OXYGEN MANAGEMENT IN NEW ZEALAND AND AUSTRALIAN INTENSIVE CARE UNITS: A KNOWLEDGE TRANSLATION STUDY

<p><b>Background: Knowledge translation literature shows a delay between publication and uptake of research findings into clinical practice. There is uncertainty about whether this delay exists in the intensive care unit (ICU) context and whether participation in research influences changes in clinical practice. Knowing whether ICU participation in research increases the likelihood of research findings being incorporated into clinical care is important to funders, researchers and patients.</b></p> <p>Aim: To investigate the effects of participating in the Intensive Care Unit Randomised Trial Comparing Two Approaches to Oxygen therapy (ICU-ROX) randomised controlled trial on attitudes and practices in relation to ICU oxygen therapy.</p> <p>Methods: The research question was examined using three different methods: a survey, an inception cohort study, and a retrospective cohort study. The practitioner attitudes survey and inception cohort study were conducted before ICU-ROX started, after ICU-ROX finished but before the results were known, and, finally, after publication of the ICU-ROX results. The retrospective cohort study (using the Australian and New Zealand ICU adult patient database) compared data from 48 weeks before and 48 weeks after publication of the ICU-ROX trial.</p> <p>Results: Practitioner attitudes survey: Responses were received from 112 specialist doctors and 153 ICU nurses from 11 ICU-ROX and 11 non-ICU-ROX sites. Before the ICU-ROX trial was conducted, respondents from ICU-ROX trial sites and those from non-ICU-ROX trial sites were similarly likely to indicate they would use a fraction of inspired oxygen (FIO2) of 0.21, in a ventilated patient with peripheral oxygen saturations (SpO2) of 91-96%. However, after participation in the ICU-ROX trial, and before the trial results were known, ICU-ROX trial site respondents were significantly more likely than their non-ICU-ROX trial site counterparts to state they would use an FIO2 of 0.21 in a patient with an SpO2 of 91-96%. The differences in all patient admission categories, except the ‘other ICU patients’ category, persisted after the ICU-ROX trial was published. Nurses were generally less likely to report they would use an FIO2 of 0.21 in a ventilated patient than doctors. Following ICU-ROX publication, 41.1% of the doctors compared to 13.6% of the nurses knew the ICU-ROX results (P<0.001), and 53.1% and 5.4%, respectively, reported having read the publication (P<0.001).</p> <p>Inception cohort study: Data were analysed from 650 patients from 11 ICU-ROX and 11 non-ICU-ROX sites. ICU-ROX site patients spent 8.2% of the time ventilated at FIO2 of 0.21, before ICU-ROX started, 7.7% after their participation in the ICU-ROX trial and 7.1% of the time after ICU-ROX publication, a change over time was not statistically significant. For the non-ICU-ROX site patients, time spent ventilated at FIO2 of 0.21 was 0.9% before ICU-ROX, 2.4% after ICU-ROX was conducted and 3.3% after publication. This change for non-ICU-ROX site patients after ICU-ROX publication was statistically significant (relative rate 3.63; 95% CI 1.39 to 9.47, P=0.01).</p> <p>Retrospective cohort study: The FIO2 from the arterial blood gas associated with the worst Acute Physiology and Chronic Health Evaluation III-J score in the first 24 hours of admission to ICU was analysed for 51,498 pre-publication admissions and 47,523 post-publication admissions from 15 ICU-ROX sites and 188 non-ICU-ROX sites. Although the average FIO2 values varied considerably from week to week, there was a statistically significant reduction in the average FIO2 over time in ICU-ROX sites (P=0.01) but not in non-ICU-ROX sites (P=0.49).</p> <p>Conclusion: Differences between attitudes of practitioners in relation to oxygen in ICU-ROX sites compared with non-ICU-ROX sites changed over time (before and after the ICU-ROX trial, and after publication of the results). Differences in oxygen therapy practice changes for ICU-ROX versus non-ICU-ROX sites shown in the inception cohort study and retrospective cohort study were small, and are unlikely to be clinically important. These studies did not demonstrate a consistent effect of participation in ICU-ROX on knowledge translation.</p>

Oxygen management in New Zealand and Australian intensive care units: A knowledge translation study

<p><b>Background: Knowledge translation literature shows a delay between publication and uptake of research findings into clinical practice. There is uncertainty about whether this delay exists in the intensive care unit (ICU) context and whether participation in research influences changes in clinical practice. Knowing whether ICU participation in research increases the likelihood of research findings being incorporated into clinical care is important to funders, researchers and patients.</b></p> <p>Aim: To investigate the effects of participating in the Intensive Care Unit Randomised Trial Comparing Two Approaches to Oxygen therapy (ICU-ROX) randomised controlled trial on attitudes and practices in relation to ICU oxygen therapy.</p> <p>Methods: The research question was examined using three different methods: a survey, an inception cohort study, and a retrospective cohort study. The practitioner attitudes survey and inception cohort study were conducted before ICU-ROX started, after ICU-ROX finished but before the results were known, and, finally, after publication of the ICU-ROX results. The retrospective cohort study (using the Australian and New Zealand ICU adult patient database) compared data from 48 weeks before and 48 weeks after publication of the ICU-ROX trial.</p> <p>Results: Practitioner attitudes survey: Responses were received from 112 specialist doctors and 153 ICU nurses from 11 ICU-ROX and 11 non-ICU-ROX sites. Before the ICU-ROX trial was conducted, respondents from ICU-ROX trial sites and those from non-ICU-ROX trial sites were similarly likely to indicate they would use a fraction of inspired oxygen (FIO2) of 0.21, in a ventilated patient with peripheral oxygen saturations (SpO2) of 91-96%. However, after participation in the ICU-ROX trial, and before the trial results were known, ICU-ROX trial site respondents were significantly more likely than their non-ICU-ROX trial site counterparts to state they would use an FIO2 of 0.21 in a patient with an SpO2 of 91-96%. The differences in all patient admission categories, except the ‘other ICU patients’ category, persisted after the ICU-ROX trial was published. Nurses were generally less likely to report they would use an FIO2 of 0.21 in a ventilated patient than doctors. Following ICU-ROX publication, 41.1% of the doctors compared to 13.6% of the nurses knew the ICU-ROX results (P<0.001), and 53.1% and 5.4%, respectively, reported having read the publication (P<0.001).</p> <p>Inception cohort study: Data were analysed from 650 patients from 11 ICU-ROX and 11 non-ICU-ROX sites. ICU-ROX site patients spent 8.2% of the time ventilated at FIO2 of 0.21, before ICU-ROX started, 7.7% after their participation in the ICU-ROX trial and 7.1% of the time after ICU-ROX publication, a change over time was not statistically significant. For the non-ICU-ROX site patients, time spent ventilated at FIO2 of 0.21 was 0.9% before ICU-ROX, 2.4% after ICU-ROX was conducted and 3.3% after publication. This change for non-ICU-ROX site patients after ICU-ROX publication was statistically significant (relative rate 3.63; 95% CI 1.39 to 9.47, P=0.01).</p> <p>Retrospective cohort study: The FIO2 from the arterial blood gas associated with the worst Acute Physiology and Chronic Health Evaluation III-J score in the first 24 hours of admission to ICU was analysed for 51,498 pre-publication admissions and 47,523 post-publication admissions from 15 ICU-ROX sites and 188 non-ICU-ROX sites. Although the average FIO2 values varied considerably from week to week, there was a statistically significant reduction in the average FIO2 over time in ICU-ROX sites (P=0.01) but not in non-ICU-ROX sites (P=0.49).</p> <p>Conclusion: Differences between attitudes of practitioners in relation to oxygen in ICU-ROX sites compared with non-ICU-ROX sites changed over time (before and after the ICU-ROX trial, and after publication of the results). Differences in oxygen therapy practice changes for ICU-ROX versus non-ICU-ROX sites shown in the inception cohort study and retrospective cohort study were small, and are unlikely to be clinically important. These studies did not demonstrate a consistent effect of participation in ICU-ROX on knowledge translation.</p>

Oxygen management in New Zealand and Australian intensive care units: A knowledge translation study

<p><b>Background: Knowledge translation literature shows a delay between publication and uptake of research findings into clinical practice. There is uncertainty about whether this delay exists in the intensive care unit (ICU) context and whether participation in research influences changes in clinical practice. Knowing whether ICU participation in research increases the likelihood of research findings being incorporated into clinical care is important to funders, researchers and patients.</b></p> <p>Aim: To investigate the effects of participating in the Intensive Care Unit Randomised Trial Comparing Two Approaches to Oxygen therapy (ICU-ROX) randomised controlled trial on attitudes and practices in relation to ICU oxygen therapy.</p> <p>Methods: The research question was examined using three different methods: a survey, an inception cohort study, and a retrospective cohort study. The practitioner attitudes survey and inception cohort study were conducted before ICU-ROX started, after ICU-ROX finished but before the results were known, and, finally, after publication of the ICU-ROX results. The retrospective cohort study (using the Australian and New Zealand ICU adult patient database) compared data from 48 weeks before and 48 weeks after publication of the ICU-ROX trial.</p> <p>Results: Practitioner attitudes survey: Responses were received from 112 specialist doctors and 153 ICU nurses from 11 ICU-ROX and 11 non-ICU-ROX sites. Before the ICU-ROX trial was conducted, respondents from ICU-ROX trial sites and those from non-ICU-ROX trial sites were similarly likely to indicate they would use a fraction of inspired oxygen (FIO2) of 0.21, in a ventilated patient with peripheral oxygen saturations (SpO2) of 91-96%. However, after participation in the ICU-ROX trial, and before the trial results were known, ICU-ROX trial site respondents were significantly more likely than their non-ICU-ROX trial site counterparts to state they would use an FIO2 of 0.21 in a patient with an SpO2 of 91-96%. The differences in all patient admission categories, except the ‘other ICU patients’ category, persisted after the ICU-ROX trial was published. Nurses were generally less likely to report they would use an FIO2 of 0.21 in a ventilated patient than doctors. Following ICU-ROX publication, 41.1% of the doctors compared to 13.6% of the nurses knew the ICU-ROX results (P<0.001), and 53.1% and 5.4%, respectively, reported having read the publication (P<0.001).</p> <p>Inception cohort study: Data were analysed from 650 patients from 11 ICU-ROX and 11 non-ICU-ROX sites. ICU-ROX site patients spent 8.2% of the time ventilated at FIO2 of 0.21, before ICU-ROX started, 7.7% after their participation in the ICU-ROX trial and 7.1% of the time after ICU-ROX publication, a change over time was not statistically significant. For the non-ICU-ROX site patients, time spent ventilated at FIO2 of 0.21 was 0.9% before ICU-ROX, 2.4% after ICU-ROX was conducted and 3.3% after publication. This change for non-ICU-ROX site patients after ICU-ROX publication was statistically significant (relative rate 3.63; 95% CI 1.39 to 9.47, P=0.01).</p> <p>Retrospective cohort study: The FIO2 from the arterial blood gas associated with the worst Acute Physiology and Chronic Health Evaluation III-J score in the first 24 hours of admission to ICU was analysed for 51,498 pre-publication admissions and 47,523 post-publication admissions from 15 ICU-ROX sites and 188 non-ICU-ROX sites. Although the average FIO2 values varied considerably from week to week, there was a statistically significant reduction in the average FIO2 over time in ICU-ROX sites (P=0.01) but not in non-ICU-ROX sites (P=0.49).</p> <p>Conclusion: Differences between attitudes of practitioners in relation to oxygen in ICU-ROX sites compared with non-ICU-ROX sites changed over time (before and after the ICU-ROX trial, and after publication of the results). Differences in oxygen therapy practice changes for ICU-ROX versus non-ICU-ROX sites shown in the inception cohort study and retrospective cohort study were small, and are unlikely to be clinically important. These studies did not demonstrate a consistent effect of participation in ICU-ROX on knowledge translation.</p>

The Totalising Nature of Secure and Forensic Mental Health Services in England and Wales

This evidence-based opinion piece explores the totalising risk averse nature of secure and forensic mental health services and associated iatrogenic harms in England and Wales. Drawing on the research literature I consider the various influences, both external and internal which impact on the provision of such services and how both the therapeutic alliance and recovery potential for patients may be improved. Especial attention is paid to the deployment of restrictive practise, practitioner attitudes, the potential for non-thinking, and how these may impact on decision-making and the care and treatment of mentally disordered offenders.

Is co-production working well in recovery colleges? Emergent themes from a systematic narrative review

Purpose “Co-production” is a process in health and social care wherein service users and practitioners work in partnership. Recovery colleges (RCs) are educational establishments offering mental health education; a cornerstone feature is that courses are designed and delivered in parity by both mental health practitioners and “peers” – people with lived experience of mental illness. This paper aims to consider, through the identification of key themes, whether co-production within RCs is operating successfully. Design/methodology/approach The paper is a systematic review of qualitative literature. Relevant concept groups were systematically searched using three bibliographic databases: Medline, Social Care Online and Scopus. Articles were quality appraised and then synthesised through inductive thematic analysis and emergent trends identified. Findings Synthesis identified three key themes relating to the impact of co-production in RCs: practitioner attitudes, power dynamics between practitioners and service users, and RCs’ relationships with their host organisations. As a result of RC engagement, traditional practitioner/patient hierarchies were found to be eroding. Practitioners felt they were more person-centred. RCs can model good co-productive practices to their host organisations. The review concluded, with some caveats, that RC co-production was of high fidelity. Originality/value RC research is growing, but the body of evidence remains relatively small. Most of what exists examine the impact of RCs on individuals’ overall recovery and mental health; there is a limited empirical investigation into whether their flagship feature of parity between peers and practitioners is genuine.

General practitioner and nurse practitioner attitudes towards electronic reminders in primary care: a qualitative analysis

ObjectivesReminders in primary care administrative systems aim to help clinicians provide evidence-based care, prescribe safely and save money. However, increased use of reminders can lead to alert fatigue. Our study aimed to assess general practitioners’ (GPs) and nurse practitioners’ (NPs) views on electronic reminders in primary care.DesignA qualitative analysis using semistructured interviews.Setting and participantsFifteen GPs and NP based in general practices located in North-West London and Yorkshire, England.MethodsWe collected data on participants’ views on: (1) perceptions of the value of information provided; (2) reminder-related behaviours and (3) how to improve reminders. We carried out a thematic analysis.ResultsParticipants were familiar with reminders in their clinical systems and felt many were important to support their clinical work. However, participants reported, on average, 70% of reminders were ignored. Four major themes emerged: (1) reaction to a reminder, which was mixed and varied by situation. (2) Factors influencing the decision to act on reminders, often related to experience, consultation styles and interests of participants. Time constraints, alert design, inappropriate presentation and litigation were also factors. (3) Negative consequences of using reminders were increased workload or costs and compromising GP and NPs behaviour. (4) Factors relating to improving users’ engagement with reminders were prevention of unnecessary reminders through data linkage across healthcare administrative systems or the development of more intelligent algorithms. Participants felt training was vital to effectively manage reminders.ConclusionsGPs and NPs believe reminders are useful in supporting the provision of good quality patient care. Improving GPs and NPs’ engagement with reminders centres on further developing their relevance to their clinical practice, which is personalised, considers cognitive workflow and suppresses inappropriate presentation.