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Respiratory Medicine Feb 2024Traditionally continuous positive airways pressure (CPAP) trials for obstructive sleep apnoea (OSA) are through face to face (F2F) set up. During Covid-19 pandemic CPAP... (Observational Study)
Observational Study
BACKGROUND
Traditionally continuous positive airways pressure (CPAP) trials for obstructive sleep apnoea (OSA) are through face to face (F2F) set up. During Covid-19 pandemic CPAP was classed as aerosol-generating hence Leeds sleep service moved to a virtual service. Patients received equipment by post followed by virtual reviews (VR). We evaluated the adherence and symptomatic benefit of postal compared to F2F method.
METHODS
Observational data were collected from databases monitoring CPAP loans. F2F patients met a sleep technician for hands on setup in 2019, and in 2020 postal patients received equipment, written guides, and links to custom made YouTube videos. All (F2F and postal) patients had a telephone and VR appointment to discuss symptoms, and CPAP machine (AirSense 10, ResMed Inc., San Diego, USA) data including data on usage and treatment apnoea-hypopnoea index (AHI). Data was analysed using unpaired T-tests, Mann-Whitney U tests, and chi-square tests to examine differences in means, medians, and proportions, respectively of the F2F and postal groups.
RESULTS
Both groups (n = 1,221, 656 F2F, 53.7%) were similar in all categories except length of CPAP trial (postal 33 vs F2F 84 days,p < 0.0001), change in AHI (postal 22.4/Hr vs F2F 25.1/Hr,p = 0.04), and trial average use (postal 4.9 vs F2F 5.2 h,p = 0.04). There was no significant difference in the proportion of patients continuing with CPAP (postal 64%, F2F 66%, p = 0.71), the improvement in Epworth Sleepiness Score (ESS) (postal 6.9/24, F2F 7.1/24, p = 0.31) or the patient's subjective rating on whether they felt much better, better, the same or worse on CPAP (p = 0.27). Logistic regression showed factors which affected odds ratios of continuing CPAP were diagnostic AHI, treatment AHI, treatment ESS and how they felt on CPAP. Trial type did not affect the odds ratios of continuing CPAP.
CONCLUSIONS
Postal CPAP trial patients had similar odds of continuing CPAP therapy compared to patients with F2F trials and achieved similar levels of ESS improvement and reporting feeling better on CPAP. This provides support for postal trials as a viable option post-pandemic.
Topics: Humans; Pandemics; Continuous Positive Airway Pressure; Sleep Apnea, Obstructive; Sleep
PubMed: 38159781
DOI: 10.1016/j.rmed.2023.107513 -
Australian Health Review : a... Oct 2023Recognition of the importance of end-of-life care will enable improvements in the quality of care delivered to patients and their families. Australia is experiencing an...
Recognition of the importance of end-of-life care will enable improvements in the quality of care delivered to patients and their families. Australia is experiencing an increasing number of deaths, (many expected), with an aging population who are living longer, often with multimorbidity. This makes end of life care a priority. The last year of someone's life takes place in a complex healthcare system, with increasing pressures on care delivery, placing the spotlight on health service providers to ensure that teams and individuals are supported and enabled to provide such care. Two rapid literature reviews identified best practice principles and processes for delivering safe and high-quality end-of-life care in acute care, aged care and community settings. The reviews identified that end-of-life care is experienced within the whole health and social care system, including hospital admissions interspersed with care in the community, outpatient and emergency department visits and potentially admission to a hospice. Much of this last year of life is spent at home, which may be a personal residence, an aged care facility, prison, supported accommodation or even on the streets. Transitions across settings requires seamless care, as well as organisational readiness to deliver safe and culturally appropriate care. This is more important now with end-of-life care subject to quality assurance mechanisms within the National Safety and Quality Health Service Standards (2nd edn): Comprehensive care. This requires all sectors to work collaboratively when caring for someone at the end of their life in order to see positive changes in care outcomes.
PubMed: 37696753
DOI: 10.1071/AH23166 -
Heliyon Apr 2024Effective restoration strategies play a crucial role in mitigating the environmental impact of mining and colliery activities while promoting ecological resilience and... (Review)
Review
Effective restoration strategies play a crucial role in mitigating the environmental impact of mining and colliery activities while promoting ecological resilience and rejuvenating ecosystem services. However, many organizations find it challenging to understand and balance their efforts in restoring degraded lands. For example, their restoration plans lack clarity and overlook relevant ecosystem services. This study reviews and focuses on the potential restoration of ecosystem services at TATA Steel's Noamundi Iron Ore Mine and West Bokaro Colliery to contribute to Sustainable Development Goals (SDGs), particularly SDG-15, for localization. The approach involved assessing the number of preventive measures being implemented to restore a particular ecosystem service. Moreover, the potential of each preventive measure is to restore that ecosystem service. The findings underscore the significance of preventive measures and comprehensive restoration plans in enhancing carbon sequestration, soil fertility, habitat creation, and genetic diversity conservation. Our results showed that the impact scores and ranks of various ecosystem services demonstrate the positive effects of restoration efforts, emphasizing the importance of reestablishing forests, restoring water bodies and wetlands, and allocating land for agriculture and public use. The research provides valuable insights for decision-makers in developing sustainable land management strategies, ensuring biodiversity conservation and local communities' well-being. By prioritizing ecosystem services in restoration initiatives, stakeholders can contribute to the sustainable management of natural resources and foster a harmonious coexistence between human activities and the environment.
PubMed: 38699718
DOI: 10.1016/j.heliyon.2024.e29877 -
Australian Health Review : a... Dec 2023Objective This study aimed to calculate the baseline carbon inventory of Mercy Health, a provider of health and aged care services in Australia, across emission Scopes...
Objective This study aimed to calculate the baseline carbon inventory of Mercy Health, a provider of health and aged care services in Australia, across emission Scopes 1, 2 and 3. The carbon inventory has clarified the baseline environmental impact, identified carbon hotspots and will inform emissions reduction interventions and a decarbonisation trajectory. Methods A hybrid carbon footprinting methodology was devised. Established carbon footprinting standards provided methodological guidance. A consulting firm with health service carbon accounting experience provided expertise, rigour and objectivity to the work. Results In the 2020-21 financial year, the carbon footprint of Mercy Health was 102.96k tCO2-e. Scope 1 emissions accounted for 11.07% (11.40k tCO2-e), followed by Scope 2 with 29.80% (30.68k tCO2-e) and Scope 3 with 59.13% (60.88k tCO2-e). The largest carbon impost group was Building energy (42.01%; 43.25k tCO2-e), followed by Food and catering (9.42%; 9.70k tCO2-e) and Business services (7.74%; 7.97k tCO2-e). Mercy Health's Health Services, Aged Care and Support Services divisions contributed 49.16, 47.81 and 3.03% (50.61k, 49.23k and 3.12k tCO2-e) of total greenhouse gas emissions respectively. Conclusions Mercy Health's Health Services division and Aged Care division each comprised around half of total organisation carbon emissions. Building energy dominated emissions, particularly electricity. The study discovered meaningful differences in the composition of carbon emissions in operational divisions of the organisation, indicating tailored interventions will be required to meet carbon abatement targets. The study demonstrates the benefit of conducting carbon footprinting within individual organisations, and the importance of studies within the Australian context.
Topics: Aged; Humans; Australia; Carbon; Carbon Footprint; Commerce; Technetium Compounds
PubMed: 37814479
DOI: 10.1071/AH23129 -
BMC Emergency Medicine Nov 2023Analgesia is a core intervention in emergency medicine. Pain is subjective, so patient-reported experience with pain and analgesia is essential for healthcare... (Observational Study)
Observational Study
BACKGROUND
Analgesia is a core intervention in emergency medicine. Pain is subjective, so patient-reported experience with pain and analgesia is essential for healthcare professionals. The aim of this study was to evaluate patient-reported side effects and satisfaction associated with pre-hospital analgesia with low-dose esketamine.
METHODS
This is an observational cross-sectional study conducted as part of quality assurance measures of the German Red Cross Emergency Medical Service, Reutlingen, Germany. The survey was administered to all patients who received prehospital esketamine analgesia from paramedics. Addresses were obtained from medical records and mailed 10 days after the event. Patient feedback was anonymous and could not be linked to operational documentation.
RESULTS
A total of 201 patients were contacted, and 119 responses were received via the online questionnaire and postal mail (response rate 59%). The mean age of the patients was 68±13 years, with 64.7% (n=77) being female. The main diagnosis reported was fractures of the extremities in 69.7%. Patients reported initial median pain intensity on a Numeric Rating Scale (NRS) of 10 [8-10]. Pain was unbearable for 96.3% of patients. After administration of analgesia, 95.3% were satisfied or very satisfied. Patients reported no side effects in 78.5%, minor side effects in 10.0%, significant but well tolerable side effects in 11.3%, borderline tolerable side effects in 0.2%, and no unbearable side effects. Borderline tolerable nausea was reported in 2% of patients along with dreams in 0.8%. No nightmares were reported. Further analysis showed that patients older than 80 years reported significantly more side effects (p < 0.001) and were thus less satisfied with the analgesia.
CONCLUSIONS
Both patient perception and analgesia with few side effects were important for both safety and satisfaction. In the present study, low-dose esketamine analgesia was associated with low side effects and high patient satisfaction.
Topics: Humans; Female; Middle Aged; Aged; Aged, 80 and over; Male; Cross-Sectional Studies; Patient Satisfaction; Analgesia; Pain; Drug-Related Side Effects and Adverse Reactions; Hospitals; Personal Satisfaction; Patient Reported Outcome Measures
PubMed: 37924027
DOI: 10.1186/s12873-023-00898-4 -
Primary Care Diabetes Aug 2023To implement a diabetes prevention programme in primary care METHODS: The programme was implemented for 12 months in two neighbouring towns, served by eight general...
AIMS
To implement a diabetes prevention programme in primary care METHODS: The programme was implemented for 12 months in two neighbouring towns, served by eight general practices. Practices requested a referral pathway involving an external administrator running electronic searches and sending postal invitations. If interested, people called and booked a place on the programme. Practices were also provided with resources to refer people directly. Six Educators were trained to deliver the programme. The RE-AIM constructs "Adoption", "Reach" and "Uptake" were assessed.
RESULTS
All practices engaged in the searches and postal invitations. Overall, 3.9 % of those aged ≥ 25 years had an HbA1c level indicative of non-diabetic hyperglycaemia (NDH) and were invited. Overall uptake (attended as percentage of invited) was 16 % (practice range 10.5-26.6 %) and was highest in two practices where the invitation was followed by a telephone call. Four people were referred directly by their practice. Groups at risk of being excluded were the Bengali population and those unable to attend because of issues such as health, mobility and frailty.
CONCLUSIONS
Comprehensive electronic searches meant everyone previously diagnosed with NDH was invited to attend. Follow-up telephone call improved uptake and providing practices with resources to make these calls themselves would likely increase uptake further.
Topics: Humans; Diabetes Mellitus, Type 2; Hyperglycemia; England; Primary Health Care
PubMed: 37246032
DOI: 10.1016/j.pcd.2023.05.001 -
IEEE Transactions on Neural Networks... Aug 2023In the unsupervised open set domain adaptation (UOSDA), the target domain contains unknown classes that are not observed in the source domain. Researchers in this area...
In the unsupervised open set domain adaptation (UOSDA), the target domain contains unknown classes that are not observed in the source domain. Researchers in this area aim to train a classifier to accurately: 1) recognize unknown target data (data with unknown classes) and 2) classify other target data. To achieve this aim, a previous study has proven an upper bound of the target-domain risk, and the open set difference, as an important term in the upper bound, is used to measure the risk on unknown target data. By minimizing the upper bound, a shallow classifier can be trained to achieve the aim. However, if the classifier is very flexible [e.g., deep neural networks (DNNs)], the open set difference will converge to a negative value when minimizing the upper bound, which causes an issue where most target data are recognized as unknown data. To address this issue, we propose a new upper bound of target-domain risk for UOSDA, which includes four terms: source-domain risk, ϵ -open set difference ( ∆ ), distributional discrepancy between domains, and a constant. Compared with the open set difference, ∆ is more robust against the issue when it is being minimized, and thus we are able to use very flexible classifiers (i.e., DNNs). Then, we propose a new principle-guided deep UOSDA method that trains DNNs via minimizing the new upper bound. Specifically, source-domain risk and ∆ are minimized by gradient descent, and the distributional discrepancy is minimized via a novel open set conditional adversarial training strategy. Finally, compared with the existing shallow and deep UOSDA methods, our method shows the state-of-the-art performance on several benchmark datasets, including digit recognition [modified National Institute of Standards and Technology database (MNIST), the Street View House Number (SVHN), U.S. Postal Service (USPS)], object recognition (Office-31, Office-Home), and face recognition [pose, illumination, and expression (PIE)].
PubMed: 34714753
DOI: 10.1109/TNNLS.2021.3119965 -
Australian Journal of Primary Health Feb 2024The Optimal Care Pathways (OCP) are a framework to promote high-quality and integrated cancer care for all Australians, from prevention through to end-of-life-care....
BACKGROUND
The Optimal Care Pathways (OCP) are a framework to promote high-quality and integrated cancer care for all Australians, from prevention through to end-of-life-care. Aboriginal and Torres Strait Islander people experience disproportionate cancer incidence and mortality, but little research has addressed whether cancer care for Aboriginal people meets the standards prescribed by the OCPs. This study aims to consider barriers and facilitators to quality cancer care for Aboriginal people.
METHODS
Semi-structured interviews were conducted with 30 health professionals who deliver care to Aboriginal people with cancer in primary care and hospital settings in New South Wales, Australia. Health professionals included Aboriginal Health Workers, nurses, general practitioners, and community workers. Interviews were conducted in 2019-2020 and explored participant perspectives of barriers and facilitators of optimal cancer care, particularly related to prevention, early detection, diagnosis, and treatment for Aboriginal people. Data were qualitatively analysed using framework analysis.
RESULTS
In general, participants perceived Aboriginal patients to have good access to preventive care. In terms of early detection and diagnosis, access to primary care, pathology, radiology, and some specialists (e.g. respiratory physicians) was seen as optimal. However, access to hospital-based gastroenterologists for colonoscopy was perceived to be poor due to long wait times. Access to optimal care for cancer treatment was perceived to be hindered due to the lack of bulk-billing for bowel cancer, breast cancer, and cardiothoracic surgery. Other barriers to care identified by participants included unclear referral pathways, poor communication between patient and the treating team, and a lack of timely provision of discharge summaries.
CONCLUSIONS
Facilitators of optimal care during treatment and survivorship included: the Integrated Team Care and Close the Gap programs, and presence of key health workers to help patients navigate the health system. The major barriers to quality cancer care for Aboriginal people appeared to be to specialist and procedural access, demonstrating that the 'Inverse Care' law applied in reducing access for populations at higher risk of cancer.
Topics: Humans; Australia; Australian Aboriginal and Torres Strait Islander Peoples; Critical Pathways; Health Services, Indigenous; Neoplasms
PubMed: 37667463
DOI: 10.1071/PY22181 -
BMC Public Health Jun 2024In Canada, substance-related accidental acute toxicity deaths (AATDs) continue to rise at the national and sub-national levels. However, it is unknown if, where, when,...
OBJECTIVES
In Canada, substance-related accidental acute toxicity deaths (AATDs) continue to rise at the national and sub-national levels. However, it is unknown if, where, when, and to what degree AATDs cluster in space, time, and space-time across the country. The objectives of this study were to 1) assess for clusters of AATDs that occurred in Canada during 2016 and 2017 at the national and provincial/territorial (P/T) levels, and 2) examine the substance types detected in AATD cases within each cluster.
METHODS
Two years of person-level data on AATDs were abstracted from coroner and medical examiner files using a standardized data collection tool, including the decedent's postal code and municipality information on the places of residence, acute toxicity (AT) event, and death, and the substances detected in the death. Data were combined with Canadian census information to create choropleth maps depicting AATD rates by census division. Spatial scan statistics were used to build Poisson models to identify clusters of high rates (p < 0.05) of AATDs at the national and P/T levels in space, time, and space-time over the study period. AATD cases within clusters were further examined for substance types most present in each cluster.
RESULTS
Eight clusters in five regions of Canada at the national level and 24 clusters in 15 regions at the P/T level were identified, highlighting where AATDs occurred at far higher rates than the rest of the country. The risk ratios of identified clusters ranged from 1.28 to 9.62. Substances detected in clusters varied by region and time, however, opioids, stimulants, and alcohol were typically the most commonly detected substances within clusters.
CONCLUSION
Our findings are the first in Canada to reveal the geographic disparities in AATDs at national and P/T levels using spatial scan statistics. Rates associated with substance types within each cluster highlight which substance types were most detected in the identified regions. Findings may be used to guide intervention/program planning and provide a picture of the 2016 and 2017 context that can be used for comparisons of the geographic distribution of AATDs and substances with different time periods.
Topics: Humans; Canada; Female; Male; Adult; Spatio-Temporal Analysis; Middle Aged; Adolescent; Young Adult; Substance-Related Disorders; Cluster Analysis; Aged
PubMed: 38898445
DOI: 10.1186/s12889-024-18883-2 -
Digital Health 2023Eliminating HIV transmission worldwide could become a reality with the advent of HIV pre-exposure prophylaxis (PrEP) where people take HIV medication to prevent HIV...
Delivering HIV prevention medication online: Findings from a qualitative study exploring the acceptability of an online HIV pre-exposure prophylaxis (PrEP) care pathway among service users and healthcare professionals.
OBJECTIVE
Eliminating HIV transmission worldwide could become a reality with the advent of HIV pre-exposure prophylaxis (PrEP) where people take HIV medication to prevent HIV acquisition. Incorporating digital health into PrEP provision could help services scale up and meet increasing demand. We aimed to explore the prospective acceptability of a novel online PrEP care pathway (the ePrEP clinic) among PrEP users and healthcare professionals. The ePrEP clinic is composed of online postal self-sampling for HIV and other sexually transmitted infections, an online consultation, and remote medication provision.
METHODS
We conducted semi-structured interviews with 15 PrEP users recruited from a large sexual health service and online cohort, and focus groups with nine healthcare professionals from the same sexual health service (May to December 2021). We analysed data using framework analysis.
RESULTS
Participants found the ePrEP clinic highly acceptable, anticipating that it would provide convenience, empower PrEP users, and increase capacity within sexual health services. The need for blood self-sampling was a considerable barrier for some. Participants anticipated that the ePrEP clinic would be appropriate for established PrEP users with adequate digital health literacy and no medically significant conditions requiring in-clinic monitoring. Participants highlighted the need for support, including access to in-clinic care, and the integration of the ePrEP clinic within existing services.
CONCLUSIONS
Our findings provide clear justification for the development of the ePrEP clinic as an addition to in-clinic PrEP care pathways and provide useful insights for those developing digital services for other conditions incorporating testing, consultations, and prescribing.
PubMed: 38047162
DOI: 10.1177/20552076231217816