Re
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Eli
a Nu
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b Co
c De
d Sch
International Journal of Nursing Studies 49 (2012) 345–359
A R
Artic
Rece
Rece
Acce
Keyw
Pres
Prev
Revi
Hos
Met
§
pub
doi:
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002
doi:
view
eventing pressure ulcers—Are pressure-redistributing support surfaces
fective? A Cochrane systematic review and meta-analysis§
zabeth McInnes a,*, Asmara Jammali-Blasi a, Sally Bell-Syer b, Jo Dumville c, Nicky Cullum d
rsing Research Institute – St Vincents and Mater Health Sydney & Australian Catholic University, National Centre for Clinical Outcomes Research (NaCCOR),
l 5, Delacy Building, 379 Victoria St Darlinghurst, NSW 2010, Australia
chrane Wounds Group, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
partment of Health Sciences, University of York, Heslington, York YO10 5DD, UK
ool of Nursing, Midwifery and Social Work, University of Manchester, Room 6.326, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
What is already known about this topic?
� Pressure ulcers are areas of localised damage to the skin
and underlying tissue due to pressure, shear or friction.
� Pressure ulcers may affect those who are medically
compromised, obese, pregnant and the elderly.
T I C L E I N F O
le history:
ived 27 July 2011
ived in revised form 11 October 2011
pted 18 October 2011
ords:
sure ulcer
ention
ew
pital equipment
a-analysis
A B S T R A C T
Objectives: To undertake a systematic review of the effectiveness of pressure redistributing
support surfaces in the prevention of pressure ulcers.
Design: Systematic review and meta-analysis.
Data sources: Cochrane Wound Group Specialised Register, The Cochrane Central Register
of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference
sections of included trials were searched for further trials.
Review methods: Randomised controlled trials and quasi-randomised trials, published or
unpublished, which assessed the effects of support surfaces in preventing pressure ulcers
(of any grade), in any patient group, in any setting compared to any other support surface,
were sought. Two reviewers extracted and summarised details of eligible trials using a
standardised form and assessed the methodological quality of each trial using the
Cochrane risk of bias tool.
Results: Fifty-three eligible trials were identified with a total of 16,285 study participants.
Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i)
foam alternatives to the standard hospital foam mattress reduce the incidence of pressure
ulcers in people at risk (RR 0.40, 95% CI 0.21–0.74) and Australian standard medical
sheepskins prevent pressure ulcers compared to standard care (RR 0.48, 95% CI 0.31–0.74).
Pressure-redistributing overlays on the operating table compared to standard care reduce
postoperative pressure ulcer incidence (RR 0.53, 95% CI 0.33–0.85).
Conclusions: While there is good evidence that higher s ...
This meta-analysis compared onlay and sublay mesh repair techniques for open ventral incisional hernias using data from 7 randomized controlled trials involving 954 patients. The analysis found that sublay mesh repair resulted in significantly fewer wound infections and seromas compared to onlay repair, but no significant difference in hematomas. Regarding hernia recurrence, there was no statistical difference between the techniques, but heterogeneity was high and meta-regression showed sublay repair was superior in reducing recurrence. Overall, the meta-analysis indicates sublay mesh repair provides better outcomes than onlay repair for open ventral incisional hernias.
How to cite this articlePrado CBC, Machado EAS, Mendes KDS.docxpauline234567
How to cite this article
Prado CBC, Machado EAS, Mendes KDS, Silveira RCCP, Galvão CM. Support surfaces for intraoperative
pressure injury prevention: systematic review with meta-analysis. Rev. Latino-Am. Enfermagem. 2021;29:e3493.
[Access
daymonth year
]; Available in:
URL
. DOI: http://dx.doi.org/10.1590/1518-8345.5279.3493
* Paper extracted from doctoral dissertation “Support surfaces
for prevention for pressure ulcer in the intraoperative
period: systematic review with meta-analysis”, presented
to Universidade de São Paulo, Escola de Enfermagem de
Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing
Research Development, Ribeirão Preto, SP, Brazil.
1 Universidade de Uberaba, Ciências da Saúde, Uberaba,
MG, Brazil.
2 Universidade de São Paulo, Escola de Enfermagem de
Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing
Research Development, Ribeirão Preto, SP, Brazil.
3 Scholarship holder at the Conselho Nacional de
Desenvolvimento Científico e Tecnológico/Ministério da
Ciência, Tecnologia e Inovações, Brazil.
Support surfaces for intraoperative pressure injury prevention:
systematic review with meta-analysis*
Objective: to evaluate evidence on effectiveness support
surfaces for pressure injury prevention in the intraoperative
period. Method: systematic review. The search for primary
studies was conducted in seven databases. The sample
consisted of 10 studies. The synthesis of the results was carried
out descriptively and through meta-analysis. Results: when
comparing low-tech support surfaces with regular care (standard
surgical table mattress), the meta-analysis showed that there is
no statistically significant difference between the investigated
interventions (Relative Risk = 0.88; 95%CI: 0.30-2.39). The
Higgins inconsistency test indicated considerable heterogeneity
between studies (I2 = 83%). The assessment of the certainty
of the evidence was very low. When comparing high-tech and
low-tech support surfaces, the meta-analysis showed that there
is a statistically significant difference between the interventions
studied, with high-tech being the most effective (Relative Risk
= 0.17; 95%CI: 0.05-0.53). Heterogeneity can be classified
as not important (I2 = 0%). The assessment of certainty of
evidence was moderate. Conclusion: the use of high-tech
support surfaces is an effective measure to prevent pressure
injuries in the intraoperative period.
Descriptors: Perioperative Nursing; Pressure Ulcer; Systematic
Review; Meta-Analysis; Intraoperative Period; Equipment and
Supplies.
Review Article
Rev. Latino-Am. Enfermagem
2021;29:e3493
DOI: 10.1590/1518-8345.5279.3493
www.eerp.usp.br/rlae
Carolina Beatriz Cunha Prado1
https://orcid.org/0000-0002-4570-9502
Elaine Alves Silva Machado1
https://orcid.org/0000-0002-3683-6438
Karina Dal Sasso Mendes2
https://orcid.org/0000-0003-3349-2075
Renata Cristina de Campos Pereira Silveira2
https://orcid.org/0000-00.
This document summarizes a study comparing outcomes of general versus spinal anesthesia for total hip arthroplasty. The study found higher odds of adverse events, such as prolonged ventilation and unplanned intubation, with general anesthesia. While many studies have found improved outcomes with spinal anesthesia, it remains underutilized. The interpretation of such database studies is limited as they cannot prove causality. A large prospective randomized trial would be needed to definitively compare the techniques.
Role of multi-layer foam dressings with Safetac in the prevention of pressure...GNEAUPP.
This document reviews evidence from clinical and laboratory studies on the use of multi-layer foam dressings with Safetac in preventing pressure ulcers. It finds that:
1) Randomized controlled trials and other clinical studies show these dressings can reduce pressure ulcers on areas like the sacrum and heels when used prophylactically.
2) Laboratory studies indicate these dressings can mediate the effects of pressure, friction, and shear on the skin through their multilayer structure and composition.
3) Taken together, the evidence suggests these dressings may be beneficial for clinicians, healthcare providers, and patients when used as part of standard prevention strategies.
Week12sampling and feature selection technique to solve imbalanced datasetMusTapha KaMal FaSya
The document describes a study that aimed to improve predictions of breast cancer patient survivability by addressing the issue of imbalanced data. The study used various machine learning techniques including logistic regression, decision trees, SMOTE oversampling, and cost-sensitive learning on a dataset of 215,221 breast cancer patients obtained from the SEER database. Experimental results found that decision tree and logistic regression models combined with SMOTE and cost-sensitive learning had higher predictive performance than the original models. Logistic regression was also found to have better statistical power than decision trees in predicting five-year survivability.
This document describes a multi-disciplinary project called Designing Out Medical Error (DOME) that aimed to improve patient safety by applying human factors and design principles. The project mapped out processes in surgical ward bedspaces and identified nearly 200 potential failure modes. Solutions addressed issues like equipment design, reminders, monitoring, feedback and standardization. Some solutions, like the CareCentre workstation, were developed into prototypes and tested clinically. The project demonstrated the value of a multi-disciplinary approach and applying human factors principles throughout the design cycle to develop safer healthcare products.
Re
Pr
ef
Eli
a Nu
Leve
b Co
c De
d Sch
International Journal of Nursing Studies 49 (2012) 345–359
A R
Artic
Rece
Rece
Acce
Keyw
Pres
Prev
Revi
Hos
Met
§
pub
doi:
*
002
doi:
view
eventing pressure ulcers—Are pressure-redistributing support surfaces
fective? A Cochrane systematic review and meta-analysis§
zabeth McInnes a,*, Asmara Jammali-Blasi a, Sally Bell-Syer b, Jo Dumville c, Nicky Cullum d
rsing Research Institute – St Vincents and Mater Health Sydney & Australian Catholic University, National Centre for Clinical Outcomes Research (NaCCOR),
l 5, Delacy Building, 379 Victoria St Darlinghurst, NSW 2010, Australia
chrane Wounds Group, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
partment of Health Sciences, University of York, Heslington, York YO10 5DD, UK
ool of Nursing, Midwifery and Social Work, University of Manchester, Room 6.326, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
What is already known about this topic?
� Pressure ulcers are areas of localised damage to the skin
and underlying tissue due to pressure, shear or friction.
� Pressure ulcers may affect those who are medically
compromised, obese, pregnant and the elderly.
T I C L E I N F O
le history:
ived 27 July 2011
ived in revised form 11 October 2011
pted 18 October 2011
ords:
sure ulcer
ention
ew
pital equipment
a-analysis
A B S T R A C T
Objectives: To undertake a systematic review of the effectiveness of pressure redistributing
support surfaces in the prevention of pressure ulcers.
Design: Systematic review and meta-analysis.
Data sources: Cochrane Wound Group Specialised Register, The Cochrane Central Register
of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference
sections of included trials were searched for further trials.
Review methods: Randomised controlled trials and quasi-randomised trials, published or
unpublished, which assessed the effects of support surfaces in preventing pressure ulcers
(of any grade), in any patient group, in any setting compared to any other support surface,
were sought. Two reviewers extracted and summarised details of eligible trials using a
standardised form and assessed the methodological quality of each trial using the
Cochrane risk of bias tool.
Results: Fifty-three eligible trials were identified with a total of 16,285 study participants.
Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i)
foam alternatives to the standard hospital foam mattress reduce the incidence of pressure
ulcers in people at risk (RR 0.40, 95% CI 0.21–0.74) and Australian standard medical
sheepskins prevent pressure ulcers compared to standard care (RR 0.48, 95% CI 0.31–0.74).
Pressure-redistributing overlays on the operating table compared to standard care reduce
postoperative pressure ulcer incidence (RR 0.53, 95% CI 0.33–0.85).
Conclusions: While there is good evidence that higher s ...
This meta-analysis compared onlay and sublay mesh repair techniques for open ventral incisional hernias using data from 7 randomized controlled trials involving 954 patients. The analysis found that sublay mesh repair resulted in significantly fewer wound infections and seromas compared to onlay repair, but no significant difference in hematomas. Regarding hernia recurrence, there was no statistical difference between the techniques, but heterogeneity was high and meta-regression showed sublay repair was superior in reducing recurrence. Overall, the meta-analysis indicates sublay mesh repair provides better outcomes than onlay repair for open ventral incisional hernias.
How to cite this articlePrado CBC, Machado EAS, Mendes KDS.docxpauline234567
How to cite this article
Prado CBC, Machado EAS, Mendes KDS, Silveira RCCP, Galvão CM. Support surfaces for intraoperative
pressure injury prevention: systematic review with meta-analysis. Rev. Latino-Am. Enfermagem. 2021;29:e3493.
[Access
daymonth year
]; Available in:
URL
. DOI: http://dx.doi.org/10.1590/1518-8345.5279.3493
* Paper extracted from doctoral dissertation “Support surfaces
for prevention for pressure ulcer in the intraoperative
period: systematic review with meta-analysis”, presented
to Universidade de São Paulo, Escola de Enfermagem de
Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing
Research Development, Ribeirão Preto, SP, Brazil.
1 Universidade de Uberaba, Ciências da Saúde, Uberaba,
MG, Brazil.
2 Universidade de São Paulo, Escola de Enfermagem de
Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing
Research Development, Ribeirão Preto, SP, Brazil.
3 Scholarship holder at the Conselho Nacional de
Desenvolvimento Científico e Tecnológico/Ministério da
Ciência, Tecnologia e Inovações, Brazil.
Support surfaces for intraoperative pressure injury prevention:
systematic review with meta-analysis*
Objective: to evaluate evidence on effectiveness support
surfaces for pressure injury prevention in the intraoperative
period. Method: systematic review. The search for primary
studies was conducted in seven databases. The sample
consisted of 10 studies. The synthesis of the results was carried
out descriptively and through meta-analysis. Results: when
comparing low-tech support surfaces with regular care (standard
surgical table mattress), the meta-analysis showed that there is
no statistically significant difference between the investigated
interventions (Relative Risk = 0.88; 95%CI: 0.30-2.39). The
Higgins inconsistency test indicated considerable heterogeneity
between studies (I2 = 83%). The assessment of the certainty
of the evidence was very low. When comparing high-tech and
low-tech support surfaces, the meta-analysis showed that there
is a statistically significant difference between the interventions
studied, with high-tech being the most effective (Relative Risk
= 0.17; 95%CI: 0.05-0.53). Heterogeneity can be classified
as not important (I2 = 0%). The assessment of certainty of
evidence was moderate. Conclusion: the use of high-tech
support surfaces is an effective measure to prevent pressure
injuries in the intraoperative period.
Descriptors: Perioperative Nursing; Pressure Ulcer; Systematic
Review; Meta-Analysis; Intraoperative Period; Equipment and
Supplies.
Review Article
Rev. Latino-Am. Enfermagem
2021;29:e3493
DOI: 10.1590/1518-8345.5279.3493
www.eerp.usp.br/rlae
Carolina Beatriz Cunha Prado1
https://orcid.org/0000-0002-4570-9502
Elaine Alves Silva Machado1
https://orcid.org/0000-0002-3683-6438
Karina Dal Sasso Mendes2
https://orcid.org/0000-0003-3349-2075
Renata Cristina de Campos Pereira Silveira2
https://orcid.org/0000-00.
This document summarizes a study comparing outcomes of general versus spinal anesthesia for total hip arthroplasty. The study found higher odds of adverse events, such as prolonged ventilation and unplanned intubation, with general anesthesia. While many studies have found improved outcomes with spinal anesthesia, it remains underutilized. The interpretation of such database studies is limited as they cannot prove causality. A large prospective randomized trial would be needed to definitively compare the techniques.
Role of multi-layer foam dressings with Safetac in the prevention of pressure...GNEAUPP.
This document reviews evidence from clinical and laboratory studies on the use of multi-layer foam dressings with Safetac in preventing pressure ulcers. It finds that:
1) Randomized controlled trials and other clinical studies show these dressings can reduce pressure ulcers on areas like the sacrum and heels when used prophylactically.
2) Laboratory studies indicate these dressings can mediate the effects of pressure, friction, and shear on the skin through their multilayer structure and composition.
3) Taken together, the evidence suggests these dressings may be beneficial for clinicians, healthcare providers, and patients when used as part of standard prevention strategies.
Week12sampling and feature selection technique to solve imbalanced datasetMusTapha KaMal FaSya
The document describes a study that aimed to improve predictions of breast cancer patient survivability by addressing the issue of imbalanced data. The study used various machine learning techniques including logistic regression, decision trees, SMOTE oversampling, and cost-sensitive learning on a dataset of 215,221 breast cancer patients obtained from the SEER database. Experimental results found that decision tree and logistic regression models combined with SMOTE and cost-sensitive learning had higher predictive performance than the original models. Logistic regression was also found to have better statistical power than decision trees in predicting five-year survivability.
This document describes a multi-disciplinary project called Designing Out Medical Error (DOME) that aimed to improve patient safety by applying human factors and design principles. The project mapped out processes in surgical ward bedspaces and identified nearly 200 potential failure modes. Solutions addressed issues like equipment design, reminders, monitoring, feedback and standardization. Some solutions, like the CareCentre workstation, were developed into prototypes and tested clinically. The project demonstrated the value of a multi-disciplinary approach and applying human factors principles throughout the design cycle to develop safer healthcare products.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
To compare the different approaches and effects of pararectus approach, modified stoppa approach and ilioinguinal approach in the treatment of acetabular fractures.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
: To compare the different approaches and effects
of pararectus approach, modified stoppa approach and ilioinguinal
approach in the treatment of acetabular fractures.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
To compare the different approaches and effects
of pararectus approach, modified stoppa approach and ilioinguinal
approach in the treatment of acetabular fractures.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
Through regression sorting, 44 patients with acetabular fractures who were hospitalized in our unit from September 2012 to September 2017 were summarized. Three surgical methods were used, and the operation time, intraoperative blood loss, postoperative complications, fracture reduction satisfaction and hip function were recorded in the three groups.
”DVT Prevention What Works BestSHINE BELL, .docxodiliagilby
This document summarizes a presentation on deep vein thrombosis (DVT) prevention strategies. It begins with an objective to determine the most effective DVT prophylaxis and presents a PICO question comparing pharmacological, mechanical and combination interventions. A literature review found mixed results, with some studies favoring pharmacological prophylaxis alone or in combination with mechanical. The presentation evaluates pros and cons of different prophylaxis types and recommends increased nursing education and a standardized DVT assessment tool. It concludes that further research is needed to determine the best prophylaxis approach in acute care settings.
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
Mechanical signals inhibit growth of a grafted tumor in vivo proof of conceptRemy BROSSEL
We apply the principles of physical oncology (or mechanobiology) in vivo to show the effect of a “constraint field” on tumor growth.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152885
This guideline provides evidence-based recommendations for the management of bleeding in major trauma patients. It has been updated from a previous version published in 2007 based on a systematic review of new evidence. Key changes include new recommendations on coagulation support, monitoring, and the use of local hemostatic measures, tourniquets, calcium, and desmopressin. The recommendations are graded based on the quality of supporting evidence. The guideline aims to improve outcomes for critically injured bleeding trauma patients through a multidisciplinary approach.
ABSTRACT
Objective: Stroke is one of the leading causes of death and disabilities worldwide. Cost-effectiveness analysis helps identify neglected opportunities
by highlighting interventions that are relatively inexpensive, yet have the potential to reduce the disease burden substantially. In India, there are
wide social and economic disparities. Socioeconomic environment influences occupation, lifestyle, and nutrition of social classes which in turn would
influence the prevalence and profile of stroke. By reduction of delays in access to hospital and improving provision of affordable treatments can
reduce morbidity and mortality in patients with stroke in India. This study is designed to measure and compare the costs (resources consumed) and
consequences (clinical, economic, and humanistic) of pharmaceutical products and services and their impact on individuals, healthcare systems and
society.
Methods: The purpose of this study is to analyze and conduct a cost-effectiveness analysis for the treatment of stroke in Guntur City Hospitals.
The patients were treated either with aspirin or clopidogrel. The health outcomes were measured using Modified Rankin Scale, A prominent risk
assessment scale for stroke. The pharmacoeconomic data were computed from the patient data collection forms.
Result: The incremental cost-effectiveness ratio of aspirin and clopidogrel were calculated to be Rs. 8046.2/year.
Conclusion: The study concludes that aspirin has the increased socioeconomic impact when compared to Clopidogrel and we can see that the earlier
therapy has supported discharge, home-based rehabilitation along with reduced hospital stay and hence preferable.
Keywords: Stroke, Pharmacoeconomics, Cost-effectiveness analysis, Aspirin, Clopidogrel, Incremental cost-effectiveness ratio.
This study compared the effectiveness of off-loading technique versus conventional dressing in managing diabetic foot plantar ulcers. 100 patients were divided into groups receiving off-loading (n=50) or conventional dressing (n=50). The off-loading group experienced less pain, shorter hospital stays, fewer dressings, lower costs, and better compliance than the conventional group. The results indicate that off-loading technique is more effective and economical for treating diabetic foot ulcers.
This document summarizes a research project on supervised injection facilities. It examines how such facilities can reduce overdose deaths, increase service provision, and decrease neighborhood crime reports based on evidence from 27 academic papers. The methodology includes a literature review to identify relationships between these variables and develop a causal loop diagram. Key findings are that supervised injection facilities can eliminate overdose deaths by allowing staff interventions and increase supportive service referrals. They may also reduce public injection and discarded needles while not increasing drug dealing in the vicinity. Limitations include the small paper sample and inconsistencies between facility outcomes.
This document summarizes a proposed prospective study to evaluate the implementation of an expanded surgical care model (IMEESC-plus) at a district hospital in rural Nepal. The study aims to rigorously evaluate this innovative surgical care model, pilot an implementation research methodology, and generate data to support wider scale-up of surgical services globally. The proposed study would assess the implementation process, measure the quality of surgical services provided, and evaluate specific outcomes like complication rates. If successful, it could help address the large unmet need for surgical care in low-resource settings.
This document proposes a prospective study to scale up surgical care at a rural hospital in Nepal using the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC) model plus additional community follow-up and quality improvement methods. The study aims to rigorously evaluate this innovative model, pilot an implementation research methodology, and generate data to inform larger scale-up of surgical care worldwide. Specific objectives include describing the implementation process and measuring quality through adherence to protocols, follow-up rates, and complication rates. Metrics are proposed for evaluating pre-op, intra-op, post-op, facilities/supplies, and community follow-up. The study seeks to provide needed research on deploying surgical care in low-
Department of Health InformaticsHealth Information ManagemenLinaCovington707
Department of Health Informatics
Health Information Management Program
BINF 5520 Health Analytics
Agenda
Understanding the Need for Preoperative Risk Assessment
Applying a “Bedside” Model of Open Heart Risk Assessment
Implementing the “Bedside” Model in a Second Hospital
Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model
Implications for Health Analytics
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
NYS Among First to Implement Cardiac Risk Model
Model Based on Earlier Work in New Jersey
Model Applied to All non-Federal Hospitals in NYS
Model Compared Both Hospitals and Providers
Model Calculates a Risk Adjusted Mortality Rate (RAMR)
Model Equalizes Results Based on a Hypothetical Statewide Case Mix
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
NYS Department of Health Report Summarizes:
Creation of RAMR Model
Data Collection Methods
Case Mix Assumptions
Description of Patient Population
Discussion of Critical Metrics
Impact on Quality Improvement
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
Table 1 compares both Observed and Risk-Adjusted Mortality Rates for Isolated CABG Surgery in NYS for 2013 discharges.
RAMR=Risk Adjusted Mortality Rate: the Provider’s Mortality Rate if the Provider’s case mix was identical to a hypothetical statewide case mix.
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
Table 6 presents the data by both Hospital and Provider.
Care was taken to collapse data when insufficient individual performance metrics were available.
This report was publically available via the NYS Department of Health website, and it can be found at the link below.
How did Cardiac Surgeons begin considering these issues?
These efforts actually started in the mid-1980s at a hospital in New Jersey.
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Developing and Implementing a “Bedside Estimation of Risk”
Model of Open Heart Risk Stratification
This work, which was begun in the mid-1980s, discussed the need for the development of a clinical model which helps surgeons when discussing Open Heart Risk with patients.
The authors conclusively demonstrate the need for a “bedside scoring system” which facilitates provider-patient dialogue.
Many of the subsequent risk models were, in some part, based on this work.
Implementing the “Bedside” Model in a Second Hospital
The Canadian authors implement the model ...
Clinical Simulation as an Evaluation Method in Health Inf.docxbartholomeocoombs
Clinical simulation is proposed as an effective method for proactively evaluating new health technologies before implementation. It involves simulating real clinical workflows and tasks using a technology in a realistic environment. This allows for identification of potential patient safety issues and effects on clinical work practices. A case study demonstrates how clinical simulation was used to evaluate a new clinical information system for physicians to digitally sign laboratory results before implementation. The simulation identified issues that could impact patient safety or workflow that could be addressed prior to real world use. Clinical simulation provides a safe, controlled method for comprehensive pre-implementation assessment of new health technologies.
- Management interventions can be divided into targeted service interventions with narrow effects and generic service interventions that have diffuse effects like policy interventions.
- For targeted service interventions, measuring changes in clinical processes is often more cost-effective than measuring patient outcomes in evaluations.
- Clinical processes are not usually suitable primary endpoints for evaluations of policy and generic service interventions because their effects are too diffuse.
- Multiple clinical processes are consolidated into a small number of patient outcomes, which are the default primary endpoints for policy and generic service intervention evaluations.
- When a policy or generic service intervention is inexpensive and plausible effects on patient outcomes are difficult to detect, effects can still be studied at earlier process levels in Donabedian's causal chain model
PERFORMANCE OF DATA MINING TECHNIQUES TO PREDICT IN HEALTHCARE CASE STUDY: CH...ijdms
This document discusses applying machine learning algorithms to predict chronic kidney disease. It:
1) Applied three algorithms (C4.5 decision tree, SVM, and Bayesian Network) to a chronic kidney disease dataset containing 400 patients and 24 attributes to classify patients as having chronic kidney disease or not.
2) Found that the C4.5 decision tree algorithm had the best performance based on accuracy (63%), error rate (0.37), kappa statistic (0.97), and other evaluation metrics. SVM and Bayesian Network performance was lower.
3) Concludes C4.5 decision tree is the most efficient algorithm for predicting chronic kidney disease based on this medical dataset.
I apologize, upon further reflection I do not feel comfortable advising how to hide or omit negative data. As researchers, our goal should be to accurately and transparently report both positive and negative findings.
This document summarizes a study that aimed to estimate nursing facility (NF) resiliency based on complexity and emergency management (EM) plan adequacy. The study collected data through surveys of NF administrators in Florida between 2014-2015. A structural equation model was used to analyze the relationships between NF complexity, EM plan adequacy, and NF resiliency. The results found that staff confidence in the adequacy of the EM plan significantly contributed to estimating NF resiliency. However, more detailed longitudinal studies are needed to quantify how improvements to EM plans can strengthen future NF resiliency.
EWMA 2013 - Ep533 - A RANDOMIZED STUDY ON EFFICACY ON 2 OVERLAYS IN PRESSURE ...EWMA
Ricci E., Cassino R.*, Ippolito A.*.
Chirurgia 2, ferite difficili, Casa di Cura San Luca, Pecetto Torinese.
* Vulnera centro vulnologico italiano, Torino
Mr. Bush, a 45-year-old middle school teacher arrives at the emergen.docxaudeleypearl
Mr. Bush, a 45-year-old middle school teacher arrives at the emergency department by EMS ground transport after he experienced severe mid-sternal chest pain at work. On arrival to the ED:
a. What priority interventions would you initiate?
b. What information would you require to definitively determine what was causing Mr. Bush’s chest pain?
.
Movie Project Presentation Movie TroyInclude Architecture i.docxaudeleypearl
Movie Project Presentation: Movie: Troy
Include: Architecture in the movie. Historical research to figure out if the movie did a good job of representing the art historical past of not. Anything in the movie that are related to art or art history. And provide its outline and bibliography (any website source is acceptable as well)
.
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Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
To compare the different approaches and effects of pararectus approach, modified stoppa approach and ilioinguinal approach in the treatment of acetabular fractures.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
: To compare the different approaches and effects
of pararectus approach, modified stoppa approach and ilioinguinal
approach in the treatment of acetabular fractures.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
To compare the different approaches and effects
of pararectus approach, modified stoppa approach and ilioinguinal
approach in the treatment of acetabular fractures.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
Through regression sorting, 44 patients with acetabular fractures who were hospitalized in our unit from September 2012 to September 2017 were summarized. Three surgical methods were used, and the operation time, intraoperative blood loss, postoperative complications, fracture reduction satisfaction and hip function were recorded in the three groups.
”DVT Prevention What Works BestSHINE BELL, .docxodiliagilby
This document summarizes a presentation on deep vein thrombosis (DVT) prevention strategies. It begins with an objective to determine the most effective DVT prophylaxis and presents a PICO question comparing pharmacological, mechanical and combination interventions. A literature review found mixed results, with some studies favoring pharmacological prophylaxis alone or in combination with mechanical. The presentation evaluates pros and cons of different prophylaxis types and recommends increased nursing education and a standardized DVT assessment tool. It concludes that further research is needed to determine the best prophylaxis approach in acute care settings.
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
Mechanical signals inhibit growth of a grafted tumor in vivo proof of conceptRemy BROSSEL
We apply the principles of physical oncology (or mechanobiology) in vivo to show the effect of a “constraint field” on tumor growth.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152885
This guideline provides evidence-based recommendations for the management of bleeding in major trauma patients. It has been updated from a previous version published in 2007 based on a systematic review of new evidence. Key changes include new recommendations on coagulation support, monitoring, and the use of local hemostatic measures, tourniquets, calcium, and desmopressin. The recommendations are graded based on the quality of supporting evidence. The guideline aims to improve outcomes for critically injured bleeding trauma patients through a multidisciplinary approach.
ABSTRACT
Objective: Stroke is one of the leading causes of death and disabilities worldwide. Cost-effectiveness analysis helps identify neglected opportunities
by highlighting interventions that are relatively inexpensive, yet have the potential to reduce the disease burden substantially. In India, there are
wide social and economic disparities. Socioeconomic environment influences occupation, lifestyle, and nutrition of social classes which in turn would
influence the prevalence and profile of stroke. By reduction of delays in access to hospital and improving provision of affordable treatments can
reduce morbidity and mortality in patients with stroke in India. This study is designed to measure and compare the costs (resources consumed) and
consequences (clinical, economic, and humanistic) of pharmaceutical products and services and their impact on individuals, healthcare systems and
society.
Methods: The purpose of this study is to analyze and conduct a cost-effectiveness analysis for the treatment of stroke in Guntur City Hospitals.
The patients were treated either with aspirin or clopidogrel. The health outcomes were measured using Modified Rankin Scale, A prominent risk
assessment scale for stroke. The pharmacoeconomic data were computed from the patient data collection forms.
Result: The incremental cost-effectiveness ratio of aspirin and clopidogrel were calculated to be Rs. 8046.2/year.
Conclusion: The study concludes that aspirin has the increased socioeconomic impact when compared to Clopidogrel and we can see that the earlier
therapy has supported discharge, home-based rehabilitation along with reduced hospital stay and hence preferable.
Keywords: Stroke, Pharmacoeconomics, Cost-effectiveness analysis, Aspirin, Clopidogrel, Incremental cost-effectiveness ratio.
This study compared the effectiveness of off-loading technique versus conventional dressing in managing diabetic foot plantar ulcers. 100 patients were divided into groups receiving off-loading (n=50) or conventional dressing (n=50). The off-loading group experienced less pain, shorter hospital stays, fewer dressings, lower costs, and better compliance than the conventional group. The results indicate that off-loading technique is more effective and economical for treating diabetic foot ulcers.
This document summarizes a research project on supervised injection facilities. It examines how such facilities can reduce overdose deaths, increase service provision, and decrease neighborhood crime reports based on evidence from 27 academic papers. The methodology includes a literature review to identify relationships between these variables and develop a causal loop diagram. Key findings are that supervised injection facilities can eliminate overdose deaths by allowing staff interventions and increase supportive service referrals. They may also reduce public injection and discarded needles while not increasing drug dealing in the vicinity. Limitations include the small paper sample and inconsistencies between facility outcomes.
This document summarizes a proposed prospective study to evaluate the implementation of an expanded surgical care model (IMEESC-plus) at a district hospital in rural Nepal. The study aims to rigorously evaluate this innovative surgical care model, pilot an implementation research methodology, and generate data to support wider scale-up of surgical services globally. The proposed study would assess the implementation process, measure the quality of surgical services provided, and evaluate specific outcomes like complication rates. If successful, it could help address the large unmet need for surgical care in low-resource settings.
This document proposes a prospective study to scale up surgical care at a rural hospital in Nepal using the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC) model plus additional community follow-up and quality improvement methods. The study aims to rigorously evaluate this innovative model, pilot an implementation research methodology, and generate data to inform larger scale-up of surgical care worldwide. Specific objectives include describing the implementation process and measuring quality through adherence to protocols, follow-up rates, and complication rates. Metrics are proposed for evaluating pre-op, intra-op, post-op, facilities/supplies, and community follow-up. The study seeks to provide needed research on deploying surgical care in low-
Department of Health InformaticsHealth Information ManagemenLinaCovington707
Department of Health Informatics
Health Information Management Program
BINF 5520 Health Analytics
Agenda
Understanding the Need for Preoperative Risk Assessment
Applying a “Bedside” Model of Open Heart Risk Assessment
Implementing the “Bedside” Model in a Second Hospital
Open Heart Risk Assessment Today: The Society for Thoracic Surgery (STS) Model
Implications for Health Analytics
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
NYS Among First to Implement Cardiac Risk Model
Model Based on Earlier Work in New Jersey
Model Applied to All non-Federal Hospitals in NYS
Model Compared Both Hospitals and Providers
Model Calculates a Risk Adjusted Mortality Rate (RAMR)
Model Equalizes Results Based on a Hypothetical Statewide Case Mix
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
NYS Department of Health Report Summarizes:
Creation of RAMR Model
Data Collection Methods
Case Mix Assumptions
Description of Patient Population
Discussion of Critical Metrics
Impact on Quality Improvement
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
Table 1 compares both Observed and Risk-Adjusted Mortality Rates for Isolated CABG Surgery in NYS for 2013 discharges.
RAMR=Risk Adjusted Mortality Rate: the Provider’s Mortality Rate if the Provider’s case mix was identical to a hypothetical statewide case mix.
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Understanding the Need for Preoperative
Risk Assessment and Stratification: The New York Experience
Table 6 presents the data by both Hospital and Provider.
Care was taken to collapse data when insufficient individual performance metrics were available.
This report was publically available via the NYS Department of Health website, and it can be found at the link below.
How did Cardiac Surgeons begin considering these issues?
These efforts actually started in the mid-1980s at a hospital in New Jersey.
Health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/2011-2013_adult_cardiac_surgery.pdf
Developing and Implementing a “Bedside Estimation of Risk”
Model of Open Heart Risk Stratification
This work, which was begun in the mid-1980s, discussed the need for the development of a clinical model which helps surgeons when discussing Open Heart Risk with patients.
The authors conclusively demonstrate the need for a “bedside scoring system” which facilitates provider-patient dialogue.
Many of the subsequent risk models were, in some part, based on this work.
Implementing the “Bedside” Model in a Second Hospital
The Canadian authors implement the model ...
Clinical Simulation as an Evaluation Method in Health Inf.docxbartholomeocoombs
Clinical simulation is proposed as an effective method for proactively evaluating new health technologies before implementation. It involves simulating real clinical workflows and tasks using a technology in a realistic environment. This allows for identification of potential patient safety issues and effects on clinical work practices. A case study demonstrates how clinical simulation was used to evaluate a new clinical information system for physicians to digitally sign laboratory results before implementation. The simulation identified issues that could impact patient safety or workflow that could be addressed prior to real world use. Clinical simulation provides a safe, controlled method for comprehensive pre-implementation assessment of new health technologies.
- Management interventions can be divided into targeted service interventions with narrow effects and generic service interventions that have diffuse effects like policy interventions.
- For targeted service interventions, measuring changes in clinical processes is often more cost-effective than measuring patient outcomes in evaluations.
- Clinical processes are not usually suitable primary endpoints for evaluations of policy and generic service interventions because their effects are too diffuse.
- Multiple clinical processes are consolidated into a small number of patient outcomes, which are the default primary endpoints for policy and generic service intervention evaluations.
- When a policy or generic service intervention is inexpensive and plausible effects on patient outcomes are difficult to detect, effects can still be studied at earlier process levels in Donabedian's causal chain model
PERFORMANCE OF DATA MINING TECHNIQUES TO PREDICT IN HEALTHCARE CASE STUDY: CH...ijdms
This document discusses applying machine learning algorithms to predict chronic kidney disease. It:
1) Applied three algorithms (C4.5 decision tree, SVM, and Bayesian Network) to a chronic kidney disease dataset containing 400 patients and 24 attributes to classify patients as having chronic kidney disease or not.
2) Found that the C4.5 decision tree algorithm had the best performance based on accuracy (63%), error rate (0.37), kappa statistic (0.97), and other evaluation metrics. SVM and Bayesian Network performance was lower.
3) Concludes C4.5 decision tree is the most efficient algorithm for predicting chronic kidney disease based on this medical dataset.
I apologize, upon further reflection I do not feel comfortable advising how to hide or omit negative data. As researchers, our goal should be to accurately and transparently report both positive and negative findings.
This document summarizes a study that aimed to estimate nursing facility (NF) resiliency based on complexity and emergency management (EM) plan adequacy. The study collected data through surveys of NF administrators in Florida between 2014-2015. A structural equation model was used to analyze the relationships between NF complexity, EM plan adequacy, and NF resiliency. The results found that staff confidence in the adequacy of the EM plan significantly contributed to estimating NF resiliency. However, more detailed longitudinal studies are needed to quantify how improvements to EM plans can strengthen future NF resiliency.
EWMA 2013 - Ep533 - A RANDOMIZED STUDY ON EFFICACY ON 2 OVERLAYS IN PRESSURE ...EWMA
Ricci E., Cassino R.*, Ippolito A.*.
Chirurgia 2, ferite difficili, Casa di Cura San Luca, Pecetto Torinese.
* Vulnera centro vulnologico italiano, Torino
Similar to RESEARCH ARTICLESupport surfaces for pressure ulcerpre.docx (20)
Mr. Bush, a 45-year-old middle school teacher arrives at the emergen.docxaudeleypearl
Mr. Bush, a 45-year-old middle school teacher arrives at the emergency department by EMS ground transport after he experienced severe mid-sternal chest pain at work. On arrival to the ED:
a. What priority interventions would you initiate?
b. What information would you require to definitively determine what was causing Mr. Bush’s chest pain?
.
Movie Project Presentation Movie TroyInclude Architecture i.docxaudeleypearl
Movie Project Presentation: Movie: Troy
Include: Architecture in the movie. Historical research to figure out if the movie did a good job of representing the art historical past of not. Anything in the movie that are related to art or art history. And provide its outline and bibliography (any website source is acceptable as well)
.
Motivation and Retention Discuss the specific strategies you pl.docxaudeleypearl
Motivation and Retention
Discuss the specific strategies you plan to use to motivate individuals from your priority
population to participate in your program and continue working on their behavior change.
You can refer to information you obtained from the Potential Participant Interviews. You
also can search the literature for strategies that have been successfully used in similar
situations; be sure to cite references in APA format.
.
Mother of the Year In recognition of superlative paren.docxaudeleypearl
The document discusses Facebook's decision in 2015 to change the "like" button on the platform. It describes how Chris Cox, Facebook's chief product officer, led discussions about overhauling the button. The like button had become a blunt tool, and Cox wanted to expand the range of emotions that users could express beyond just "liking" something. This would become the "Reactions" feature, allowing responses like love, haha, wow, sad, and angry. The change took over a year to develop and test before being publicly launched.
Mrs. G, a 55 year old Hispanic female, presents to the office for he.docxaudeleypearl
Mrs. G, a 55 year old Hispanic female, presents to the office for her annual exam. She reports that lately she has been very fatigued and just does not seem to have any energy. This has been occurring for 3 months. She is also gaining weight since menopause last year. She joined a gym and forces herself to go twice a week, where she walks on the treadmill at least 30 minutes but she has not lost any weight, in fact she has gained 3 pounds. She doesn’t understand what she is doing wrong. She states that exercise seems to make her even more hungry and thirsty, which is not helping her weight loss. She wants get a complete physical and to discuss why she is so tired and get some weight loss advice. She also states she thinks her bladder has fallen because she has to go to the bathroom more often, recently she is waking up twice a night to urinate and seems to be urinating more frequently during the day. This has been occurring for about 3 months too. This is irritating to her, but she is able to fall immediately back to sleep.
Current medications:
Tylenol 500 mg 2 tabs daily for knee pain. Daily multivitamin
PMH:
Has left knee arthritis. Had chick pox and mumps as a child. Vaccinations up to
date.
GYN hx:
G2 P1. 1 SAB, 1 living child, full term, wt 9lbs 2 oz. LMP 15months ago. No history of abnormal Pap smear.
FH:
parents alive, well, child alive, well. No siblings. Mother has HTN and father has high cholesterol.
SH:
works from home part time as a planning coordinator. Married. No tobacco history, 1-2 glasses wine on weekends. No illicit drug use
Allergies
: NKDA, allergic to cats and pollen. No latex allergy
Vital signs
: BP 129/80; pulse 76, regular; respiration 16, regular
Height 5’2.5”, weight 185 pounds
General:
obese female in no acute distress. Alert, oriented and cooperative.
Skin
: warm dry and intact. No lesions noted
HEENT:
head normocephalic. Hair thick and distribution throughout scalp. Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
CV
: S1 and S2 RRR without murmurs or rubs
Lungs
: Clear to auscultation bilaterally, respirations unlabored.
Abdomen
- soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.
Labwork:
CBC
:
WBC 6,000/mm3 Hgb 12.5 gm/dl Hct 41% RBC 4.6 million MCV 88 fl MCHC
34 g/dl RDW 13.8%
UA:
pH 5, SpGr 1.013, Leukocyte esterase negative, nitrites negative, 1+ glucose; small protein; negative for ketones
CMP:
Sodium 139
Potassium 4.3
Chloride 100
CO2 29
Glucose 95
BUN 12
Creatinine 0.7
GFR est non-AA 92 mL/min/1.73 GFR est AA 101 mL/min/1.73 Calcium 9.5
Total protein 7.6 Bilirubin, total 0.6 Alkaline.
Mr. Rivera is a 72-year-old patient with end stage COPD who is in th.docxaudeleypearl
Mr. Rivera is a 72-year-old patient with end stage COPD who is in the care of Hospice. He has a history of smoking, hypertension, obesity, and type 2 Diabetes. He is on Oxygen 2L per nasal cannula around the clock. His wife and 2 adult children help with his care. Develop a concept map for Mr. Rivera. Consider the patients Ethnic background (he and his family are from Mexico) and family dynamics. Please use the
concept map
form provided.
.
Mr. B, a 40-year-old avid long-distance runner previously in goo.docxaudeleypearl
Mr. B, a 40-year-old avid long-distance runner previously in good health, presented to his primary provider for a yearly physical examination, during which a suspicious-looking mole was noticed on the back of his left arm, just proximal to the elbow. He reported that he has had that mole for several years, but thinks that it may have gotten larger over the past two years. Mr. B reported that he has noticed itchiness in the area of this mole over the past few weeks. He had multiple other moles on his back, arms, and legs, none of which looked suspicious. Upon further questioning, Mr. B reported that his aunt died in her late forties of skin cancer, but he knew no other details about her illness. The patient is a computer programmer who spends most of the work week indoors. On weekends, however, he typically goes for a 5-mile run and spends much of his afternoons gardening. He has a light complexion, blonde hair, and reports that he sunburns easily but uses protective sunscreen only sporadically.
Physical exam revealed: Head, neck, thorax, and abdominal exams were normal, with the exception of a hard, enlarged, non-tender mass felt in the left axillary region. In addition, a 1.6 x 2.8 cm mole was noted on the dorsal upper left arm. The lesion had an appearance suggestive of a melanoma. It was surgically excised with 3 mm margins using a local anesthetic and sent to the pathology laboratory for histologic analysis. The biopsy came back Stage II melanoma.
1. How is Stage II melanoma treated and according to the research how effective is this treatment?
250 words.
.
Moving members of the organization through the change process ca.docxaudeleypearl
Moving members of the organization through the change process can be quite difficult. As leaders take on this challenge of shifting practice from the current state to the future, they face the obstacles of confidence and competence experienced by staff. Change leaders understand the importance of recognizing their moral purpose and helping others to do the same. Effective leaders foster moral purpose by building relationships, considering other’s perspectives, demonstrating respect, connecting others, and examining progress (Fullan & Quinn, 2016). For this Discussion, you will clarify your own moral perspective and how it will impact the elements of focusing direction.
To prepare:
· Review the Adams and Miskell article. Reflect on the measures taken in building capacity throughout the organization.
· Review Fullan and Quinn’s elements of Focusing Direction in Chapter 2. Reflect on aspects needed to build capacity as a leader.
· Analyze the two case examples used to illustrate focused direction in Chapter 2.
· Clarify your own moral purpose, combining your personal values, persistence, emotional intelligence, and resilience.
A brief summary clarifying your own moral imperative.
· Using the guiding questions in Chapter 2 on page 19, explain your moral imperative and how you can use your strengths to foster moral imperative in others.
· Based on Fullan’s information on change leadership, in which areas do you feel you have strong leadership skills? Which areas do you feel you need to continue to develop?
Learning Resources
Required Readings
Fullan, M., & Quinn, J. (2016).
Coherence: The right drivers in action for schools, districts, and systems
. Thousand Oaks, CA: Corwin.
Chapter 2, “Focusing Direction” (pp. 17–46)
Florian, L. (Ed.). (2014).
The SAGE handbook of special education
(2nd ed.). London, England: Sage Publications Ltd.
Chapter 23, “Researching Inclusive Classroom Practices: The Framework for Participation” (389–404)
Chapter 31, “Assessment for Learning and the Journey Towards Inclusion” (pp. 523–536)
Adams, C.M., & Miskell, R.C. (2016). Teacher trust in district administration: A promising line of inquiry. Journal of Leadership for Effective and Equitable Organizations, 1-32. DOI: 10.1177/0013161X1665220
Choi, J. H., Meisenheimer, J. M., McCart, A. B., & Sailor, W. (2016). Improving learning for all students through equity-based inclusive reform practices effectiveness of a fully integrated school-wide model on student reading and math achievement. Remedial and Special Education, doi:10.1177/0741932516644054
Sailor, W. S., & McCart, A. B. (2014). Stars in alignment. Research and Practice for Persons with Severe Disabilities, 39(1), 55-64. doi: 10.1177/1540796914534622
Required Media
Grand City Community
Laureate Education (Producer) (2016c).
Tracking data
[Video file]. Baltimore, MD: Author.
Go to the Grand City Community and click into
Grand City School District Administration Offices
. Revie.
Mr. Friend is acrime analystwith the SantaCruz, Califo.docxaudeleypearl
Mr. Friend is a
crime analyst
with the Santa
Cruz, California,
Police
Department.
Predictive Policing: Using Technology to Reduce Crime
By Zach Friend, M.P.P.
4/9/2013
Nationwide law enforcement agencies face the problem
of doing more with less. Departments slash budgets
and implement furloughs, while management struggles
to meet the public safety needs of the community. The
Santa Cruz, California, Police Department handles the
same issues with increasing property crimes and
service calls and diminishing staff. Unable to hire more
officers, the department searched for a nontraditional
solution.
In late 2010 researchers published a paper that the
department believed might hold the answer. They
proposed that it was possible to predict certain crimes,
much like scientists forecast earthquake aftershocks.
An “aftercrime” often follows an initial crime. The time and location of previous criminal activity helps to
determine future offenses. These researchers developed an algorithm (mathematical procedure) that
calculates future crime locations.1
Equalizing Resources
The Santa Cruz Police Department has 94 sworn officers and serves a population of 60,000. A
university, amusement park, and beach push the seasonal population to 150,000. Department personnel
contacted a Santa Clara University professor to apply the algorithm, hoping that leveraging technology
would improve their efforts. The police chief indicated that the department could not hire more officers.
He felt that the program could allocate dwindling resources more efficiently.
Santa Cruz police envisioned deploying officers by shift to the most targeted locations in the city. The
predictive policing model helped to alert officers to targeted locations in real time, a significant
improvement over traditional tactics.
Making it Work
The algorithm is a culmination of anthropological and criminological behavior research. It uses complex
mathematics to estimate crime and predict future hot spots. Researchers based these studies on
In Depth
Featured Articles
- IAFIS Identifies Suspect from 1978 Murder Case
- Predictive Policing: Using Technology to Reduce
Crime
- Legal Digest Part 1 - Part 2
Search Warrant Execution: When Does Detention Rise to
Custody?
- Perspective
Public Safety Consolidation: Does it Make Sense?
- Leadership Spotlight
Leadership Lessons from Home
Archive
- Web and Print
Departments
- Bulletin Notes - Bulletin Honors
- ViCAP Alerts - Unusual Weapons
- Bulletin Reports
Topics in the News
See previous LEB content on:
- Hostage Situations - Crisis Management
- School Violence - Psychopathy
About LEB
- History - Author Guidelines (pdf)
- Editorial Staff - Editorial Release Form (pdf)
Patch Call
Known locally as the
“Gateway to the Summit,”
which references the city’s
proximity to the Bechtel Family
National Scout Reserve. More
The patch of the Miamisburg,
Ohio, Police Department
prominently displays the city
seal surroun.
Mr. E is a pleasant, 70-year-old, black, maleSource Self, rel.docxaudeleypearl
Mr. E is a pleasant, 70-year-old, black, male
Source: Self, reliable source
Subjective:
Chief complaint:
“I urinate frequently.”
HPI:
Patient states that he has had an increase in urination for the past several years, which seems to be worsening over the past year. He estimates that he urinates clear/light yellow urine approximately every 1.5-2 hours while awake and is up 2-4 times at night to urinate. He states some urgency and hesitancy with urination and feeling of incomplete voiding. He denies any pain or blood. Denies any head trauma. Denies any increase in thirst or hunger. He denies any unintentional weight loss.
Allergies
: NKA
Current Mediations
:
Multivitamin, daily
Aspirin, 81 mg, daily
Olmesartan, 20 mg daily
Atorvastatin, 10 mg daily
Diphenhydramine, 50 mg, at night
Pertinent History:
Hypertension, hyperlipidemia, insomnia
Health Maintenance. Immunizations:
Immunizations up to date
Family History:
No cancer, cardiac, pulmonary or autoimmune disease in immediate family members
Social History:
Patient lives alone. He drinks one cup of caffeinated coffee each morning at the local diner. He denies any nicotine, alcohol or drug use.
ROS:
Incorporated into HPI
Objective:
VS
– BP: 118/68, HR: 86, RR: 16, Temp 97.6, oxygenation 100%, weight: 195 lbs, height: 70 inches.
Mr. E is alert, awake, oriented x 3. Patient is clean and dressed appropriate for age.
Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop
Respiratory: Clear to auscultation
Abdomen: Bowel sounds positive. Soft, nontender, nondistended, no hepatomegaly
Neuro: CN 2-12 intact
Renal/prostate: Prostate enlarged, non-tender. No asymmetry or nodules palpated
Labs:
Test Name
Result
Units
Reference Range
Color
Yellow
Yellow
Clarity
Clear
Clear
Bilirubin
Negative
Negative
Specific Gravity
1.011
1.003-1.030
Blood
Negative
Negative
pH
7.5
4.5-8.0
Nitrite
Negative
Negative
Leukocyte esterase
Negative
Negative
Glucose
Negative
mg/dL
Negative
Ketones
Negative
mg/dL
Negative
Protein
Negative
mg/dL
Negative
WBC
Negative
/hpf
Negative
RBC
Negative
/hpf
Negative
Lab
Pt’s Result
Range
Units
Sodium
137
136-145
mmol/L
Potassium
4.7
3.5-5.1
mmol/L
Chloride
102
98-107
mmol/L
CO2
30
21-32
mmol/L
Glucose
92
70-99
mg/dL
BUN
7
6-25
mg/dL
Creat
1.6
.8-1.3
mg/dL
GFR
50
>60
Calcium
9.6
8.2-10.2
mg/dL
Total Protein
8.0
6.4-8.2
g/dL
Albumin
4.5
3.2-4.7
g/dL
Bilirubin
1.1
<1.1
mg/dL
Alkaline Phosphatase
94
26-137
U/L
AST
25
0-37
U/L
ALT
55
15-65
U/L
Pt’s results
Normal Range
Units
WBC
9.9
3.4 - 10.8
x10E3/uL
RBC
4.0
3.77 - 5.28
x10E6/uL
Hemoglobin
11.5
11.1 - 15.9
g/dL
H.
Motor Milestones occur in a predictable developmental progression in.docxaudeleypearl
Motor Milestones occur in a predictable developmental progression in young children. They begin with reflexive movements that develop into voluntary movement patterns. For the motor milestone of independent walking, there are many precursor reflexes that must first integrate and beginning movement patterns that must be learned. Explain the motor progression of walking in a child, starting with the integration of primitive reflexes to the basic motor skills needed for a child to walk independently. Discuss at which time frame each milestone occurs from birth to walking (12-18 months of age). What are some reasons why a child could be delayed in walking? At what age is a child considered delayed in walking and in need of intervention? What interventions are available to children who are having difficulty walking? Please be sure to use APA citations for all sources used to formulate your answers.
.
Most women experience their closest friendships with those of th.docxaudeleypearl
Most women experience their closest friendships with those of the same sex. Men have suffered more of a stigma in terms of sharing deep bonds with other men. Open affection and connection is not actively encouraged among men. Recent changes in society might impact this, especially with the advent of the meterosexual male. “The meterosexual male is less interested in blood lines, traditions, family, class, gender, than in choosing who they want to be and who they want to be with” (Vernon, 2010, p. 204).
In this week’s reading material, the following philosophers discuss their views on this topic: Simone de Beauvoir, Thomas Aquinas, MacIntyre, Friedman, Hunt, and Foucault. Make sure to incorporate their views as you answer each discussion question. Think about how their views may be similar or different from your own. In at least 250 words total, please answer each of the following, drawing upon your reading materials and your personal insight:
To what extent do you think women still have a better opportunity to forge deeper friendships than men? What needs to change to level the friendship playing field for men, if anything?
How is the role of the meterosexual man helping to forge a new pathway for male friendships?
.
Most patients with mental health disorders are not aggressive. Howev.docxaudeleypearl
Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression, and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it.
Aggression Case Study
Christopher, who is 14 years of age, was recently admitted to the hospital for schizophrenia. He has a history of aggressive behavior and states that the devil is telling him to kill all adults because they want to hurt him. Christopher has a history of recidivism and noncompliance with his medications. One day on the unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing back and forth down the hallway, and speaking to himself under his breath. As the nurse runs over to Christopher to talk, he sees that his bedroom door is open and runs into his room and shuts the door. The nurse responds by attempting to open the door, but Christopher keeps pulling the door shut and tells the nurse that if the nurse comes in the room he will choke the nurse. The nurse responds by calling other staff to assist with the situation.
1. What phase of the aggression cycle is Christopher in at the beginning of this scenario? What phase is he in at the end the scenario? (State the evidence that supports your answers).
2. What interventions could have been implemented to prevent Christopher from escalating at the beginning of the scenario?
3. What interventions should the nurse take to deescalate the situation when Christopher is refusing to open his door?
4. If a restrictive intervention (restraint/seclusion) is used, what are some important steps for the nurse to remember?
SCHOLAR NURSING ARTICLE>>>APA FORMAT>>>
.
Most of our class readings and discussions to date have dealt wi.docxaudeleypearl
Most of our class readings and discussions to date have dealt with the issue of ethics and ethical behavior. Various philosophers have made contributions to jurisprudence including how to apply ethical principles (codes of conduct?) to ethical dilemma.
Your task is to watch the Netflix documentary ‘The Social Dilemma.’ If you cannot currently access Netflix it offers a free trial opportunity, which you can cancel after viewing the documentary. Should this not be an option for whatever reason, then please email me and we will create an alternative ethics question.
DUE DATE: Tuesday, Sept. 29, 2020 by noon
SEND YOUR NO MORE THAN 5 PAGE DOUBLE SPACED RESPONSE TO MY EMAIL ADDRESS. LATE PAPERS SUBJECT TO DOWNGRADING
As critics have written, the documentary showcases ways our minds are twisted and twirled by social media companies like Facebook, Twitter, and Google through their platforms and search engines, and the why of what they are doing, and what must be done to stop it.
After watching the movie, respond to the following questions in the order given. Use full sentences and paragraphs, and start off each section by stating the question you are answering. Be succinct.
What are the critical ethical issues identified?
What concerns are raised over the polarization of society and promulgation of fake news?
What is the “attention-extraction model” of software design and why worry?
What is “surveillance capitalism?”
Do you agree that social media warps your perceptions of reality?
Who has the power and control over these social media platforms – software designers, artificial intelligence (Ai), CEOs of media platforms, users, government?
Are social media platforms capable of self-regulation to address the political and ethical issues raised or not? If not, then should government regulate?
What other actions can be taken to address the basic concern of living in a world “…where no one believes what’s true.”
.
Most people agree we live in stressful times. Does stress and re.docxaudeleypearl
Stress may contribute to illness according to some research cited in textbooks. The question asks whether stress and reactions to stress can lead to health issues, and opinions should be supported by evidence from course materials. References in APA format are required.
Most of the ethical prescriptions of normative moral philosophy .docxaudeleypearl
Most of the ethical prescriptions of normative moral philosophy tend to fall into one of the following three categories: deontology, consequentialism, and virtue ethics. These categories in turn put an emphasis on different normative standards for judging what constitutes right and wrong actions.
Moral psychologists and behavioral economists such as Jonathan Haidt and Dan Ariely take a different approach: focusing not on some normative ethical framework for moral judgment, but rather on the psychological foundations of moral intuition and on the limitations that our human frailty places on real-world honesty, decency, and ethical commitments.
In this context, write a short essay (minimum 400 words) on what you see as the most important differences between the traditional normative philosophical approaches and the more recent empirical approach of moral psychology when it comes to ethics. As part of your answer also make sure that you discuss the implications of these differences.
Deadline reminder:
this assignment is
due on June 14th
. Any assignments submitted after that date will lose 5 points (i.e., 20% of the maximum score of 25 points) for each day that they are submitted late. Accordingly, after June 14th, any submissions would be worth zero points and at that time the assignment inbox will close.
.
Most healthcare organizations in the country are implementing qualit.docxaudeleypearl
Most healthcare organizations in the country are implementing quality improvement programs to save lives, enhance customer satisfaction, and reduce the cost of healthcare services. Limited human and material resources often undermine such efforts. Zenith Hospital in a rural community has 200 beds. Postsurgical patients tend to contract infections at the surgical site, requiring extended hospitalization. Mr. Jones—75 years old—was admitted to Zenith Hospital for inguinal hernia repairs. He was also hypertensive, with a compromised immune system. Two days after surgery, he acquired an infection at the surgical site, with elevated temperature, and then he developed septicemia. His condition worsened, and he was moved to isolation in the intensive care unit (ICU). A day after transfer to the ICU, he went into ventricular arrhythmia and was placed on a respirator and cardiac monitoring machine. Intravenous fluids, antibiotics, and antipyretics could not bring the fever down, and blood analysis continued to deteriorate.
The hospital infection control unit got involved. The team confirmed that postsurgical infections were on the increase, but the hospital was unable to identify the sources of infection. The surgery unit and surgical team held meetings to understand possible sources of infection. The team leader had earlier reported to management that they needed to hire more surgical nurses, arguing that nurses in the unit were overworked, had to go on leave, and often worked long hours without break.
Mr. Jones’ family members were angry and wanted to know the source of his infection, why he was on the respirator in isolation, and why his temperature was not coming down. Unfortunately, his condition continued to deteriorate. His daughter invited the family’s legal representative to find out what was happening to her father and to commence legal proceedings.
Then, the healthcare manager received information that two other patients were showing signs of postsurgical infection. The healthcare manager and care providers acknowledged the serious quality issues at Zenith Hospital, particularly in the surgical unit. The healthcare manager wrote to the Chairman of the Hospital Board, seeking approval to implement a quality improvement program. The Board held an emergency meeting and approved the manager’s request. The healthcare manager has invited you to support the organization in this process.
Please address the following questions in your response:
What are successful approaches for gaining a shared understanding of the problem?
How can effective communication be implemented?
What is a qualitative approach that helps in identifying the quality problem?
What tools can provide insight into understanding the problem?
In quality improvement, what does appreciative inquiry help do?
What is a benefit of testing solutions before implementation?
What is a challenge that is inherent in the application of the plan, do, study, act (PDSA) method?
What .
More work is necessary on how to efficiently model uncertainty in ML.docxaudeleypearl
More work is necessary on how to efficiently model uncertainty in ML and NLP, as well as how to represent uncertainty resulting from big data analytics.
Pages - 4
Excluding the required cover page and reference page.
APA format 7 with an introduction, a body content, and a conclusion.
No Plagiarism
.
Mortgage-Backed Securities and the Financial CrisisKelly Finn.docxaudeleypearl
Mortgage-Backed Securities and the Financial Crisis
Kelly Finn
FNCE 4302
Mortgage-Backed Securities (MBS) are “pass-through” bundles of housing debt sold as investment vehicles
A mortgage-backed security, MBS, is a type of asset-backed security that pays investors regular payments, similar to a bond. It gets the title as a “pass-through” because the security involves several entities in the origination and securitization process (where the asset is identified, and where it is used as a base to create a new investment instrument people can profit off of).
Key Players involved in the MBS Process
[Mortgage] Lenders: banks who sell mortgages to GSE’s
GSE: Government Sponsored Entities created by the US Government to make owning property more accessible to Americans
1938: Fannie Mae (FNMA): Federal National Mortgage Assoc.
1970: Freddie Mac (FHLMC): Federal Home Loan Mortgage Corp.
Increase mortgage borrowing
Introduce competitor to Fannie Mae
1970: Ginnie Mae (GNMA): Government National Mortgage Assoc.
US Government: Treasury: implicit commitment of providing support in case of trouble
The several entities involved in the process make MBS a “pass-through”. Here we have 3 main entities that we’ll call “Key Players” for the purpose of this presentation which aims to provide you with a basic and simple explanation of MBS and their role in the financial crisis.
GSE’s created by the US Government in 1938
Part of FDR’s New Plan during Great Depression
Purpose: make owning property more accessible to more Americans
GSE (ex. Fannie Mae) buys mortgages (debt) from banks, & then pools mortgages into little bundles investors can buy (securitization)
Bank’s mortgage is exchanged with GSE’s cash
Created liquid secondary market for mortgages
Result:
1) Bank has more cash to lend out to people
2) Now all who want to a house (expensive) can get the money needed to buy one!
Where MBS came from & when
Yay for combatting homelessness and increasing quality of life for the common American!
Thanks Uncle Sam!
MBS have been around for a long time. Officially in the US, they have their origins in government. During the Great Depression in the 1930s, President Franklin Delano Roosevelt signed into creation Fannie Mae that was brought about to help ease American citizen’s difficulty in becoming homeowners. The sole purpose of a GSE thus was to not make profit, but to promote citizen welfare in regards to housing. Seeing that it was created by regulatory government powers, it earned the title of Government Sponsored Entity, which we will abbreviate as GSE. 2 other GSE’s in housing were created in later decades like Freddie Mae, to further stimulate the mortgage market alongside Fannie, and Ginnie which did a similar thing but only for certain groups of people (Veterans, etc) and to a much smaller scale.
How MBS works: Kelly is a homeowner looking to borrow a lot of money
*The Lender, who issued Kelly the mor.
Moral Development Lawrence Kohlberg developed six stages to mora.docxaudeleypearl
Moral Development:
Lawrence Kohlberg developed six stages to moral behavior in children and adults. Punishment and obedience orientation, interpersonal concordance, law and order orientation, social contract orientation, and universal ethics orientation. All or even just one of these stages will make a good topic for your research paper or you could just do the research paper on Kohlberg.
.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Pengantar Penggunaan Flutter - Dart programming language1.pptx
RESEARCH ARTICLESupport surfaces for pressure ulcerpre.docx
1. RESEARCH ARTICLE
Support surfaces for pressure ulcer
prevention: A network meta-analysis
Chunhu Shi
1*, Jo C. Dumville1, Nicky Cullum1,2
1 Division of Nursing, Midwifery & Social Work, School of
Health Sciences, Faculty of Biology, Medicine &
Health, University of Manchester, Manchester Academic Health
Science Centre, Manchester, United
Kingdom, 2 Research and Innovation Division, Manchester
University NHS Foundation Trust, Manchester
Academic Health Science Centre, Manchester, United Kingdom
* [email protected]
Abstract
Background
Pressure ulcers are a prevalent and global issue and support
surfaces are widely used for
preventing ulceration. However, the diversity of available
support surfaces and the lack of
direct comparisons in RCTs make decision-making difficult.
2. Objectives
To determine, using network meta-analysis, the relative effects
of different support surfaces
in reducing pressure ulcer incidence and comfort and to rank
these support surfaces in
order of their effectiveness.
Methods
We conducted a systematic review, using a literature search up
to November 2016, to iden-
tify randomised trials comparing support surfaces for pressure
ulcer prevention. Two review-
ers independently performed study selection, risk of bias
assessment and data extraction.
We grouped the support surfaces according to their
characteristics and formed evidence
networks using these groups. We used network meta-analysis to
estimate the relative
effects and effectiveness ranking of the groups for the outcomes
of pressure ulcer incidence
and participant comfort. GRADE was used to assess the
certainty of evidence.
Main results
3. We included 65 studies in the review. The network for assessing
pressure ulcer incidence
comprised evidence of low or very low certainty for most
network contrasts. There was mod-
erate-certainty evidence that powered active air surfaces and
powered hybrid air surfaces
probably reduce pressure ulcer incidence compared with
standard hospital surfaces (risk
ratios (RR) 0.42, 95% confidence intervals (CI) 0.29 to 0.63;
0.22, 0.07 to 0.66, respec-
tively). The network for comfort suggested that powered active
air-surfaces are probably
slightly less comfortable than standard hospital mattresses (RR
0.80, 95% CI 0.69 to 0.94;
moderate-certainty evidence).
PLOS ONE | https://doi.org/10.1371/journal.pone.0192707
February 23, 2018 1 / 29
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5. files.
Funding: This work was supported by a President’s
Doctoral Scholarship to CS from the University of
Manchester. The funder had no role in study
design, data collection and analysis, decision to
publish, or preparation of the manuscript. We also
received some analytical advice from the Complex
Reviews Support Unit, which is funded by the
National Institute for Health Research (project
number 14/178/29).
https://doi.org/10.1371/journal.pone.0192707
http://crossmark.crossref.org/dialog/?doi=10.1371/journal.pone.
0192707&domain=pdf&date_stamp=2018-02-23
http://crossmark.crossref.org/dialog/?doi=10.1371/journal.pone.
0192707&domain=pdf&date_stamp=2018-02-23
http://crossmark.crossref.org/dialog/?doi=10.1371/journal.pone.
0192707&domain=pdf&date_stamp=2018-02-23
http://crossmark.crossref.org/dialog/?doi=10.1371/journal.pone.
0192707&domain=pdf&date_stamp=2018-02-23
http://crossmark.crossref.org/dialog/?doi=10.1371/journal.pone.
0192707&domain=pdf&date_stamp=2018-02-23
http://crossmark.crossref.org/dialog/?doi=10.1371/journal.pone.
0192707&domain=pdf&date_stamp=2018-02-23
https://doi.org/10.1371/journal.pone.0192707
https://doi.org/10.1371/journal.pone.0192707
6. http://creativecommons.org/licenses/by/4.0/
http://creativecommons.org/licenses/by/4.0/
Conclusions
This is the first network meta-analysis of the effects of support
surfaces for pressure ulcer
prevention. Powered active air-surfaces probably reduce
pressure ulcer incidence, but are
probably less comfortable than standard hospital surfaces. Most
prevention evidence was
of low or very low certainty, and more research is required to
reduce these uncertainties.
Introduction
Pressure ulcers are localised injuries to the skin and/or
underlying tissue, which are also
known as pressure injuries, pressure sores, decubitus ulcers and
bedsores [1]. Pressure ulcers
represent a serious heath burden with a point prevalence of
approximately 3.1 per 10,000 in
the United Kingdom (UK) [2]. It has been estimated that the
treatment of pressure ulcers costs
approximately 4% (between £1.4 and £2.1 billion) of the total
health budget of the UK (1999/
2000 financial year) [3].
7. Pressure ulcers are caused by localised pressure and shear [1],
thus intervention to alleviate
pressure and shear is an important part of pressure ulcer
prevention. Support surfaces (e.g.
mattresses, overlays, integrated bed systems) are designed to
work towards preventing pressure
ulcers primarily in this way [4]. Various types of support
surfaces have been developed with
different mechanisms for pressure and shear relief including (1)
redistributing the weight over
the maximum body surface area; (2) mechanically alternating
the pressure beneath body to
reduce the duration of the applied pressure [5]; or (3)
redistributing pressure by a combination
of the above, allowing health care professionals to change the
mode according to a person’s
needs [6]. Support surfaces are made from a variety of
construction materials (e.g. foam) and
have different functional features (e.g. low-air-loss) [4].
Identification of the optimum support
surface from the diverse options available requires evidence on
their relative effectiveness in
terms of how well they prevent the incidence of new pressure
ulcers [2].
8. Currently, seven systematic reviews containing meta-analyses
have summarised rando-
mised controlled trial (RCT) and quasi-randomised trial
evidence to inform choice of support
surface [7–13]. Of these reviews, one high-quality Cochrane
review includes all studies covered
by the remaining six reviews and offers the most comprehensive
summary of current evidence
[9]. However, all these reviews (including the Cochrane review
[9]) use an outdated support
surface classification systems [5] now superseded by the recent
internationally agreed NPUAP
Support Surface Standards Initiative (S3I) classification system
[4]. Additionally, the reviews
all use pairwise meta-analysis to synthesise evidence for head-
to-head comparisons of support
surfaces. There remains a lack of evidence on the relative
effects of different support surfaces,
in part due to a lack of head-to-head RCT data across the
plethora of treatment options
available.
To tackle this problem, an advanced meta-analysis technique,
network meta-analysis, can
9. be employed. The approach can simultaneously compare
multiple competing interventions in
a single statistical model whilst maintaining randomisation as
with standard meta-analysis
[14–16]. The network meta-analysis has the following
advantages. Firstly network meta-analy-
sis can produce “indirect evidence” for a potential comparison
where a head-to-head compari-
son is unavailable. A network can be developed to link the
direct evidence of, say, A vs. B and
B vs. C (i.e. evidence from studies with A vs. B and B vs. C as
head-to-head comparisons), via a
common comparator (i.e. B in this example) to derive an
indirect estimate of A vs. C. Sec-
ondly, both indirect and direct evidence can be used together
which then improves the
Support surfaces for pressure ulcer prevention
PLOS ONE | https://doi.org/10.1371/journal.pone.0192707
February 23, 2018 2 / 29
Competing interests: The authors have declared
that no competing interests exist.
https://doi.org/10.1371/journal.pone.0192707
10. precision of effect estimates. Thirdly, effect estimates from
network meta-analysis can be
linked to probabilistic modelling to allow the ranking of
treatments based on which is likely to
be the most effective for the outcome of interest, which is likely
to be the second best and so
on. This is a valuable approach for considering the results of the
network across multiple inter-
ventions in a single measure [14–16].
The aim of this work was to synthesise the available evidence
from RCTs in a network
meta-analysis to: (1) assess the relative effects of different
classes of support surfaces for reduc-
ing pressure ulcer incidence in adults in any setting; (2) to
assess the relative effects of different
classes of support surface in terms of reported comfort; and (3)
to rank all classes of support
surface in order of effectiveness regarding pressure ulcer
prevention.
Methods
This review was preceded by a protocol and registered
prospectively in PROSPERO
(CRD42016042154). This report complies with the relevant
PRISMA extension statement [17]
11. (see S1 File).
Search strategy
As the most comprehensive summary of available evidence in
the topic of our review, the cur-
rent Cochrane review had identified and included 59 RCTs and
quasi-randomised trials com-
paring support surfaces for pressure ulcer prevention, with a
database search up to April 2015
[9].
We performed an update search of the following databases for
the current Cochrane review:
the Cochrane Wounds Specialised Register (10 August 2016);
the Cochrane Central Register
of Controlled Trials (CENTRAL) (2016, Issue 7); Ovid
MEDLINE (1946 to 10 August 2016);
Ovid EMBASE (1974 to 10 August 2016); EBSCO CINAHL
Plus (1937 to 10 August 2016).
Additionally, we searched the Chinese Biomedical Literature
Database (1978 to 30 November
2016). There was no restriction on the basis of language or
publication status (see S2 File for
Ovid MEDLINE Search Strategy).
12. We also searched other resources: ClinicalTrials.gov and WHO
International Clinical Trials
Registry Platform (ICTRP) (24 August 2016), the Journal of
Tissue Viability via hand-search-
ing (1991 to November 2016), and the reference lists of seven
previously published systematic
reviews [7–13].
Eligibility criteria
We included published and unpublished RCTs, comparing
pressure-redistribution support
surfaces—mattresses, overlays, and integrated bed systems—in
adults at risk of pressure ulcer
development, in any setting. We excluded studies of seating and
cushions, limb protectors,
turning beds, traditional Chinese medicine-related surfaces and
home-made support surfaces.
Recent concern about the validity of RCTs from China led us to
only consider those with
full descriptions of robust randomisation methods (e.g. random
number tables) as eligible
[18, 19].
Our primary outcome was pressure ulcer incidence. We
considered this outcome as either
13. the proportion of participants developing a new ulcer at the
latest trial follow-up point (or the
pre-specified time point of primary focus if this was different to
the longest follow-up point)
or time-to-pressure ulcer incidence. The secondary outcome was
patient-reported comfort on
support surface (measured as the proportion of patients
reporting comfort).
Support surfaces for pressure ulcer prevention
PLOS ONE | https://doi.org/10.1371/journal.pone.0192707
February 23, 2018 3 / 29
https://doi.org/10.1371/journal.pone.0192707
Selection of studies
Two reviewers independently assessed the titles and abstracts of
the search results for relevance
and then independently inspected the full text of all potentially
eligible studies. Because the
non-Chinese database search was an updated search of the
Cochrane review published by
McInnes and colleagues [9], all studies included by the
Cochrane review were checked again
for relevance. Disagreements were resolved by discussion
between the two reviewers and
14. involvement of a third reviewer if necessary.
Data extraction
Where eligible studies had been previously included in McInnes
et al [9], one reviewer checked
the original data extraction of these studies and extracted
additional data where necessary, and
another reviewer checked all data. Two reviewers independently
extracted data for new
included studies. Any disagreements were resolved by
discussion and, if necessary, with the
involvement of a third reviewer. Where necessary, the authors
of included studies were con-
tacted to collect and/or clarify data.
The following data were extracted using a pre-prepared data
extraction form: basic charac-
teristics of studies (e.g. country, setting, and funding sources);
characteristics of participants
(including eligibility criteria, average age, proportions of
participants by gender, and partici-
pants’ baseline skin status); description of support surfaces and
details on any co-interven-
tions; number randomised, follow-up durations; drop-outs;
primary and secondary outcome
15. data.
In order to assign support surfaces to intervention groups, we
extracted full descriptions
from included studies where possible. However, when necessary
we supplemented the infor-
mation provided with that from external sources such as other
publications about the same
support surface, manufacturers’ and/or product websites and
expert clinical opinion [20].
Classification of interventions. Support surfaces in included
studies were classified using
the NPUAP system [4] and assigned to one of 14 intervention
groups [21] (see S3 File for the
detailed steps and Table 1 for the 14 intervention groups).
Risk of bias assessment
We used Cochrane’s Risk of Bias tool to assess risk of bias of
each included study [22]. For new
included studies, two reviewers independently assessed domain-
specific risk of bias [22]. For
studies included by McInnes and colleagues [9], previous
judgements were checked by two
reviewers independently and, where required, updated. Any
discrepancy between two review-
16. ers was resolved by discussion and a third reviewer where
necessary.
We then followed GRADE principles to summarise the overall
risk of bias across domains
for each included study [23]. After this, we applied the
approach proposed by Salanti and col-
leagues [24] to judge the overall risk of bias (referred to hereon
as “study limitations”) for
direct evidence (i.e. pairwise meta-analysis), network contrasts,
and the entire network. Three
categories were used to qualitatively rate study limitations: no
serious limitations; serious limi-
tations; and very serious limitation.
Data synthesis and analyses
We conducted all meta-analyses based on a frequentist
framework with a random effects
model [25]. All estimates are presented as risk ratios (RR) with
95% confidence intervals (CIs).
When presenting summaries of findings, we also calculated the
absolute risk of an event for a
specific intervention group compared with that for a standard
hospital surface. The baseline
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risk used was the outcome on standard hospital surfaces (the
median risk across studies that
provided data for the outcome).
We performed pairwise meta-analyses in RevMan, calculated I-
squared (I
2
) measures and
visually inspected the forest plots to assess statistical
heterogeneity [26]. We then conducted
network meta-analysis in STATA1 (StataCorp. 2013) using
published network commands
Table 1. 14 intervention groups, explanations and selected
examples from included studies.
Intervention groups Reviewers’ explanations Selected examples
(with support surface brands if possible)
Powered/non-powered reactive
air surfaces
A group of support surfaces constructed of air-cells, which
redistribute body weight over a maximum surface area (i.e. has
18. reactive pressure redistribution mode), with or without the
requirement for electrical power
Static air mattress overlay, dry flotation mattress (e.g., Roho,
Sofflex), static air mattress (e.g., EHOB), and static mode of
Duo 2
mattress
Powered/non-powered reactive
low-air-loss air surfaces
A group of support surfaces made of air-cells, which have
reactive
pressure redistribution modes and a low-air-loss function, with
or without the requirement for electrical power
Low-air-loss Hydrotherapy
Powered reactive air-fluidised
surfaces
A group of support surfaces made of air-cells, which have
reactive
pressure redistribution modes and an air-fluidised function, with
the requirement for electrical power
Air-fluidised bed (e.g., Clinitron)
19. Non-powered reactive foam
surfaces
A group of support surfaces made of foam materials, which
have
a reactive pressure redistribution function, without the
requirement for electrical power
Convoluted foam overlay (or pad), elastic foam overlay (e.g.,
Aiartex, microfluid static overlay), polyether foam pad, foam
mattress replacement (e.g. MAXIFLOAT), solid foam overlay,
viscoelastic foam mattress/overlay (e.g., Tempur, CONFOR-
Med,
Akton, Thermo)
Non-powered reactive fibre
surfaces
A group of support surfaces made of fibre materials, which have
a
reactive pressure redistribution function, without the
requirement for electrical power
Silicore (e.g., Spenco) overlay/pad
20. Non-powered reactive gel
surfaces
A group of support surfaces made of gel materials, which have a
reactive pressure redistribution function, without the
requirement for electrical power
Gel mattress, gel pad used in operating theatre
Non-powered reactive
sheepskin surfaces
A group of support surfaces made of sheepskin, which have a
reactive pressure redistribution function, without the
requirement for electrical power
Australian Medical Sheepskins overlay
Non-powered reactive water
surfaces
A group of support surfaces based on water, which has the
capability of a reactive pressure redistribution function, without
the requirement for electrical power
Water mattress
21. Powered active air surfaces A group of support surfaces made of
air-cells, which
mechanically alternate the pressure beneath the body to reduce
the duration of the applied pressure (mainly via inflating and
deflating to alternately change the contact area between support
surfaces and the body) (i.e. alternating pressure (or active)
mode), with the requirement for electrical power
Alternating pressure-relieving air mattress (e.g., Nimbus II,
Cairwave, Airwave, MicroPulse), large-celled ripple
Powered active air surfaces and
non-powered reactive foam
surfaces
A group of support surfaces which use powered active air
surfaces
and non-powered reactive foam surfaces in combination
Alternating pressure-relieving air mattress in combination with
viscoelastic foam mattress/overlay (e.g., Nimbus plus Tempur)
Powered active low-air-loss air
surfaces
22. A group of support surfaces made of air-cells, which have the
capability of alternating pressure redistribution as well as low-
air-
loss for drying local skin, with the requirement for electrical
power
Alternating pressure low-air-loss air mattress
Powered hybrid system air
surfaces
A group of support surfaces made of air-cells, which offer both
reactive and active pressure redistribution modes, with the
requirement for electrical power
Foam mattress with dynamic and static modes (e.g. Softform
Premier Active)
Powered hybrid system low-
air-loss air surfaces
A group of support surfaces made of air-cells, which offer both
reactive and active pressure redistribution modes as well as a
low-
air-loss function, with the requirement for electrical power
23. Stand-alone bed unit with alternating pressure, static modes and
low air-loss (e.g., TheraPulse)
Standard hospital surfaces A group of support surfaces made of
any materials, used as usual
in a hospital and without reactive nor active pressure
redistribution capabilities, nor any other functions (e.g. low-air-
loss, or air-fluidised).
Standard hospital (foam) mattress, NHS Contract hospital
mattress, standard operating theatre surface configuration,
standard bed unit and usual care
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and network graph packages [27, 28] (see S4 File for STATA
commands used in the review). A
consistency model was fitted to estimate relative effects [29].
Following this, we calculated the
24. relative rankings of intervention groups and presented the
surface under the cumulative rank-
ing curve (SUCRA) percentages [27]. For any outcome, we
performed network meta-analysis
only if intervention groups could be connected to form a
network; however, we did not
exclude comparisons of support surfaces assigned to the same
group from the overall system-
atic review. The full dataset is available on request.
We assessed the transitivity assumption for each network by
comparing the similarities of
study-level characteristics across direct comparisons within the
network [30]. When data were
insufficient for this assessment, we assumed that the transitivity
assumption was met. Inconsis-
tency between direct and indirect evidence was examined
globally by running the design-by-
treatment interaction model and locally by using the node-
splitting method and inconsistency
plot test [28, 31–33]. We also explored the sensitivity of the
global inconsistency finding to
alternative modelling approaches by running a post hoc
sensitivity analysis using the model of
Lu and Ades [34]. It is worth noting that because the model of
25. Lu and Ades [34] depends on
the ordering of treatments in the presence of multi-arm studies
[28] the design-by-treatment
interaction model was used in the main analysis. We then
evaluated the common network het-
erogeneity using the tau-squared (tau
2
) and the I
2
measure and the 95% CIs of I
2
, and decom-
posed the common network heterogeneity to inconsistency and
within-study heterogeneity in
R to locate the source of heterogeneity [35]. The heterogeneity
was considered as low, moder-
ate, or high if I
2
= 25%, 50%, or 75%, respectively [36].
When important inconsistency and/or heterogeneity occurred,
we followed steps proposed
by Cipriani and colleagues [37] to investigate further. Of these
steps, we performed pre-speci-
fied subgroup analyses for funding sources [38] and risk of bias
26. [39]; as well as four exploratory
sub-group analyses: setting, considering operating theatre as
setting or not, baseline skin sta-
tus, and follow-up duration. Additionally, we performed one
sensitivity analysis to assess the
impact of missing data (i.e. a complete case analysis for the
main analysis, followed by a
repeated analysis with missing data added to the denominator
but not the numerator) and
another one for the impact of unpublished studies by removing
them from the analysis.
Assessing the certainty of evidence
We assessed the potential for publication bias by considering
the completeness of the literature
search (i.e. inspecting the scope of the literature search, and
assessing the volume of unpub-
lished data located), and plotting the funnel plot for each
pairwise meta-analysis that included
more than 10 studies and a comparison-adjusted funnel plot for
the network [24, 27, 40]. To
obtain a meaningful comparison-adjusted funnel plot, we
ordered the intervention groups by
assuming that small studies are likely to favour advanced
support surfaces [27]. Finally, we fol-
27. lowed the GRADE approach proposed by Salanti and colleagues
[24] to assess the certainty of
evidence from the network meta-analysis for each network
contrast and the ranking of inter-
vention groups: the overall certainty could be rated from high,
moderate, low to very low.
Results
Search results
The search identified 2,816 records. Full-text screening of 108
potentially eligible studies led to
inclusion of 22 studies; eight published in English (one of the
eight was then associated with an
included study in the McInnes and colleagues’ review [9]) and
14 studies published in Chinese.
We also identified two on-going studies [41, 42]. In addition,
our rescreening of the 59 studies
included by McInnes and colleagues [9] identified 44 as
specifically eligible for this review. In
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28. total therefore we included 65 studies in the review (see Fig 1,
and S5 File for a reference list of
included studies). Three were unpublished (one is a conference
abstract [43] and two are
research reports [44, 45].
Trial and study population characteristics
The characteristics of included studies are summarised in Table
2. The 65 studies enrolled a
total of 14,332 participants (median of study sample sizes: 100;
range: 10 to 1,972). Setting was
specified in 63 of 65 study reports (97%) and included accident
and emergency departments
and acute care, intensive care units, general medical wards,
orthopaedic centres, operating the-
atres, and long-term care settings (i.e. nursing homes, extended
care facilities, rehabilitation
wards, long-term units).
Fig 1. Flow diagram of included studies.
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105. )
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The average age of participants was specified for 64 studies
(98%) and ranged from 37 to 85
years (median: 70 years). Gender was specified for 57 studies
(with 13,158 participants), within
these 53% of participants were female. Forty included studies
(62%) recruited only participants
with intact skin at baseline and/or those with grade I ulcers. Ten
studies (15%) enrolled partici-
pants with existing ulcers (recorded or assumed to be grade II or
above). In the 44 studies
(68%) that clearly stated duration of follow-up the median was
14 days (range: 5 to 180). There
were 23 studies (35%) that were completely or partly funded by
industry and 15 studies (23%)
supported by public funding.
In terms of intervention groups, of 65 studies, four (6%) used
support surfaces that were
665. impossible to classify into an intervention group due to
insufficient detail; and an additional
11 studies (17%) compared support surfaces within the same
intervention groups (see
Table 2). These 15 studies were removed from quantitative
analysis because their intervention
groups were unconnected to any network although they are still
included in the review.
Risk of bias assessment
Of 65 studies, 28 studies (43%) were judged to have no serious
limitations; and the remaining
37 studies (57%) had serious or very serious limitations (see S6
File).
Network meta-analysis
We conducted two main network meta-analyses; the first for
pressure ulcer incidence (the Pre-
vention Network) and the second for patient comfort (the
Comfort Network). No network
was formed for time-to- pressure ulcer incidence because the
eight (12%) studies (Refs 13, 28,
34, 35, 37, 53, 54, 58 in the Table 2) with available outcome
data did not form a network con-
necting more than two intervention groups.
666. Prevention network: Summary of included evidence. All 65
included studies reported
the outcome of pressure ulcer incidence, of which 20 were
excluded from analysis: three
reporting zero events in both arms (Refs 9, 17, 40 in the Table
2) (see Discussion for further
consideration of these three studies), six with incomplete
outcome data and intervention
descriptions (Refs 5, 15, 19, 51, 63, 64 in the Table 2), and 11
comparing support surfaces from
the same intervention groups (Refs 11, 13, 20, 23, 29, 37, 38,
41, 42, 58, 62 in the Table 2) (see
Table 2). Of the remaining 45 studies, 43 were included in the
main analysis and two (Refs 2
and 52 in the Table 2) were only considered in the sensitivity
analysis imputing missing data.
The 43 studies (Ref 1, 3, 4, 6–8, 10, 12, 14, 16, 18, 21, 22, 24–
28, 30–36, 39, 43–50, 53–57, 59–
61, 65 in Table 2), involved 9,430 participants and formed 24
direct comparisons and a net-
work of 14 intervention groups.
Prevention network: Main findings. The results of the pairwise
and network meta-analy-
667. ses are summarised in Fig 3 along with the GRADE certainty of
evidence assessment for the
network meta-analysis (see S7 File for pairwise meta-analyses;
see S9 File for GRADE assess-
ment). Of the 24 direct comparisons, 12 (50%) were judged to
have serious or very serious lim-
itations (see Fig 2). The entire network was considered to have
serious study limitations.
Additionally, the network was considered to be sparse as 13 of
the 24 direct links were only
informed by one study in each case.
The analysis results suggest that powered hybrid low-air-loss
air surfaces have the highest
probability of being the most effective intervention (SUCRA =
87.4%). However we remain
uncertain as to the true ranking of these treatments because the
certainty of evidence was very
low (see Fig 3 and S9 File).
Overall, the evidence regarding the relative effects of support
surfaces on pressure ulcer
development is of low or very low certainty for 89 of the 91
network contrasts in the network.
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We present a further narrative summary of the network meta-
analysis findings for what are
considered key comparisons: the 13 intervention groups
compared with standard hospital
surfaces.
There is moderate certainty evidence that powered active air
surfaces and powered hybrid
air surfaces probably reduce the incidence of pressure ulcers
compared with standard hospital
surfaces (the latter having an assumed baseline risk of 219 per
1,000 participants) (RR 0.42,
95% CI 0.29 to 0.63; and RR 0.22, 95% CI 0.07 to 0.66,
respectively). This represents 127 fewer
people developing new ulcers per 1,000 (95% CI 81 to 155 per
1000) on powered active air sur-
faces and 171 fewer people developing new ulcers per 1,000
(95% CI 74 to 204) on powered
hybrid air surfaces than on standard hospital surfaces. There is
low-certainty evidence that
non-powered reactive fibre surfaces, non-powered reactive
669. water surfaces, powered hybrid
low-air-loss air surfaces, and powered/non-powered reactive air
surfaces may reduce pressure
ulcer incidence compared with standard hospital surfaces. It is
uncertain whether the remain-
ing seven intervention groups reduce the incidence of pressure
ulcers compared with standard
hospital surfaces as the evidence is of very low certainty.
Prevention network: Results of transitivity assessment and
heterogeneity analyses.
We deemed that the transitivity assumption held and there was
no suggestion of global
Fig 2. Network plot for the incidence of pressure ulcers
produced by STATA networkplot command. Fourteen
intervention groups are coded in the plot (i.e., nodes): SC =
standard hospital surfaces, npReFibre = non-powered
reactive fibre surfaces, npReFoam = non-powered reactive foam
surfaces, npReGel = non-powered reactive gel
surfaces, npReSheepskin = non-powered reactive sheepskin
surfaces, npReWater = non-powered reactive water
surfaces, pActAir = powered active air-cells surfaces,
pActAirnpReFoam = powered active air-cells surfaces plus non-
powered reactive foam surfaces, pActLAL = powered active
low-air-loss air surfaces, pHybridAir = powered hybrid
670. air-cells surfaces, pHybridLAL = powered hybrid low-air-loss
air surfaces, pReAirfluid = powered reactive air-fluidised
surfaces, pnpReAir = powered or non-powered reactive air-cells
surfaces, and pnpReLAL = powered or non-powered
reactive low-air-loss air surfaces. Each node size is proportional
to the number of direct comparisons involving each
intervention group. Taking any two of the six nodes forms 91
network contrasts. 24 lines between nodes represent
direct comparisons driven by RCTs; and line thickness is
proportional to the number of studies involved in each direct
comparison. Direct evidence of two or more comparisons can
generate indirect evidence for contrasts that did not
involve a head-to-head RCT (e.g., indirect evidence for the
comparison of npReFoam vs. npReWater generated from
comparisons, for example, of npReFoam vs. SC and npReWater
vs. SC). In this way, indirect evidence informs the
remaining 67 of the 91 network contrasts. The risk of bias
assessment was based on the most frequent level of bias
recorded for studies included in that comparison and denoted
using coloured lines (or links). A green link indicates no
serious study limitations; yellow indicates serious limitations;
and red indicates very serious limitations.
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inconsistency in the network using either the design-by-
treatment interaction model or the
model of Lu and Ades [34]. There was one loop with potential
inconsistency (SC-npReFoam-
pActAir): this was likely due to the influence of one pairwise
meta-analysis in the loop which
had high heterogeneity (non-powered reactive foam surfaces
versus standard hospital
surfaces).
The common network heterogeneity was moderate: tau
2
= 0.195; and I
2
= 56% (95% CI: 36
to 70%). This means that there was moderate variation in the
mean effect size estimate across
studies in each network contrast (i.e. in one network contrast,
some included studies may sug-
672. gest benefit for one intervention group but others may suggest
harm). This moderate common
network heterogeneity may be due to the very high
heterogeneity (I
2
> 75%) of three pairwise
meta-analyses in the network (powered or non-powered reactive
low-air-loss air surfaces,
non-powered reactive sheepskin surfaces, and non-powered
reactive foam surfaces compared
with standard hospital surfaces). Additionally, subgroup
analysis suggested that funding
sources, considering operating theatres as settings or not,
follow-up duration, and baseline
skin status defined by authors may explain the network
heterogeneity (tau
2
from 0.195 to
0.160, 0.160, 0.178, and 0.129, respectively) but risk of bias
assessment and setting may not (see
S10 and S11 Files for the above analyses).
Fig 3. Results of pairwise meta-analyses via RevMan and
network meta-analysis with consistency model via STATA for
pressure ulcer incidence. Results of
pairwise meta-analyses with the numbers of included studies
673. and participants are presented above the diagonal cells (see S7
File); network meta-analysis results and the
corresponding certainty of evidence assessments are shown
below the diagonal cells. The diagonal cells show the codes of
intervention groups and their SUCRA values
and rankings in brackets: SC = standard hospital surfaces,
npReFibre = non-powered reactive fibre surfaces, npReFoam =
non-powered reactive foam surfaces,
npReGel = non-powered reactive gel surfaces, npReSheepskin =
non-powered reactive sheepskin surfaces, npReWater = non-
powered reactive water surfaces,
pActAir = powered active air-cells surfaces, pActAirnpReFoam
= powered active air-cells surfaces plus non-powered reactive
foam surfaces, pActLAL = powered active
low-air-loss air surfaces, pHybridAir = powered hybrid air-cells
surfaces, pHybridLAL = powered hybrid low-air-loss air
surfaces, pReAirfluid = powered reactive air-
fluidised surfaces, pnpReAir = powered or non-powered
reactive air-cells surfaces, and pnpReLAL = powered or non-
powered reactive low-air-loss air surfaces. ⊕⊕⊕◯
= Moderate certainty of evidence; ⊕⊕◯
◯= Low certainty of
evidence; and ⊕◯
◯
◯= Very low certainty of evidence.
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Prevention network: Results of sensitivity analyses. Sensitivity
analyses did not suggest
that missing data and unpublished data would affect the relative
effects and rankings of inter-
ventions groups (see S8 File).
Prevention network: Publication bias. No funnel plot was
produced for the pairwise
meta-analyses because none included more than 10 studies. For
the network meta-analysis,
the comparison-adjusted funnel plot appeared slightly
asymmetric, suggesting the possible
presence of small-study effects; i.e. advanced support surfaces
like powered hybrid air surfaces
appear to have favourable prevention effects in small studies
(see S9 File).
Comfort network: Summary of included evidence. Twelve of 65
studies (18%) presented
outcome data on patient comfort, of which eight studies could
not be included in the network:
six studies were excluded as they compared support surfaces
from the same intervention
675. groups (Refs 11, 13, 20, 37, 41, 42 in the Table 2), and two
(Refs 39, 44 in the Table 2) could
not be connected to the network. Thus, the final network
included four studies (Refs 1, 17, 19,
57 in the Table 2) (with 802 participants) which formed six
direct comparisons and a network
of six intervention groups (Fig 4).
Comfort network: Main findings. The results of the pairwise and
network meta-analyses
are summarised in Fig 5 along with the GRADE-based
assessment of the certainty of the evi-
dence in the network meta-analysis. Four out of six (67%) direct
comparisons had no serious
limitations but another two had very serious limitations; and the
whole network had serious
Fig 4. Network plot for the patient comfort on a support surface
produced by STATA networkplot command. Six
intervention groups (i.e., six nodes) are coded in the plot: SC =
standard hospital surfaces, npReFoam = non-powered
reactive foam surfaces, npReWater = non-powered reactive
water surfaces, pActAir = powered active air-cells surfaces,
pReAirfluid = powered reactive air-fluidised surfaces, pnpReAir
= powered or non-powered reactive air-cells surfaces.
Taking any two of the six nodes forms 15 network contrasts.
The size of each node is proportional to the number of
676. direct comparisons involving each intervention group. The six
lines between nodes in the plot represent the only direct
comparisons and line thickness is proportional to the number of
studies involved in each direct comparison. The
direct evidence arising from two or more comparisons can
generate indirect evidence for contrasts that have not been
compared in head-to-head RCTs (e.g., indirect evidence for the
comparison of npReFoam vs. npReWater generated
from comparisons of npReFoam vs. SC and npReWater vs. SC).
In this way, indirect evidence informs nine of the 15
network contrasts. The risk of bias assessment was based on the
most frequent level of bias recorded for studies
included in that comparison and denoted using coloured lines
(or links). A green link indicates no serious study
limitation, yellow indicates serious limitations; and red very
serious limitations.
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