psychosocial rehabilitation is a service that supports recovery from mental illness by providing opportunities for skill development, self-determination, and social interaction. One type of psychosocial rehabilitation is the Clubhouse model. The purpose of the current project was to create, test, and refine a realist theory of psychosocial rehabilitation at Progress Place, an accredited Clubhouse. Method Realist evaluation is a theory driven evaluation that uncovers contexts, mechanisms, and outcomes, in order to develop a theory as to how a program works. The current study involved two phases, encompassing four steps: Phase 1 included (1) initial theory development and (2) initial theory refinement; and Phase 2 included (3) theory testing and (4) refinement. Results The data from this two-phase approach identified three demi-regularities of recovery comprised of specific mechanisms and outcomes: the Restorative demi-regularity, the Reaffirming demi-regularity, and the Re-engaging demi-regularity. The theory derived from these demi-regularities suggests that there are various mechanisms that produce outcomes of recovery from the psychosocial rehabilitation perspective, and as such, it is necessary that programs promote a multifaceted, holistic perspective on recovery. Conclusions The realist evaluation identified that Progress Place promotes recovery for members. Additional research on the Clubhouse model should be conducted to further validate that the model initiates change and promotes recovery outcomes.

scholarly journals Whole system approaches to health in higher education

2019 ◽  
Vol 119 (4) ◽  
pp. 246-258
Author(s):  
Mark Dooris ◽  
Alan Farrier ◽  
Susan Powell ◽  
Maxine Holt
Keyword(s):  
Higher Education ◽  
Phase 1 ◽  
International Perspective ◽  
Phase 2 ◽  
Structured Interviews ◽  
Two Phase ◽  
Content Type ◽  
Key Issues ◽  
Strategic Influence ◽  
The Uk

Purpose The purpose of this paper is to report on an evaluation of the UK Healthy Universities Network (UKHUN), which explored engagement of network members; identified what members value about the network; examined facilitators and barriers to engagement; and informed the network’s future development. Design/methodology/approach The study was a two phase mixed-method study, with participants being staff from Higher Education institutions. Phase 1 involved a documentary review and an online 14-question survey (n=32). Phase 2 comprised follow-up semi-structured interviews and focus groups, conducted using Skype (n=11). These were audio recorded and transcripts were thematically analysed in a two-stage process. Findings A number of key themes emerged from the thematic analysis: value of network meetings and events; popularity of the network website; increased communication and collaboration; sense of leadership offered by the network; interest and inclusion of an international perspective; importance of institutional support. Research limitations/implications Only six universities who are involved in the network took part in Phase 2. Although a range of organisations were chosen purposively, it is possible that additional key issues at other universities were excluded. Originality/value The UKHUN is valued by its membership, particularly its biannual meetings, online presence, leadership, ethos and communication methods. Key barriers include the capacity of staff to attend meetings and contribute to the network, influenced by a lack of institutional commitment and prioritisation. Findings from the evaluation have informed a “refresh” of the network’s website and a revision of its membership structure, as well as guiding its positioning to achieve greater strategic influence.

A computationally fast approach to maximum‐likelihood deconvolution

Geophysics ◽  
1984 ◽  
Vol 49 (5) ◽  
pp. 550-565 ◽  
Author(s):  
Chong‐Yung Chi ◽  
Jerry M. Mendel ◽  
Dan Hampson
Keyword(s):  
Maximum Likelihood ◽  
Initial Conditions ◽  
Phase 1 ◽  
Real Data ◽  
Phase 2 ◽  
Statistical Parameters ◽  
Two Phase ◽  
Nonminimum Phase ◽  
Fast Approach ◽  
Fine Adjustment

In this paper we derive and implement a maximum‐likelihood deconvolution (MLD) algorithm, based on the same channel and statistical models used by Kormylo and Mendel (1983a), that leads to many fewer computations than their MLD algorithm. Both algorithms can simultaneously estimate a nonminimum phase wavelet and statistical parameters, detect locations of significant reflectors, and deconvolve the data. Our MLD algorithm is implemented by a two‐phase block component method (BCM). The phase‐1 block functions like a coarse adjustment of unknown quantities and provides a set of good initial conditions for the phase‐2 block, which functions like a fine adjustment of unknown quantities. We demonstrate good performance of our algorithm for both synthetic and real data.

scholarly journals Early Diagnostic Marker Panel Determination for Microarray Based Clinical Studies

2005 ◽  
Vol 4 (1) ◽  
Author(s):  
Jochen Jaeger ◽  
Dieter Weichenhan ◽  
Boris Ivandic ◽  
Rainer Spang
Keyword(s):  
Phase 1 ◽  
Classification Model ◽  
Marker Genes ◽  
Phase 2 ◽  
Two Phase ◽  
Marker Panel ◽  
Performance Loss ◽  
Genome Wide ◽  
Number Of Patients ◽  
Cost Efficient

We present a novel, cost efficient two-phase design for predictive clinical gene expression studies: early marker panel determination (EMPD). In Phase-1, genome-wide microarrays are used only for a small number of individual patient samples. From this Phase-1 data a panel of marker genes is derived. In Phase-2, the expression values of these marker panel genes are measured for a large group of patients and a predictive classification model is learned from this data. Phase-2 does not require the use of expensive whole genome microarrays, thus making EMPD a cost efficient alternative for current trials. The expected performance loss of EMPD is compared to designs which use genome-wide microarrays for all patients. We also examine the trade-off between the number of patients included in Phase-1 and the number of marker genes required in Phase-2. By analysis of five published datasets we find that in Phase-1 already 16 patients per group are sufficient to determine a suitable marker panel of 10 genes, and that this early decision compromises the final performance only marginally.

scholarly journals Stem cell factor amplifies newborn and sickle erythropoiesis in liquid cultures

Blood ◽  
1993 ◽  
Vol 81 (10) ◽  
pp. 2591-2599 ◽  
Author(s):  
RS Weinberg ◽  
JC Thomson ◽  
R Lao ◽  
G Chen ◽  
BP Alter
Keyword(s):  
Stem Cell ◽  
Progenitor Cells ◽  
Stem Cell Factor ◽  
Mononuclear Cells ◽  
Phase 1 ◽  
Newborn Infants ◽  
Cell Number ◽  
Phase 2 ◽  
Two Phase ◽  
Erythroid Progenitor

A two-phase liquid-culture system was used to substantially amplify and differentiate erythroblasts, starting with mononuclear cells from the blood of normal adults, newborn infants, and patients with sickle cell anemia. After the first 7 days (phase 1), in medium plus fetal bovine serum (FBS) alone, or in combination with stem cell factor (SCF) or conditioned medium (CM), the cell number was unchanged, and the cells all looked like lymphocytes. These cells were then diluted into medium with erythropoietin (Ep) alone, with Ep and either SCF or CM, or in methylcellulose with the same factors (phase 2). After 14 days in liquid phase 2 with SCF and Ep, the cell numbers increased an average of 30-fold in the sickle, 24-fold in the newborn, and 4-fold in the normal adult cultures; almost all the cells were erythroblasts and erythrocytes. SCF in phase 1 increased the number of late progenitors (CFU-E) assayed in methylcellulose, with the largest number in sickle, followed by newborn cultures and then adult cultures. We conclude that erythroid progenitor cells survive for at least 7 days without Ep (but with FBS). Progenitor cells are amplified, particularly with SCF. Later in culture, SCF with Ep increases the final number of differentiated erythroid cells. Both the early and the late effects of SCF are most effective in sickle, followed by newborn cultures and then adult cultures.

scholarly journals Enhancing Label Representations with Relational Inductive Bias Constraint for Fine-Grained Entity Typing

2021 ◽  
Author(s):  
Jinqing Li ◽  
Xiaojun Chen ◽  
Dakui Wang ◽  
Yuwei Li
Keyword(s):  
State Of The Art ◽  
Phase 1 ◽  
Phase 2 ◽  
Two Phase ◽  
Inductive Bias ◽  
Fine Grained ◽  
Wide Range ◽  
Dynamic Experiments ◽  
Novel Method ◽  
Public Datasets

Fine-Grained Entity Typing (FGET) is a task that aims at classifying an entity mention into a wide range of entity label types. Recent researches improve the task performance by imposing the label-relational inductive bias based on the hierarchy of labels or label co-occurrence graph. However, they usually overlook explicit interactions between instances and labels which may limit the capability of label representations. Therefore, we propose a novel method based on a two-phase graph network for the FGET task to enhance the label representations, via imposing the relational inductive biases of instance-to-label and label-to-label. In the phase 1, instance features will be introduced into label representations to make the label representations more representative. In the phase 2, interactions of labels will capture dependency relationships among them thus make label representations more smooth. During prediction, we introduce a pseudo-label generator for the construction of the two-phase graph. The input instances differ from batch to batch so that the label representations are dynamic. Experiments on three public datasets verify the effectiveness and stability of our proposed method and achieve state-of-the-art results on their testing sets.

P008: Hereditary Angioedema Rapid Triage Tool (HAE-RT): translating clinical research into clinical practice

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S59-S59
Author(s):  
S. Betschel ◽  
E. Avilla ◽  
S. Waserman ◽  
J. Badiou ◽  
K. Binkley ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Hereditary Angioedema ◽  
Delphi Study ◽  
Phase 1 ◽  
Stakeholder Involvement ◽  
Retrospective Chart Review ◽  
Recurrent Abdominal Pain ◽  
Predictor Variables ◽  
Two Phase ◽  
Presenting Symptoms

Introduction: Hereditary angioedema (HAE) patients (both diagnosed and undiagnosed) commonly present to the emergency department (ED). Presenting symptoms (swelling and pain) may be erroneously attributed to common allergic and gastrointestinal conditions resulting in major delays in diagnosis and appropriate treatment. No published tools currently exist for HAE screening and management in undiagnosed disease. The overall goal of the study was to develop a HAE-RT tool for ED settings. Methods: A two-phase mixed methods approach was used to develop the HAE-RT Tool including: Phase 1: A Delphi Study [HAE specialists (N=9) and National Patient Advocacy Group Members (N=3)] was conducted to reach consensus (80% agreement) on predictor variables to include. Phase 2: A retrospective chart review was conducted to assess the predictive findings of the predictor variables. A convenient sample of patients presenting with angioedema (with and without HAE) between January 2012 January 2017 were included in the study. Results: Of the 12 experts invited, 9 (75%) participated in the Delphi study. Of 8 HAE-specific predictive variables, 4 reached consensuses including: (1) recurrent angioedema; (2) absence of urticaria; (3) past recurrent abdominal pain/swelling; (4) response to allergic therapy. The retrospective study included 85 patients (N=46 with HAE; N=39 non-HAE; overall 72% female). HAE patients were significantly more likely to have a family history of HAE (72% vs 0%; P<0.0001); previous recurrent angioedema (96%; P<0.009); present with no hives (91%; P<0.036); previous recurrent abdominal pain (80%; P<0.0001); and only 2% responded positively to allergy treatments (P<0.0001). Conclusion: Our study emphasizes the importance of key stakeholder involvement and feedback to facilitate the prioritization of important information that must be included in the design of an HAE-RT tool. The next step is to observe the effect of the HAE-RT tool on patient triage in the ED.

Sample study protocol for adapting and/or translating the 5C scale to assess the psychological antecedents of vaccination

2019 ◽  
Author(s):  
Cornelia Betsch ◽  
Katrine Habersaat ◽  
Sergei Deshevoi ◽  
Dorothee K. Heinemeier ◽  
Natalia Kostenko ◽  
...  
Keyword(s):  
Study Protocol ◽  
Cultural Context ◽  
Phase 1 ◽  
Collective Responsibility ◽  
Phase 2 ◽  
Two Phase ◽  
Cultural Setting ◽  
Original Group ◽  
Vaccination Confidence ◽  
Item Scale

Background: Published in 2018, the 5C scale is psychometrically validated to assess five psychological antecedents of vaccination (confidence, complacency, constraints, calculation, and collective responsibility). The original version offers a validated English and German scale to assess these determinants with a short 5-item scale (1 item per antecedent) and a long 15-item scale (3-items per antecedent). As the original group of authors has received several requests about how to adapt the scale to another country, language, or cultural context, this sample study protocol provides guidance for this process. Here, we propose a two-phase process of how to adapt the 5C scale to a new country, language, or cultural setting. Methods: Phase 1 comprises the translation and the adaptation to a specific cultural context (if necessary). Phase 2 involves the validation of the translated and potentially expanded scale. Discussion: Following the suggested study protocol will allow better comparability across the data obtained from the scale when used in different countries, languages, and contexts—even if slight changes in the wording of the items are necessary. The data obtained from the 5C scale allows monitoring the antecedents of vaccination, and detecting potentially early warning signals. Consequently, data obtained from the 5C scale can support developing, implementing, and evaluating an intervention. The materials and the syntax for data analysis to support the process described in this protocol are available in https://osf.io/2agxe/.

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