429 research outputs found
Experiences and views of patients, carers and healthcare professionals on using modems in domiciliary non-invasive ventilation (NIV): a qualitative study
BACKGROUND: Advances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients' homes. Possible benefits and challenges of modem technology have yet to be established. This study explored the perspectives and experiences of patients, their carers and healthcare professionals (HCPs) on the addition of modem technology in managing home NIV. METHODS: A qualitative study using a combination of focus groups for HCPs and interviews for carers/patients was undertaken. 12 HCPs and 22 patients/carers participated. These focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Five main themes were identified. 'Surveillance: a paradox of findings': HCPs were concerned about unduly scrutinising patients' lives, potentially impacting on HCP patient relationships. Conversely, patients welcomed modem monitoring and did not express concerns regarding invasion of privacy. 'Sanctions': HCPs reported the modem increased access to care and allowed appropriate assessment of ongoing treatment. 'Complacency and ethics': HCPs expressed concerns patients may become complacent in seeking help due to expectations of modem monitoring, as well as being concerned regarding the ethics of modems. There was a suggestion patients and carers' expectations of monitoring were different to that of clinical practice, resulting in complacency in some cases. 'Increased time for patient focused care': HCPs in the focus groups described a number of ways in which using modems was more efficient. 'Confidence: can be improved with technology': patients and carers were positive about the impact of the modems on their health and well-being, particularly their confidence. CONCLUSION: HCPs expressed concerns about surveillance were not corroborated by patients, suggesting acceptability of remote monitoring. Data suggests a need for increased clarity to patients/carers regarding clinical practice relating to responsiveness to modem data. The issue of complacency requires further consideration. Modem technology was acceptable and considered a useful addition by HCPs, patients and carers. TRIAL REGISTRATION NUMBER: NCT03905382
Clinical impact of customised positive airway pressure (PAP) therapy interfaces versus usual care in the treatment of patients with sleep-disordered breathing (3DPiPPIn): a randomised controlled trial protocol
STRENGTHS AND LIMITATIONS OF THIS STUDY:
â The randomised control trial design enhances the reliability of findings by reducing selection bias.
â Block randomisation minimised by age and ethnicity ensures a balanced representation of these vari- ables, which are most likely to affect facial geom- etries across treatment groups.
â The well-defined target population ensures that results will apply to patients with sleep-disordered breathing.
â The lack of blinding and the single-site design could introduce bias in assessing outcomes.
â It has not been possible to include a health econom- ics assessment due to the constraints of funding.Confidentiality:
All data will be handled in accordance with the General Data Protection Regulation V.2018. Data collected will be password protected and only accessible by the research team.Introduction: Sleep-disordered breathing affects 1.6âmillion people in the UK. The recognised treatment is positive airway pressure (PAP) therapy, delivered via a generic conventional interface (mask). PAP therapy improves morbidity, mortality and quality of life, but treatment effectiveness depends on interface fit and tolerance. Interface side effects include pressure ulcers, skin reactions and interface leak. Three-dimensional (3D) printing is an innovative technology that can produce customised interfaces.
Aims: The primary aim is to assess the impact of customised versus conventional interfaces on residual Apnoea Hypopnea Index at 6âmonths.
Methods and analysis: This is a randomised control trial via block randomisation, minimised by age >65âand ethnicity, using a computerised random number generator. Patients with sleep-disordered breathing under the care of the Royal Free London NHS Foundation Trust will be recruited. Patients new to therapy will be randomised to customised interface or conventional interface for 6âmonths. A sample size of 160 is required for 80% power with a significance of 5%, accounting for a 20% dropout rate. Descriptive statistics will report demographics. The primary and secondary outcomes will be compared using linear regression adjusted for baseline score.
Ethics and dissemination: This protocol has been approved by the Hampshire B Research Ethics Committee (REC reference: 22/SC/0405). Results will be disseminated to healthcare professionals and patients through conferences, open-access journals, newsletters, a study webpage, infographics, animations, social media and healthcare awards.
ISRCTN registration number: 74082423.The authors would like to acknowledge the support of the Associate Principal Investigators via the NIHR Associate Principal Investigator Scheme: Lynne McDonnell and Nneoma Okoli. The authors would like to acknowledge the support of the clinical trials administrators (Sharon Augustt and Sint Sint) and Research Portfolio Manager (Tolu Williams) at the Royal Free London NHS Foundation Trust
The State-Moro Armed Conflict in the Philippines: Unresolved national question or question of governance?
The continuing struggle of the Moro secessionist movement in the Philippines is one of Southeast Asiaâs longest armed conflicts. The tenacity of the conflict lies in two competing concerns: the assertion of self-determination rights of the Moro separatist movement; and the affirmation of the Philippinesâ sovereign right to territorial integrity. However, beneath these rights are crucial issues that remain unanswered both by the contending forcesâproblems where internecine violence and conflict emanate from. This article argues that self-determination rights can be adequately exercised by people who have clearly defined their national identity and concept of a nation. Unfortunately, the Moro multi-ethnic national identity has yet to be crystallised while the idea of a Bangsamoro (Bangsa Nation) remains weak. On the other hand, the state has yet to address the Morosâ legitimate demands of political autonomy, socio-economic development, and social justice and discrimination. Without underestimating the ethnic component of secessionism, the article concludes that poor governance has prolonged, complicated, and further justified the Morosâ quest to secede from the Republic
An evaluation of ciprofloxacin pharmacokinetics in critically ill patients undergoing continuous veno-venous haemodiafiltration
BACKGROUND:
The study aimed to investigate the pharmacokinetics of intravenous ciprofloxacin and the adequacy of 400 mg every 12 hours in critically ill Intensive Care Unit (ICU) patients on continuous veno-venous haemodiafiltration (CVVHDF) with particular reference to the effect of achieved flow rates on drug clearance.
METHODS:
This was an open prospective study conducted in the intensive care unit and research unit of a university teaching hospital. The study population was seven critically ill patients with sepsis requiring CVVHDF.Blood and ultrafiltrate samples were collected and assayed for ciprofloxacin by High Performance Liquid Chromatography (HPLC) to calculate the model independent pharmacokinetic parameters; total body clearance (TBC), half-life (t1/2) and volume of distribution (Vd). CVVHDF was performed at prescribed dialysate rates of 1 or 2 L/hr and ultrafiltration rate of 2 L/hr. The blood flow rate was 200 ml/min, achieved using a Gambro blood pump and Hospal AN69HF haemofilter.
RESULTS:
Seventeen profiles were obtained. CVVHDF resulted in a median ciprofloxacin t1/2 of 13.8 (range 5.15-39.4) hr, median TBC of 9.90 (range 3.10-13.2) L/hr, a median Vdss of 125 (range 79.5-554) L, a CVVHDF clearance of 2.47+/-0.29 L/hr and a clearance of creatinine (Clcr) of 2.66+/-0.25 L/hr. Thus CVVHDF, at an average flow rate of ~3.5 L/hr, was responsible for removing 26% of ciprofloxacin cleared. At the dose rate of 400 mg every 12 hr, the median estimated Cpmax/MIC and AUC0-24/MIC ratios were 10.3 and 161 respectively (for a MIC of 0.5 mg/L) and exceed the proposed criteria of >10 for Cpmax/MIC and > 100 for AUC0-24/MIC. There was a suggestion towards increased ciprofloxacin clearance by CVVHDF with increasing effluent flow rate.
CONCLUSIONS:
Given the growing microbial resistance to ciprofloxacin our results suggest that a dose rate of 400 mg every 12 hr, may be necessary to achieve the desired pharmacokinetic - pharmacodynamic (PK-PD) goals in patients on CVVHDF, however an extended interval may be required if there is concomitant hepatic impairment. A correlation between ciprofloxacin clearance due to CVVHDF and creatinine clearance by the filter was observed (r2 = 0.76), providing a useful clinical surrogate marker for ciprofloxacin clearance within the range studied
Spatial estimation of actual evapotranspiration over irrigated turfgrass using sUAS thermal and multispectral imagery and TSEB model
Green urban areas are increasingly affected by water scarcity and climate change. The combination of warmer temperatures and increasing drought poses substantial challenges for water management of urban landscapes in the western U.S. A key component for water management, actual evapotranspiration (ETa) for landscape trees and turfgrass in arid regions is poorly documented as most rigorous evapotranspiration (ET) studies have focused on natural or agricultural areas. ET is a complex and non-linear process, and especially difficult to measure and estimate in urban landscapes due to the large spatial variability in land cover/land use and relatively small areas occupied by turfgrass in urban areas. Therefore, to understand water consumption processes in these landscapes, efforts using standard measurement techniques, such as the eddy covariance (EC) method as well as ET remote sensing-based modeling are necessary. While previous studies have evaluated the performance of the remote sensing-based two-source energy balance (TSEB) in natural and agricultural landscapes, the validation of this model in urban turfgrass remains unknown. In this study, EC flux measurements and hourly flux footprint models were used to validate the energy fluxes from the TSEB model in green urban areas at golf course near Roy, Utah, USA. High-spatial resolution multispectral and thermal imagery data at 5.4 cm were acquired from small Unmanned Aircraft Systems (sUAS) to model hourly ETa. A protocol to measure and estimate leaf area index (LAI) in turfgrass was developed using an empirical relationship between spectral vegetation indices (SVI) and observed LAI, which was used as an input variable within the TSEB model. In addition, factors such as sUAS flight time, shadows, and thermal band calibration were assessed for the creation of TSEB model inputs. The TSEB model was executed for five datasets collected in 2021 and 2022, and its performance was compared against EC measurements. For ETa to be useful for irrigation scheduling, an extrapolation technique based on incident solar radiation was used to compute daily ETa from the hourly remotely-sensed UAS ET. A daily flux footprint and measured ETa were used to validate the daily extrapolation technique. Results showed that the average of corrected daily ETa values in summer ranged from about 4.6 mm to 5.9 mm in 2021 and 2022. The Near Infrared (NIR) and Red Edge-based SVI derived from sUAS imagery were strongly related to LAI in turfgrass, with the highest coefficient of determination (R2) (0.76â0.84) and the lowest root mean square error (RMSE) (0.5â0.6). The TSEBâs latent and sensible heat flux retrievals were accurate with an RMSE 50 W mâ2 and 35 W mâ2 respectively compared to EC closed energy balance. The expected RMSE of the upscaled TSEB daily ETa estimates across the turfgrass is below 0.6 mm dayâ1, thus yielding an error of 10% of the daily total. This study highlights the ability of the TSEB model using sUAS imagery to estimate the spatial variation of daily ETa for an urban turfgrass surface, which is useful for landscape irrigation management under drought conditions.Peer reviewe
Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial
Data availability statement:
Data are available upon reasonable request. Data will be made available on the Figshare data repository.Objective: To investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.
Design: A feasibility randomised controlled trial with a parallel process evaluation.
Setting: Acute Stroke Unit and participantsâ homes (London, UK).
Participants: 24 adults (>18 years), acute and subacute poststroke, new unilateral weakness, scoring 9â25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate.
Interventions: Participants randomised to the intervention or control group on a 2:1 ratio. The intervention group (n=16) received usual care plus the Neurofenix platform for 7âweeks. The control group (n=8) received usual care only.
Outcomes: Safety was assessed through adverse events (AEs), pain, spasticity and fatigue. Feasibility was assessed through training and support requirements and intervention fidelity. Acceptability was assessed through a satisfaction questionnaire. Impairment, activity and participation outcomes were also collected at baseline and 7âweeks to assess their suitability for use in a definitive trial.
Randomisation: Computer-generated, allocation sequence concealed by opaque, sealed envelopes.
Blinding: Participants and assessors were not blinded; statistician blinded for data processing and analysis.
Results: 192 stroke survivors were screened for eligibility, and 24 were recruited and randomised. Intervention group: n=16, mean age 66.5 years; median 9.5âdays post stroke. Control group: n=8, mean age 64.6 years; median 17.5âdays post stroke. Three participants withdrew before the 7-week assessment, n=21 included in the analysis (intervention group n=15; control group n=6). No significant group differences in fatigue, spasticity, pain scores or total number of AEs. The median (IQR) time to train participants was 98 (64) min over 1â3 sessions. Participants trained with the platform for a median (range) of 11 (1-58) hours, equating to 94âmin extra per week. The mean satisfaction score was 34.9 out of 40.
Conclusion: The Neurofenix platform is safe, feasible and well accepted as an adjunct to usual care in acute and subacute stroke rehabilitation. There was a wide range of engagement with the platform in a cohort of stroke survivors which was varied in age and level of impairment. Recruitment, training and support were manageable and completion of data was good, indicating that a future randomised controlled trial would be feasible.
Trial registration number: ISRCTN11440079.This work was supported by The Stroke Association and MedCity grant number SA MC 21\10001
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