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Healthcare analytics has traditionally relied upon linear and logistic regression models to address clinical research questions mostly because they produce highly interpretable results [1, 2]. These results contain valuable statistics such as p-values, coefficients, and odds ratios that provide healthcare professionals with knowledge about the significance of each covariate and exposure for predicting the outcome of interest [1]. Thus, they are often favored over new deep learning models that are generally more accurate but less interpretable and scalable. However, the statistical power of linear and logistic regression is contingent upon satisfying modeling assumptions, which usually requires altering or transforming the data, thereby hindering interpretability. Thus, generalized additive models are useful for overcoming this limitation while still preserving interpretability and accuracy. The major research question in this work involves investigating whether particular sedative agents (fentanyl, propofol, versed, ativan, and precedex) are associated with different discharge dispositions for patients with acute traumatic brain injury (TBI). To address this, we compare the effectiveness of various models (traditional linear regression (LR), generalized additive models (GAMs), and deep learning) in providing guidance for sedative choice. We evaluated the performance of each model using metrics for accuracy, interpretability, scalability, and generalizability. Our results show that the new deep learning models were the most accurate while the traditional LR and GAM models maintained better interpretability and scalability. The GAMs provided enhanced interpretability through pairwise interaction heat maps and generalized well to other domains and class distributions since they do not require satisfying the modeling assumptions used in LR. By evaluating the model results, we found that versed was associated with better discharge dispositions while ativan was associated with worse discharge dispositions. We also identified other significant covariates including age, the Northeast region, the Acute Physiology and Chronic Health Evaluation (APACHE) score, Glasgow Coma Scale (GCS), and ethanol level. The versatility of versed may account for its association with better discharge dispositions while ativan may have negative effects when used to facilitate intubation. Additionally, most of the significant covariates pertain to the clinical state of the patient (APACHE, GCS, etc.) whereas most non-significant covariates were demographic (gender, ethnicity, etc.). Though we found that deep learning slightly improved over LR and generalized additive models after fine-tuning the hyperparameters, the deep learning results were less interpretable and therefore not ideal for making the aforementioned clinical insights. However deep learning may be preferable in cases with greater complexity and more data, particularly in situations where interpretability is not as critical. Further research is necessary to validate our findings, investigate alternative modeling approaches, and examine other outcomes and exposures of interest. / Master of Science / Patients with Traumatic Brain Injury (TBI) often require sedative agents to facilitate intubation and prevent further brain injury by reducing anxiety and decreasing level of consciousness. It is important for clinicians to choose the sedative that is most conducive to optimizing patient outcomes. Hence, the purpose of our research is to provide guidance to aid this decision. Additionally, we compare different modeling approaches to provide insights into their relative strengths and weaknesses. To achieve this goal, we investigated whether the exposure of particular sedatives (fentanyl, propofol, versed, ativan, and precedex) was associated with different hospital discharge locations for patients with TBI. From best to worst, these discharge locations are home, rehabilitation, nursing home, remains hospitalized, and death. Our results show that versed was associated with better discharge locations and ativan was associated with worse discharge locations. The fact that versed is often used for alternative purposes may account for its association with better discharge locations. Further research is necessary to further investigate this and the possible negative effects of using ativan to facilitate intubation. We also found that other variables that influence discharge disposition are age, the Northeast region, and other variables pertaining to the clinical state of the patient (severity of illness metrics, etc.). By comparing the different modeling approaches, we found that the new deep learning methods were difficult to interpret but provided a slight improvement in performance after optimization. Traditional methods such as linear regression allowed us to interpret the model output and make the aforementioned clinical insights. However, generalized additive models (GAMs) are often more practical because they can better accommodate other class distributions and domains.

Background: The status of Safety Management is highly relevant to evaluate an organization’s ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and suffciently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond. Method: A nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA). Results: Results for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffng being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff. Conclusion: The status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffng and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findingsmight also be applicable across nations and sectors beyond the medical field.

Medicinteknisk utrustning (MT) har en stor och avgörande roll i dagens samhälle för att kunna utföra en patientsäker sjukvård. De senaste tekniska framstegen har försett sjukvården med otaliga skräddarsydda MT-produkter för olika behov som uppstår vid behandling av patienterna. Trots detta har vissa hälso- och sjukvårdssektorer särskilda behov som inte kan tillgodoses genom marknadens utbud. När en sådan situation uppstår, tillåter regelverket sjukvårdsverksamheter att utveckla egentillverkade produkter eller modifiera befintlig MT-utrustning för att lösa det specifika sjukvårdsproblemet. Egentillverkning av en MT-produkt är en reglerad process i enlighet med EU-förordning om MT-produkter MDR (EU 2017/745) artikel 5.5. Detta regelverk säkerställer en patientsäker och kvalitetssäkrad MT-utrustning för intern användning inom sjukvårdsverksamheten.  Karolinska Universitetssjukhuset (Karolinska) som är Nordens största sjukhus har, i enlighet med regelverket, tagit fram egna interna riktlinjer för egentillverkning av MT-produkter. Covid-19-pandemin har aktualiserat att tillämpa dessa rutiner i praktiken. Karolinska har vårdat ett stort antal Covid-19-patienter med svåra respiratoriska symptom som har krävt ett särskilt omhändertagande bland annat på intensivvårdsavdelningen (IVA).  Ett av de mest förekommande kirurgiska ingreppen på IVA-patienter under denna period har varit trakeotomi. På grund av de stora svårigheter som uppstår med att flytta patienten till vanlig operationssal har öron-näsa-halsenheten (ÖNH) på Karolinska, som ansvarar för alla kirurgiska trakeotomier på sjukhuset, behövt utföra operationen på patienten i IVA-sängen. För att utföra en mer patientsäker på-plats-operation och förbättra denna ohållbara arbetsmiljö har ÖNH-kirurger önskat och sökt ett mobilt operationsbord som kan dockas till de olika IVA-sängtyperna som finns på sjukhuset. Eftersom detta operationsbord inte fanns att köpa på marknaden har MT-mekaniska verkstaden på Karolinska utvecklat en prototyp av trakeotomibordet som uppfyller ÖNH-kirurgernas specifika behov.  I detta arbete undersöktes egentillverkning av MT-produkter inom Karolinska i samband med utveckling av trakeotomibordet. I detta avseende studerades hela processen som krävs av regelverket och Karolinskas interna föreskrifter, från behovsanalys och definition av MT-produkten till kvalitetssäkring och riskhanteringen som garanterar en godkänd MT-utrustning för intern användning inom Karolinska Universitetssjukhuset. / Medical devices have a crucial role in performing a high-quality healthcare with patient safety in focus. Recent technological advances have provided healthcare systems with countless customized medical products for the various needs that arise in the treatment of patients. Despite this, some health care sectors have special needs that cannot be met by the market supply. In such circumstances, the regulations allow healthcare providers to develop in-house production or modify existing medical equipment to solve the specific need of the medical staff. In-house production of a medical device is a detailed regulated process defined in accordance with MDR (EU 2017/745) Article 5 (5). This regulatory framework ensures a patient-safe and quality-assured medical equipment for internal use within the healthcare.  Karolinska University Hospital (Karolinska), which is the Nordic region's largest hospital, follows the regulatory praxis for in-house production of medical devices. These praxes were put into use during the Covid-19 pandemic. Karolinska had to take care of many Covid-19 patients with severe respiratory symptoms who required special care, including intensive care unit (ICU).  One of the most common surgical procedures on ICU patients during this period was tracheotomy. Due to the complications that occur in moving patients to regular operating theatre, the ear-nose-throat unit (ENT) at Karolinska, which is responsible for all surgical tracheotomies at the hospital, has had to perform operations directly on ICU beds.  To improve the quality of the operations and the surgeon's work condition, the Karolinska ENT have sought a mobile operating table with ability to be docked to various ICU beds, available at the hospital. Since this medical equipment was not available on the market, the medical engineering workshop at Karolinska has developed a prototype of the tracheotomy table that meets the specific needs of ENT surgeons. This project studies the in-house production of a medical device at Karolinska through examining the development of tracheostomy table’s prototype by medical engineering workshop. In this respect, the regulatory requirements that approve the tracheostomy table for internal use within Karolinska University Hospital, are studied.

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)

The abstract on the file is incorrect, use the the one in the system as it summerizes the full text. / This attempted to describe factors contributing to sleep deprivation in the a multidisciplinary intensive care unit in KwaZulu-Natal Province. A quantitative, descriptive research design was adopted and structured interviews were conducted with 34 adult patients. Most factors contributing to these patients' sleep deprivation are basic physiological needs. Much can be done to enhance patients' abilities to sleep if noise (from alarms, monitors, televisions, telephones and footsteps) could be controlled, patients' pain would be managed effectively, doctors would visit the patients regularly, doctors and nurses use lay terms when talking to patients. Visible clocks and windows will help patients to maintain time orientation. Friendly, approachable and respectful nurses who introduce themselves to the patients help' to reduce patients' stress levels and improve their abilities to sleep. / Health Sciences / M.A. (Health Studies)

No description available.

本研究目的在於建構加護病房護理人員之非理性信念、情緒特質及情緒管理對人際關係之影響路徑模式。本研究採問卷調查法，參與者為200位加護病房護理人員，研究工具則包含非理性信念、情緒特質、情緒管理與人際關係等四份量表。研究中以驗證性因素分析、描述統計、單因子多變量變異數分析及結構方程模式分析資料，主要的研究結果如下： 一、教育程度在大學以下者比教育程度為研究所者具有較強烈之「希望感」正向情緒特質。護理年資高者較護理年資淺者能在人際關係方面展現主動關懷的行為。此外，修過情緒管理課程或壓力管理課程者比從未修過該課程者，具有較強烈之正向情緒特質。值得注意的是，從未修過壓力管理課程者卻比修過該課程者，具有較強烈之「自卑感」負向情緒特質。 二、非理性信念愈強者，其負向情緒激發愈強烈。但非理性信念與正向或負向情緒特質交互作用後，非理性信念對負向情緒激發的影響會被削弱。此外，非理性信念對積極回應策略沒有效果。 三、正向情緒特質對負向情緒激發具有負向效果，但卻對積極回應策略具有正向效果。 四、負向情緒特質對負向情緒激發具有正向效果，但對積極回應策略具有負向效果。 五、不同非理性信念者，其人際關係並無顯著差異。 六、正向情緒特質對人際關係具有正向效果。 七、負向情緒特質愈強者，其人際關係愈差，且負向情緒特質是透過負向情緒激發或積極回應策略對人際關係產生間接影響效果，雖然其效果並不大。 八、不同負向情緒激發者，其人際關係並無顯著差異，但當負向情緒激發受到正向情緒特質的影響後，會對人際關係產生正向的效果。 九、積極回應策略對人際關係具有正向效果。 十、修正模式一與二顯示非理性信念對負向情緒激發與積極回應策略皆無直接效果，非理性信念對人際關係亦無間接效果。但不同的是，在修正模式一中，正向情緒特質會對負向情緒激發產生負向效果，但對積極回應策略與人際關係產生直接的正向效果。此外，正向情緒特質會分別透過負向情緒激發與積極回應策略的中介，進而對人際關係產生負向與正向的效果。而在修正模式二中，負向情緒特質會對負向情緒激發產生正向的直接效果，但對積極回應策略會產生負向的直接效果。此外，負向情緒特質會透過積極回應策略的中介，對人際關係產生負向的效果，且負向情緒激發會透過積極回應策略的中介，對人際關係產生正向的效果。 　　針對上述結果，本研究分別針對護理人員培育機構與醫療院所提出課程教學與人員輔導之建議，並指陳後續研究可以參考與改進的方向。 / The purpose of this study was to propose and examine a path model of irrational beliefs, emotional traits, emotional management, and interpersonal relationship among nurses in the intensive care unit (ICU). Two hundred ICU nurses in Taiwan participated in this study. The employed instruments included the Inventory of Irrational Beliefs, the Inventory of Emotional Traits, the Inventory of Emotional Management, and the Inventory of Interpersonal Relationship. Moreover, the used data analysis methods were Confirmatory factor analysis (CFA), One-way Multivariate Analysis of variance (MANOVA), and Structural Equation Modeling (SEM). The main findings of this study were as follows: 1. Participants with an educational degree under college had a stronger “sense of hope” than those with an educational degree of graduate schools. Those with long period of working experiences in hospitals showed more proactive caring behaviors than their counterparts. Moreover, those who had taken emotional-management or stress-coping courses had more positive emotional traits than their counterparts. Finally, those who had never taken stress-coping courses had a stronger sense of inferiority complex than their counterparts. 2. Participants who had a stronger irrational belief experienced more negative- emotion arousal than their counterparts. However, the interaction of irrational beliefs and emotional traits could weaken the effects of irrational beliefs on negative-emotion arousal. On the other hand, the participants’ irrational beliefs did not have effects on their employment of proactive response strategies. 3. While the ICU nurses’ positive emotional traits did not have effects on their negative-emotion arousal, such traits had positive effects on their employment of proactive response strategies. 4. While the nurses’ negative emotional traits had positive effects on their negative- emotion arousal, such traits had negative effects on their employment of proactive response strategies. 5. The nurses’ irrational beliefs did not have effects on their interpersonal relationship. 6. The nurses’ positive emotional traits had positive effects on their interpersonal relationship. 7. The nurses’ negative emotional traits had negative effects on their interpersonal relationship, and such effects were brought about via negative-emotion arousal or the employment of proactive response strategies. 8. The nurses’ negative-emotion arousal did not have effects on their interpersonal relationship; however, when influenced by positive emotional traits, the negative-emotion arousal had positive effects on interpersonal relationship. 9. The nurses’ employment of proactive response strategies had positive effects on their interpersonal relationship. 10. The results of Modified Model 1 and Model 2 indicated that the nurses’ irrational beliefs did not have direct effects on their employment of proactive response strategies as well as on their interpersonal relationship. In modified Model 1, however, positive emotional traits had negative effects on negative-emotion arousal and proactive emotional strategies; moreover, positive emotional traits had indirect negative effects on interpersonal relationship via negative-emotion arousal while such traits had indirect positive effects on interpersonal relationship via proactive response strategies. In modified model 2, on the contrary, negative emotional traits had positive effects on negative-emotion arousal while such traits had negative effects on proactive emotional strategies; moreover, negative emotional traits had indirect negative effects on interpersonal relationship via proactive response strategies while negative-emotion arousal had indirect positive effects on interpersonal relationship via proactive response strategies. With accordance to the above findings, the researcher proposed some suggestions with regards to teaching and counseling for nursing training institutes and medical institutions; moreover, some suggestions were proposed for future studies.

Author: Bc. Marie Hejnová Title: Effect of Functional Electrical Stimulation-Assisted Ergometry on Muscle Cross-Sectional Diameter, Nitrogen and Fluid Balance in Critically Ill Objectives: The aim of this thesis was to investigate the effect of functional electrical stimulation-assisted cycling ergometry (FES-CE) on cross-sectional diameter of the quadriceps femoris (QF) muscle of both lower extremities in critically ill patients. Another objective was to evaluate if the measured values are responding to the changes in muscle tissue or are caused by an oedema. Methods: The intervention group received daily intensified physical therapy and FES-CE. We measured cross-sectional diameter of the QF muscle repeatedly by a diagnostic ultrasound. We recorded daily nitrogen balance to objectivize catabolism of muscle and fluid balance to objectivize amount of cumulative fluid. Results: The total of 115 patients were evaluated. Average decrease of cross-sectional diameter of QF muscle in the intervention group was 0.020 ± 0.070 cm/day, in the control group it was 0.017 ± 0.084 cm/day (p = 0.87). We registered an opposite result from the eighth day onwards, the intervention group had average decrease 0.025 ± 0.047 cm/day and the control group 0.040 ± 0.076 cm/day (p = 0.38). The nitrogen intake was...

Introdução: A assistência ao parto no Brasil tem enfrentado desafios nos últimos anos, no sentido de reduzir práticas desnecessárias e inseguras. No entanto, medidas utilizadas para acelerar o trabalho de parto e demais intervenções durante o trabalho de parto e parto ainda são frequentes e podem impactar negativamente as condições de vitalidade do recém-nascido. Objetivos: Analisar a associação entre os fatores sociodemográficos, organizacionais, obstétricos e assistenciais e desfecho neonatal desfavorável entre RNs de termo e estimar sua frequência. Método: Estudo transversal, a partir dos dados do inquérito nacional Nascer no Brasil, referentes à região Sudeste. A amostra foi composta por puérperas que tiveram RNs vivos, natimortos (peso 500 gramas e/ou idade gestacional 22 semanas), nascidos em hospitais com 500 partos em 2011 e 2012. Foram excluídos os recém-nascidos prematuros, gemelares e aqueles com malformações. A variável dependente desfecho neonatal desfavorável foi construída por meio da composição das variáveis intubação traqueal, massagem cardíaca, uso de drogas na reanimação neonatal, internação em UTI neonatal e Apgar <7 no 5.o minuto de vida no período pós-natal imediato. A associação entre as variáveis de interesse e a variável desfecho foi estimada por meio de regressão logística binária univariada e múltipla, calculando-se Odds ratio (OR) brutas e ajustadas com intervalos de confiança de 95 por cento (IC 95 por cento ). Resultados: A amostra foi composta por 8.783 mulheres e seus RNs. A proporção de RNs que apresentou desfecho neonatal desfavorável foi de 9,6 por cento (844). Ensino fundamental incompleto (OR=2,139; IC 95 por cento 1,292-3,540), baixo peso ao nascer (peso 2.500g; OR=2,822; IC 95 por cento 1,641-4,851), intercorrência obstétrica (OR=1,421; IC 95 por cento 1,055-1,914) e parto fórceps (OR=3,761; IC 95 por cento 1,824-7,754) constituíram fatores associados ao desfecho neonatal desfavorável. Discussão: Os fatores independentemente associados ao desfecho neonatal desfavorável na Região Sudeste do Brasil foram em sua maioria condições clínicas que têm influência sobre a condição do recém-nascido no período pós-parto imediato. Recém-nascidos com baixo peso e aqueles filhos de mulheres com problemas obstétricos têm condições como líquido amniótico reduzido ou insuficiência placentária que resultam em alterações da vitalidade. Mulheres com baixa escolaridade têm maior dificuldade em acessar os serviços de saúde, o que pode dificultar a identificação e tratamento de problemas obstétricos e baixo peso ao nascer. O parto fórceps pode representar a resolução de trabalhos de parto distócicos e também ser um marcador para os fetos cuja vitalidade encontrava-se alterada durante o trabalho de parto. Conclusões: Fatores clínicos e associados a desigualdades sociais têm impacto negativo sobre a vitalidade dos recém-nascidos. Os desfechos neonatais desfavoráveis ainda são pouco investigados, por isso ações que visem à melhoria da atenção pré-natal e do trabalho de parto, principalmente entre mulheres com baixa escolaridade e aquelas com complicações obstétricas, podem resultar em melhores desfechos de saúde para o recém-nascido. Encontramos uma proporção de 9,6 por cento (844) entre os recém-nascidos no termo gestacional que apresentaram desfecho neonatal desfavorável. Neste estudo foi possível observar a existência de associação entre fatores sociodemográficos, clínicos e assistenciais maternos e desfechos neonatais desfavoráveis entre os RNs de termo / Introduction: Childbirth care in Brazil has faced challenges in recent years to reduce unnecessary and unsafe practices. However, measures used to accelerate labour and other interventions during labour and delivery are still frequent and may negatively impact the vitality of the newborn. Objectives: To analyze the association between sociodemographic, organizational, obstetric and care factors and unfavorable neonatal outcomes among term newborns and to estimate the frequency of these outcomes. Method: A cross-sectional study, based on data from the national survey \"Birth in Brazil\" in the the Southeast region of Brazil. The sample consisted of mothers who had live births, stillbirths (weight 500 grams and / or gestational age 22 weeks) in hospitals with 500 births in 2011 and 2012. Premature babies, twins, preterm newborns and those with malformations were excluded from the analysis. The dependent variable \"unfavorable neonatal outcome\" was constructed through the composition of the variables tracheal intubation, cardiac massage, drug use in neonatal resuscitation, neonatal ICU admission, and Apgar <7 at the 5th minute of life in the immediate postnatal period. The association between the variables of interest and the outcome variable was estimated using univariate and multiple binary logistic regression, calculating crude and adjusted Odds Ratio (OR) with 95 per cent confidence intervals (95 per cent CI). Results: The sample consisted of 8,773 women and their newborns. The proportion of newborns who presented an unfavorable neonatal outcome was 9.6 per cent (844). Incomplete primary education (OR = 2.139, 95 per cent CI 1.292-3.540), low birth weight (weight 2.500g, OR = 2.822, 95 per cent CI 1.641-4.851), obstetric complication (OR = 1.421, 95 per cent CI 1.055-1.914) and Forceps (OR = 3.761, 95 per cent CI, 1.824-7.754) were factors associated with unfavorable neonatal outcome. Discussion: Factors independently associated with unfavorable neonatal outcomes in the Southeast Region of Brazil were mostly clinical conditions that influence the condition of the newborn in the immediate postpartum period. Infants with low birth weight and those of women with obstetric problems have conditions such as reduced amniotic fluid or placental insufficiency that result in changes in vitality. Women with low schooling have greater difficulty in accessing health services, which make it difficult to identify and treat obstetric problems and low birth weight. Forceps delivery may represent resolution of dystocic labor and was also be a marker for fetuses whose vitality was altered during labor. Conclusions: Clinical factors associated with social inequalities have a negative impact on the vitality of newborns. Negative neonatal outcomes are still poorly investigated, so actions aimed at improving prenatal care and labor, especially among women with low schooling and those with obstetric complications, may result in better health outcomes for the newborn. We found a proportion of 9.6 per cent (844) among neonates in the gestational term who presented an unfavorable neonatal outcome. In this study it was possible to observe the existence of an association between sociodemographic, clinical and maternal care factors and unfavorable neonatal outcomes among the term newborns