scholarly journals A Delphi study to explore and gain consensus regarding the most important barriers and facilitators affecting physiotherapist and pharmacist non-medical prescribing

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246273
Author(s):  
Emma Graham-Clarke ◽  
Alison Rushton ◽  
John Marriott
Keyword(s):  
Content Analysis ◽  
Patient Care ◽  
Delphi Study ◽  
A Priori ◽  
Improve Patient Care ◽  
Importance Rating ◽  
Allied Health Professionals ◽  
Factors Affecting ◽  
The United Kingdom ◽  
Coefficient Of Concordance

Non-medical prescribing was introduced into the United Kingdom to improve patient care, but early research indicated a third of Allied Health Professionals may not use their prescribing qualification. A previous literature review, highlighting factors influencing prescribing, identified only papers with nursing and pharmacy participants. This investigation explored consensus on factors affecting physiotherapist and pharmacist non-medical prescribers. A three round Delphi study was conducted with pharmacist and physiotherapist prescribers. Round One comprised information gathering on facilitators and barriers to prescribing participants had experienced, and underwent content analysis. This was followed by two sequential consensus seeking rounds with participants asked to rate the importance of statements to themselves. Consensus criteria were determined a priori, including median, interquartile range, percentage agreement and Kendall’s Coefficient of Concordance (W). Statements reaching consensus were ranked for importance in Round Three and analysed to produce top ten ranks for all participants and for each professional group. Participants, recruited October 2018, comprised 24 pharmacists and 18 physiotherapists. In Round One, content analysis of 172 statements regarding prescribing influences revealed 24 themes. 127 statements were included in Round Two for importance rating (barriers = 68, facilitators = 59). After Round Two, 29 statements reached consensus (barriers = 1, facilitators = 28), with no further statements reaching consensus following Round Three. The highest ranked statement in Round Three overall was: “Being able to prescribe to patients is more effective and really useful working [in my area]”. Medical support and improved patient care factors appeared the most important. Differences were noted between physiotherapist and pharmacist prescribers regarding the top ten ranked statements, for example team working which pharmacists ranked higher than physiotherapists. Differences may be explained by the variety of practice areas and relative newness of physiotherapy prescribing. Barriers appear to be post or person specific, whereas facilitators appear universal.

Factors affecting arteriovenous fistula dysfunction: A narrative review

2019 ◽  
Vol 21 (2) ◽  
pp. 134-147 ◽  
Author(s):  
Joana Gameiro ◽  
Jose Ibeas
Keyword(s):  
Patient Care ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Improve Patient Care ◽  
Factors Affecting ◽  
Associated Risk Factors ◽  
Care Costs ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation ◽  
Improve Patient

Vascular access dysfunction is one of the most important causes of morbidity and mortality in haemodialysis patients, contributing to up to one third of hospitalisations and accounting for a significant amount of the health care costs of these patients. In the past decades, significant scientific advances in understanding mechanisms of arteriovenous fistula maturation and failure have contributed to an increase in the amount of research into techniques for creation and strategies for arteriovenous fistula dysfunction prevention and treatment, in order to improve patient care and outcomes. The aim of this review is to describe the pathogenesis of vascular access failure and provide a comprehensive analysis of the associated risk factors and causes of vascular access failure, in order to interpret possible future therapeutic approaches. Arteriovenous fistula failure is a multifactorial process resulting from the combination of upstream and downstream events with consequent venous neo-intimal hyperplasia and/or inadequate outward remodelling. Inflammation appears to be central in the biology of arteriovenous fistula dysfunction but important triggers still need to be revealed. Given the significant association of arteriovenous fistula failure and patient’s prognosis, it is therefore imperative to further research in this area in order to improve prevention, surveillance and treatment, and ultimately patient care and outcomes.

scholarly journals Strategies for a Circular Economy in the Construction and Demolition Sector: Identifying the Factors Affecting the Recommendation of Recycled Concrete

2021 ◽  
Vol 13 (8) ◽  
pp. 4113
Author(s):  
Valeria Superti ◽  
Cynthia Houmani ◽  
Ralph Hansmann ◽  
Ivo Baur ◽  
Claudia R. Binder
Keyword(s):  
Circular Economy ◽  
A Priori ◽  
Recycled Concrete ◽  
Recycled Aggregates ◽  
Factors Affecting ◽  
Structural Applications ◽  
Adoption Of Innovation ◽  
Decision Making Processes ◽  
Behavioural Factors ◽  
High Level

With increasing urbanisation, new approaches such as the Circular Economy (CE) are needed to reduce resource consumption. In Switzerland, Construction & Demolition (C&D) waste accounts for the largest portion of waste (84%). Beyond limiting the depletion of primary resources, implementing recycling strategies for C&D waste (such as using recycled aggregates to produce recycled concrete (RC)), can also decrease the amount of landfilled C&D waste. The use of RC still faces adoption barriers. In this research, we examined the factors driving the adoption of recycled products for a CE in the C&D sector by focusing on RC for structural applications. We developed a behavioural framework to understand the determinants of architects’ decisions to recommend RC. We collected and analysed survey data from 727 respondents. The analyses focused on architects’ a priori beliefs about RC, behavioural factors affecting their recommendations of RC, and project-specific contextual factors that might play a role in the recommendation of RC. Our results show that the factors that mainly facilitate the recommendation of RC by architects are: a senior position, a high level of RC knowledge and of the Minergie label, beliefs about the reduced environmental impact of RC, as well as favourable prescriptive social norms expressed by clients and other architects. We emphasise the importance of a holistic theoretical framework in approaching decision-making processes related to the adoption of innovation, and the importance of the agency of each involved actor for a transition towards a circular construction sector.

scholarly journals Using areas of known occupancy to identify sources of variation in detection probability of raptors: taking time lowers replication effort for surveys

2016 ◽  
Vol 3 (10) ◽  
pp. 160368 ◽  
Author(s):  
Campbell Murn ◽  
Graham J. Holloway
Keyword(s):  
Detection Probability ◽  
Spatial Scales ◽  
Survey Methods ◽  
A Priori ◽  
Low Density ◽  
Occupancy Models ◽  
Imperfect Detection ◽  
Factors Affecting ◽  
Sources Of Variation ◽  
Time Of Year

Species occurring at low density can be difficult to detect and if not properly accounted for, imperfect detection will lead to inaccurate estimates of occupancy. Understanding sources of variation in detection probability and how they can be managed is a key part of monitoring. We used sightings data of a low-density and elusive raptor (white-headed vulture Trigonoceps occipitalis ) in areas of known occupancy (breeding territories) in a likelihood-based modelling approach to calculate detection probability and the factors affecting it. Because occupancy was known a priori to be 100%, we fixed the model occupancy parameter to 1.0 and focused on identifying sources of variation in detection probability. Using detection histories from 359 territory visits, we assessed nine covariates in 29 candidate models. The model with the highest support indicated that observer speed during a survey, combined with temporal covariates such as time of year and length of time within a territory, had the highest influence on the detection probability. Averaged detection probability was 0.207 (s.e. 0.033) and based on this the mean number of visits required to determine within 95% confidence that white-headed vultures are absent from a breeding area is 13 (95% CI: 9–20). Topographical and habitat covariates contributed little to the best models and had little effect on detection probability. We highlight that low detection probabilities of some species means that emphasizing habitat covariates could lead to spurious results in occupancy models that do not also incorporate temporal components. While variation in detection probability is complex and influenced by effects at both temporal and spatial scales, temporal covariates can and should be controlled as part of robust survey methods. Our results emphasize the importance of accounting for detection probability in occupancy studies, particularly during presence/absence studies for species such as raptors that are widespread and occur at low densities.

Abstract 11119: Real-Time Nanopore Sequencing for Bacterial Pneumonia After Out-of-Hospital Cardiac Arrest, a Pilot Proof-of-Concept Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alexandra Weissman ◽  
Mariam Bramah Lawani ◽  
Thomas Rohan ◽  
Clifton W CALLAWAY
Keyword(s):  
Patient Care ◽  
Pathogen Detection ◽  
Bacterial Pathogen ◽  
Improve Patient Care ◽  
Antibiotic Administration ◽  
Nanopore Sequencing ◽  
Proof Of Concept ◽  
Chi Square ◽  
Significant Difference ◽  
Improve Patient

Introduction: Pneumonia is common after OHCA but is difficult to diagnose in the first 72 hours following ROSC, this results in early untargeted antibiotic administration based on non-specific imaging and laboratory findings. Antibiotic resistance is rising, is influenced by untargeted antibiotic administration, and can increase patient morbidity and mortality as well as healthcare costs. Precision methods of bacterial pathogen detection in OHCA patients are needed to improve patient care. This proof-of-concept pilot study aimed to assess feasibility of bacterial pathogen sequencing and comparability of sequencing results to clinical culture after OHCA. Methods: Blood and bronchoalveolar lavage (BAL) were obtained from residual clinical specimens collected within 12 hours of ROSC. Bacterial DNA was extracted using the Qiagen PowerLyzer PowerSoil DNA kit, sequenced using the MinION nanopore sequencer, and analyzed with Oxford Nanopore Technologies’ EPI2ME bioinformatics software. Sequencing results were compared to culture results using McNemar’s chi-square statistic. Study-defined pneumonia was based on presence of at least two characteristics within 72 hours of ROSC: fever (temperature ≥38°C); persistent leukocytosis >15,000 or leukopenia <3,500 for 48 hours; persistent chest radiography infiltrates for 48 hours per clinical radiology read; bacterial pathogen cultured. Results: We enrolled 38 consecutive OHCA subjects: mean age 61.8 years (18.0); 16 (42%) female; 25 (66%) White, 7 (18%) Black, 6 (16%) “Other” race; 7 subjects (18%) survived and 31 (82%) died; 16 (42%) subjects had pneumonia. Sequencing results were available in 12 hours while culture results were available in 48-72 hours after collection. There was a non-significant difference in the proportion of the same pathogens identified for each method per McNemar’s chi-square: p = 0.38, difference of 0.095 (-0.095, 0.286). Conclusions: Nanopore sequencing detects pathogenic bacteria comparable to clinical microbiologic culture and in less time. This technology can produce a paradigm shift in early bacterial pathogen detection in OHCA survivors, which can improve patient care. The technology is applicable to other patient populations and for viral and fungal pathogens.

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