A realistic evaluation of track and trigger systems and acute care training for early recognition and treatment of deteriorating ward-based patients: research protocol.

Aim The aim of the study is to evaluate factors that enable or constrain the implementation and service delivery of early warnings systems or acute care training in practice. Background To date there is limited evidence to support the effectiveness of acute care initiatives (early warning systems, acute care training, outreach) in reducing the number of adverse events (cardiac arrest, death, unanticipated Intensive Care admission) through increased recognition and management of deteriorating ward based patients in hospital [1-3]. The reasons posited are that previous research primarily focused on measuring patient outcomes following the implementation of an intervention or programme without considering the social factors (the organisation, the people, external influences) which may have affected the process of implementation and hence measured end-points. Further research which considers the social processes is required in order to understand why a programme works, or does not work, in particular circumstances [4]. Method The design is a multiple case study approach of four general wards in two acute hospitals where Early Warning Systems (EWS) and Acute Life-threatening Events Recognition and Treatment (ALERT) course have been implemented. Various methods are being used to collect data about individual capacities, interpersonal relationships and institutional balance and infrastructures in order to understand the intended and unintended process outcomes of implementing EWS and ALERT in practice. This information will be gathered from individual and focus group interviews with key participants (ALERT facilitators, nursing and medical ALERT instructors, ward managers, doctors, ward nurses and health care assistants from each hospital); non-participant observation of ward organisation and structure; audit of patients' EWS charts and audit of the medical notes of patients who deteriorated during the study period to ascertain whether ALERT principles were followed. Discussion & progress to date This study commenced in January 2007. Ethical approval has been granted and data collection is ongoing with interviews being conducted with key stakeholders. The findings from this study will provide evidence for policy-makers to make informed decisions regarding the direction for strategic and service planning of acute care services to improve the level of care provided to acutely ill patients in hospital. References 1. Esmonde L, McDonnell A, Ball C, Waskett C, Morgan R, Rashidain A et al. Investigating the effectiveness of Critical Care Outreach Services: A systematic review. Intensive Care Medicine 2006; 32: 1713-1721 2. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems for the prevention of Intensive Care admission and death of critically ill patients on general hospital wards. Cochrane Database of Systematic Reviews 2007, Issue 3. www.thecochranelibrary.com 3. Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S, Pronovost PJ (2007) Rapid Response Systems: A systematic review. Critical Care Medicine 2007; 35 (5): 1238-43 4. Pawson R and Tilley N. Realistic Evaluation. London; Sage: 1997

Development and evaluation of a research-based prosthodontic clinical record

Introduction: Bien que l'importance de transférer les données de la recherche à la pratique a été largement démontrée, ce processus est toujours lent et fait face à plusieurs défis tels que la conceptualisation des évidences, la validité interne et externe de la recherche scientifique et les coûts élevés de la collecte de grandes quantités de données axées sur le patient. Les dossiers dentaires des patients contiennent des renseignements valables qui donneraient aux chercheurs cliniques une opportunité d'utiliser un large éventail d'informations quantitatives ou qualitatives. La standardisation du dossier clinique permettrait d’échanger et de réutiliser des données dans différents domaines de recherche. Objectifs: Le but de cette étude était de concevoir un dossier patient axé sur la recherche dans le domaine de la prosthodontie amovible à la clinique de premier cycle de l’Université de Montréal. Méthodes: Cette étude a utilisé des méthodes de recherche-action avec 4 étapes séquentielles : l'identification des problèmes, la collecte et l'interprétation des données, la planification et l’évaluation de l'action. Les participants de l'étude (n=14) incluaient des professeurs, des chercheurs cliniques et des instructeurs cliniques dans le domaine de la prosthodontie amovible. La collecte des données a été menée à l’aide d’une revue de littérature ciblée et complète sur les résultats en prosthodontie ainsi que par le biais de discussions de groupes et d’entrevues. Les données qualitatives ont été analysées en utilisant QDA Miner 3.2.3. Résultats: Les participants de l'étude ont soulevé plusieurs points absents au formulaire actuel de prosthodontie à la clinique de premier cycle. Ils ont partagé leurs idées pour la conception d'un nouveau dossier-patient basé sur 3 objectifs principaux: les objectifs cliniques, éducatifs et de recherche. Les principaux sujets d’intérêt en prosthodontie amovibles, les instruments appropriés ainsi que les paramètres cliniques ont été sélectionnés par le groupe de recherche. Ces résultats ont été intégrés dans un nouveau formulaire basé sur cette consultation. La pertinence du nouveau formulaire a été évaluée par le même groupe d'experts et les modifications requises ont été effectuées. Les participants de l'étude ont convenu que le cycle de recherche-action doit être poursuivi afin d'évaluer la faisabilité d’implémentation de ce dossier modifié dans un cadre universitaire. Conclusion: Cette étude est une première étape pour développer une base de données dans le domaine de la prothodontie amovible. La recherche-action est une méthode de recherche utile dans ce processus, et les éducateurs académiques sont bien placés pour mener ce type de recherche.

Uptake pathways: the potential of Bayesian belief networks to assist the management, monitoring and evaluation of development-orientated research

The effectiveness of development assistance has come under renewed scrutiny in recent years. In an era of growing economic liberalisation, research organisations are increasingly being asked to account for the use of public funds by demonstrating achievements. However, in the natural resources (NR) research field, conventional economic assessment techniques have focused on quantifying the impact achieved rather understanding the process that delivered it. As a result, they provide limited guidance for planners and researchers charged with selecting and implementing future research. In response, “pathways” or logic models have attracted increased interest in recent years as a remedy to this shortcoming. However, as commonly applied these suffer from two key limitations in their ability to incorporate risk and assess variance from plan. The paper reports the results of a case study that used a Bayesian belief network approach to address these limitations and outlines its potential value as a tool to assist the planning, monitoring and evaluation of development-orientated research.

Liquid-vapour homogenisation of fluid inclusions in stalagmites: Evaluation of a new thermometer for paleoclimate research

We present a new approach to determine palaeotemperatures (mean annual surface temperatures) based on measurements of the liquid–vapour homogenisation temperature of fluid inclusions in stalagmites. The aim of this study is to explore the potential and the limitations of this new palaeothermometer and to develop a reliable methodology for routine applications in palaeoclimate research. Therefore, we have investigated recent fluid inclusions from the top part of actively growing stalagmites that have formed at temperatures close to the present-day cave air temperature. A precondition for measuring homogenisation temperatures of originally monophase inclusions is the nucleation of a vapour bubble by means of single ultra-short laser pulses. Based on the observed homogenisation temperatures (Th(obs)) and measurements of the vapour bubble diameter at a known temperature, we calculated stalagmite formation temperatures (Tf) by applying a thermodynamic model that takes into account the effect of surface tension on liquid–vapour homogenisation. Results from recent stalagmite samples demonstrate that calculated stalagmite formation temperatures match the present-day cave air temperature within ± 0.2 °C. To avoid artificially induced changes of the fluid density we defined specific demands on the selection, handling and preparation of the stalagmite samples. Application of the method is restricted to stalagmites that formed at cave temperatures greater than ~ 9–11 °C.

Research on Candida dubliniensis in a Brazilian yeast collection obtained from cardiac transplant, tuberculosis, and HIV-positive patients, and evaluation of phenotypic tests using agar screening methods

The aim of this study was to research Candida dubliniensis among isolates present in a Brazilian yeast collection and to evaluate the main phenotypic methods for discrimination between C. albicans and C. dubliniensis from oral cavity. A total of 200 isolates, presumptively identified as C. albicans or C. dubliniensis obtained from heart transplant patients under immunosuppressive therapy, tuberculosis patients under antibiotic therapy, HIV-positive patients under antiretroviral therapy, and healthy subjects, were analyzed using the following phenotypic tests: formation and structural arrangement of chlamydospores on corn meal agar, casein agar, tobacco agar, and sunflower seed agar; growth at 45 degrees C; and germ tube formation. All strains were analyzed by polymerase chain reaction (PCR). In a preliminary screen for C. dubliniensis, 48 of the 200 isolates on corn meal agar, 30 of the 200 on casein agar, 16 of the 200 on tobacco agar, and 15 of the 200 on sunflower seed agar produced chlamydoconidia; 27 of the 200 isolates showed no or poor growth at 45 degrees C. All isolates were positive for germ tube formation. These isolates were considered suggestive of C. dubliniensis. All of them were subjected to PCR analysis using C. dubliniensis-specific primers. C. dubliniensis isolates were not found. C. dubliniensis isolates were not recovered in this study done with immunocompromised patients. Sunflower seed agar was the medium with the smallest number of isolates of C. albicans suggestive of C. dubliniensis. None of the phenotypic methods was 100% effective for discrimination between C. albicans and C. dubliniensis. (C) 2011 Elsevier Inc. All rights reserved.

EVALUATION OF THE PERCEPTION TOWARDS RESEARCH INVOLVING HUMAN BEINGS IN BRASILEAN POST DEGREE STUDENTS

In Brazil, research involving human beings must obey to ethical norms foresaw by the 196/96 National Health Council Resolution of the Ministry of Health. This paper gives account of a knowledge evaluation about some concepts and rules established by the resolution by Dental post degree students. It is concluded that in spite of the spreading and importance of the resolution most students do not know about it. In the same situation are those who work in research.