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How can we design and engineer research that leads to the development and effective implementation of complex healthcare interventions? We advocate for a systems design-based approach when initiating clinical research to anticipate the proposition of complex interventions. Using cognitive care as an example, we investigate how hybrid design-inspired methodologies can promote organisational effectiveness and how strong clinical evidence can support successful conceptualisation and uptake of novel interventions into routine clinical practice.
Scholarly interpretations of the descent and description of the New Jerusalem in Revelation 21–22 have tended to evaluate the city against biblical and extra-canonical descriptions of the Jerusalem Temple, apocalyptic accounts of heaven and ancient utopian literature in general. While some have noted the ways in which the New Jerusalem parallels the description of Babylon elsewhere in the Apocalypse, no one has yet considered the ways in which the New Jerusalem mimics, mirrors and adapts the excesses of elite Roman architecture and decor. The argument of this article is that when viewed against the backdrop of literary and archaeological evidence for upper-class living space, the luxury of the New Jerusalem is domesticated and functions to democratise access to wealth in the coming epoch. The ways in which Revelation's New Jerusalem rehearses the conventions of morally problematic displays of luxury can partially explain later patristic discomfort with literalist readings of this passage.
Introduction: Despite recent advances in resuscitation, some patients remain in ventricular fibrillation (VF) after multiple defibrillation attempts during out-of-hospital cardiac arrest (OHCA). Vector change defibrillation (VC) and double sequential external defibrillation (DSED) have been proposed as alternate therapeutic strategies for OHCA patients with refractory VF. The primary objective was to determine the feasibility, safety and sample size required for a future cluster randomized controlled trial (RCT) with crossover comparing VC or DSED to standard defibrillation for patients experiencing refractory VF. Secondary objectives were to evaluate the intervention effect on VF termination and return of spontaneous circulation (ROSC). Methods: We conducted a pilot cluster RCT with crossover in four Canadian paramedic services and included all treated adult OHCA patients who presented in VF and received a minimum of three defibrillation attempts. In addition to standard cardiac arrest care, each EMS service was randomly assigned to provide continued standard defibrillation (control), VC or DSED. Services crossed over to an alternate defibrillation strategy after six months. Prior to the launch of the trial, 2,500 paramedics received in-person training for VC and DSED defibrillation using a combination of didactic, video and simulated scenarios. Results: Between March 2018 and September 2019, 152 patients were enrolled. Monthly enrollment varied from 1.4 to 6.1 cases per service. With respect to feasibility, 89.5% of cases received the defibrillation strategy they were randomly allocated to, and 93.1% of cases received a VC or DSED shock prior to the sixth defibrillation attempt. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement or concerns expressed by paramedics, patients, families, or ED staff about the trial. In the standard defibrillation group, 66.6% of cases resulted in VF termination, compared to 82.0% in VC and 76.3% of cases in the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. Conclusion: Findings from our pilot RCT suggest the DOSE VF protocol is feasible and safe. VF termination and ROSC were higher with VC and DSED compared to standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact patient-centered, clinical outcomes
Lack of validated measures creates obstacles for psychology research progress. The validation of widely used instruments can facilitate research and clinical work.
Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ) is a cost-effective and psychometrically sound (Spitzer et al., 1999) instrument which is used for the diagnosis of specific psychiatric disorders according to the established diagnostic criteria. Unfortunately, despite its potential utility, PHQ has not been validated or used with Greek language populations.
The aim of this study is to conduct a PHQ validation in 520 Greek native-language participants in Cyprus. Appropriate self-report Greek-language measures were identified based on the convergence between the diagnostic specifications of these measures and PHQ diagnoses. The identified measures and the translated PHQ were used for data collection. Participants’ demographic and health information was also gathered.
Currently, the project is in its final stages of data collection, and will be completed by December, 2010. Preliminary results, suggest that a number of PHQ subscales have high internal consistency (e.g. Cronbach's alpha coefficient of .81 on Somatization, .83 on Depression) and correlate moderately with other diagnostic measures used (e.g. depression scale r = .43, p < .001 with BDI-II; panic scale r = .5, p < .001 with PDSQ panic scale).
Upon completion of data collection, PHQ factor structure, reliability, validity, sensitivity, and specificity will be further investigated. Item and correlation analysis will be confirmed.
Strength and weaknesses of PHQ subscales and the employed validation method will also be discussed.
Evidence supports the hypothesis that the patient-psychiatrist relationship is a central feature of psychiatric care. It is also known that patient treatment satisfaction will result in improved adherence; therefore, the aim of this study was to investigate the relationship between patient treatment satisfaction and continuity of psychiatric care.
The objective of this study was to evaluate the extent to which the continuity of psychiatric care is related to patient satisfaction.
This research was conducted as an observational, non-experimental survey of all the patients who attend the NZOZ Centrum Terapii DIALOG in Warsaw, Poland. Patient satisfaction was assessed by using the 10-point subjective scale (1- lowest, 10 – highest level of satisfaction).
A total of 160 patients met the inclusion criteria; 92 of them have visited a psychiatrist less than 5 times, 68 of them visited psychiatrist 5 times or more. The probability of the patient’s recommendation of the psychiatrist as calculated by the NPS method was 72,83% of the patients that have visited psychiatrist less than 5 times and 64,71% of the patients that have visited a psychiatrist 5 times or more. The average level of satisfaction was 9,16 points for the first group, and 8,89 points for the second group.
The results of this study show the adverse correlation between continuity of psychiatric care and patient satisfaction. Further investigation should be made on how to prevent a decline in the level of patient satisfaction during continuous psychiatric care.
The magnitude of the postprandial hypotensive (PPH) response has been shown to be an independent risk factor for falls, fractures, and death. Despite this well-established risk, meal tests are rarely done in the falls clinic setting because of logistical issues. In order to better target potential PPH patients among older falling adults, this study examines which subject characteristics are associated with larger PPH responses. A total of 52 falls clinic patients (mean age 77.8 ± 0.9 years, 29 women, 23 men) were recruited for a 90 minute meal test. Significant variables were then entered into a stepwise multivariate linear model containing age, sex, presence of diabetes, presence of hypertension, baseline systolic blood pressure (SBP), and the orthostatic drop in SBP. Although further work is required, our study suggests that men, patients with higher blood pressure, and patients with an orthostatic drop might be more likely to have higher postprandial hemodynamic responses.