Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative-evidence synthesis

Background:
Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions.

Objectives:
1. To locate, appraise and synthesize qualitative evidence concerning the barriers and facilitators of the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

2. To integrate this synthesis with two Cochrane effectiveness reviews of protocolized weaning to help explain observed heterogeneity by identifying contextual factors that impact on the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

3. To use the integrated body of evidence to suggest the circumstances in which weaning protocols are most likely to be used.

Search methods:
We used a range of search terms identified with the help of the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) mnemonic. Where available, we used appropriate methodological filters for specific databases. We searched the following databases: Ovid MEDLINE, Embase, OVID, PsycINFO, CINAHL Plus, EBSCOHost, Web of Science Core Collection, ASSIA, IBSS, Sociological Abstracts, ProQuest and LILACS on the 26th February 2015. In addition, we searched: the grey literature; the websites of professional associations for relevant publications; and the reference lists of all publications reviewed. We also contacted authors of the trials included in the effectiveness reviews as well as of studies (potentially) included in the qualitative synthesis, conducted citation searches of the publications reporting these studies, and contacted content experts.

We reran the search on 3rd July 2016 and found three studies, which are awaiting classification.

Selection criteria:
We included qualitative studies that described: the circumstances in which protocols are designed, implemented or used, or both, and the views and experiences of healthcare professionals either involved in the design, implementation or use of weaning protocols or involved in the weaning of critically-ill adults and children from mechanical ventilation not using protocols. We included studies that: reflected on any aspect of the use of protocols, explored contextual factors relevant to the development, implementation or use of weaning protocols, and reported contextual phenomena and outcomes identified as relevant to the effectiveness of protocolized weaning from mechanical ventilation.

Data collection and analysis:
At each stage, two review authors undertook designated tasks, with the results shared amongst the wider team for discussion and final development. We independently reviewed all retrieved titles, abstracts and full papers for inclusion, and independently extracted selected data from included studies. We used the findings of the included studies to develop a new set of analytic themes focused on the barriers and facilitators to the use of protocols, and further refined them to produce a set of summary statements. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to arrive at a final assessment of the overall confidence of the evidence used in the synthesis. We included all studies but undertook two sensitivity analyses to determine how the removal of certain bodies of evidence impacted on the content and confidence of the synthesis. We deployed a logic model to integrate the findings of the qualitative evidence synthesis with those of the Cochrane effectiveness reviews.

Main results:
We included 11 studies in our synthesis, involving 267 participants (one study did not report the number of participants). Five more studies are awaiting classification and will be dealt with when we update the review.

The quality of the evidence was mixed; of the 35 summary statements, we assessed 17 as ‘low’, 13 as ‘moderate’ and five as ‘high’ confidence. Our synthesis produced nine analytical themes, which report potential barriers and facilitators to the use of protocols. The themes are: the need for continual staff training and development; clinical experience as this promotes felt and perceived competence and confidence to wean; the vulnerability of weaning to disparate interprofessional working; an understanding of protocols as militating against a necessary proactivity in clinical practice; perceived nursing scope of practice and professional risk; ICU structure and processes of care; the ability of protocols to act as a prompt for shared care and consistency in weaning practice; maximizing the use of protocols through visibility and ease of implementation; and the ability of protocols to act as a framework for communication with parents.

Authors' conclusions:
There is a clear need for weaning protocols to take account of the social and cultural environment in which they are to be implemented. Irrespective of its inherent strengths, a protocol will not be used if it does not accommodate these complexities. In terms of protocol development, comprehensive interprofessional input will help to ensure broad-based understanding and a sense of ‘ownership’. In terms of implementation, all relevant ICU staff will benefit from general weaning as well as protocol-specific training; not only will this help secure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is in place. In order to maximize relevance and acceptability, protocols should be designed with the patient profile and requirements of the target ICU in mind. Predictably, an under-resourced ICU will impact adversely on protocol implementation, as staff will prioritize management of acutely deteriorating and critically-ill patients.

Fungal communities in archives: assessment strategies and impact on paper conservation and human health

The main results presented in this PhD Dissertation have been published in interna-tional journals included in the Science Citation Index (SCI)

Las Revistas internacionales de geografía física: análisis de las publicaciones reflejadas en el Science Citation Index del Journal of Citation Reports durante el período 1989-2004

El manejo de los índices de impacto de las revistas internacionales es capital para investigadores, profesores y estudiantes de tercer ciclo ya que permite seleccionar la publicación más adecuada para dirigir las investigaciones. Al margen, en la actualidad, las trayectorias curriculares se están midiendo a través de las publicaciones en revistas indexadas, por lo que el conocimiento de estos índices es fundamental. En el presente trabajo se reflejan las revistas de geografía física que han aparecido en las categorías de Geografía del Science Citation Index del Journal Citation Reports desde 1989 hasta 2004. Se realiza una visión global de cada revista con los valores de factor de impacto y la editorial que las publica, así como una revisión de la temática de cada una de ellas y el perfil de su audiencia potencial

Environmental and ecological economics in the 21st century: an age adjusted citation analysis of the influential articles, journals, authors and institutions

We investigate the influence of articles, authors, journals and institutions in the field of environmental and ecological economics. We depart from studies that investigated the literature until 2001 and include a time period that has witnessed an enormous increase of importance in the field. We adjust for the age effect given the huge impact of the year of an article's publication on its influence and we show that this adjustment does make a substantial difference — especially for disaggregated units of analysis with diverse age characteristics such as articles or authors. We analyse 6597 studies on environmental and ecological economics published between 2000 and 2009. We provide rankings of the influential articles, authors, journals and institutions and find that Ecological Economics, Energy Economics and the Journal of Environmental Economics and Management have the most influential articles, they publish very influential authors and their articles are cited most. The University of Maryland, Resources for the Future, the University of East Anglia and the World Bank appear to be the most influential institutions in the field of environmental and ecological economics.

Environmental and ecological economics in the 21st century: an age adjusted citation analysis of the most influential articles, journals, authors and institutions

We investigate the influence of articles, authors, journals and institutions in the field of environmental and ecological economics. We depart from studies that investigated the literature until 2001 and include a time period that has witnessed an enormous increase of importance in the field. We adjust for the age effect given the huge impact of the year of an article's publication on its influence and we show that this adjustment does make a substantial difference — especially for disaggregated units of analysis with diverse age characteristics such as articles or authors. We analyse 6597 studies on environmental and ecological economics published between 2000 and 2009. We provide rankings of the influential articles, authors, journals and institutions and find that Ecological Economics, Energy Economics and the Journal of Environmental Economics and Management have the most influential articles, they publish very influential authors and their articles are cited most. The University of Maryland, Resources for the Future, the University of East Anglia and the World Bank appear to be the most influential institutions in the field of environmental and ecological economics.

Impact of biomass burning aerosol on the monsoon circulation transition over Amazonia

Ensemble simulations of a regional climate model (RegCM3) forced by aerosol radiative forcing suggest that biomass burning aerosols can work against the seasonal monsoon circulation transition, thus re-enforce the dry season rainfall pattern for Southern Amazonia. Strongly absorbing smoke aerosols warm and stabilize the lower troposphere within the smoke center in southern Amazonia (where aerosol optical depth >0.3). These changes increase the surface pressure in the smoke center, weaken the southward surface pressure gradient between northern and southern Amazonia, and consequently induce an anomalous moisture divergence in the smoke center and an anomalous convergence in northwestern Amazonia (5 degrees S-5 degrees N, 60 degrees W-70 degrees W). The increased atmospheric thermodynamic stability, surface pressure, and divergent flow in Southern Amazonia may inhibit synoptic cyclonic activities propagated from extratropical South America, and re-enforce winter-like synoptic cyclonic activities and rainfall in southeastern Brazil, Paraguay and northeastern Argentina. Citation: Zhang, Y., R. Fu, H. Yu, Y. Qian, R. Dickinson, M. A. F. Silva Dias, P. L. da Silva Dias, and K. Fernandes (2009), Impact of biomass burning aerosol on the monsoon circulation transition over Amazonia, Geophys. Res. Lett., 36, L10814, doi: 10.1029/2009GL037180.

Exploring the contribution of different types of cited materials to marketing knowledge over time : a citation analysis

This paper examines the degree to which articles appearing in JM, JMR, and JCR cite different types of references (journals, books, book chapters, conference proceedings, professional and popular press, and “others”) between 1975 and 2003. The results suggest that the number of citations to journals articles has increased over time and there have been significant falls in reference to non-journal sources of materials. References to some non-journal sources (i.e., newspaper and professional materials) have increased in JCR and JMR, but decreased in JM. The impact of shifts in the types of citation materials on knowledge development is also discussed.

Using choquet integrals for evaluating citation indices in journal ranking

The use of citation-based indices to evaluate the quality of journals is becoming increasingly widespread. Recently, ISI Web of Knowledge has begun to include three new indices in their journal statistics, including a 5-year impact factor. Here, we continue our earlier research which modeled the behavior of journal assessors based on some of these indices and the Choquet integral. We interpret the obtained fuzzy measures of many new datasets toward understanding the importance of these newly published indices and how indicative they may be of a journal's quality. The problem is one of ordinal classification, and the values of the best-fitting fuzzy measures can be obtained using the FMtools software package.

The impact of IT intervention programs for girls

The goal of our study is to investigate the longitudinal effects of one intervention program for schoolgirls in the Information Technology (IT) field. This bi-annual event has been conducted regularly since 2006 with the aim of confronting a decline in the interest among girls to study IT and promoting study and work opportunities in the field. Each event has been evaluated with pre- and post-event surveys. Longitudinally, both students and teachers have also been surveyed three to four years after the event in which they participated. Results from the 2006 cohort surveyed in 2009-2010 are reported on in this paper. The main conclusion is that, unfortunately, any increase in the uptake of IT in schools that occurred as a result of attending the event was transitory. Therefore, it is crucial that inspiring, engaging, and empowering computing classes are being offered continuously at all secondary schools.

External impact of arts management research: An extended analysis

Arts management is a discipline whose research domain has grown in impact over the last quarter century.This study provides an external thematic, content and citation analysis of arts management articles in top-tiermainstream management and marketing journals between 1987 and 2010. It explicates article, author andcitation frequencies based on author information, publication patterns and thematic citation metrics, thuscontributing to the development of the arts management body of knowledge. Specifically, the study examinesthe function of arts management research as a bridging mechanism to its parent disciplines in managementand marketing. The authors identify thematic citation metrics of research published in mainstream journalsas well as frequencies and publication patterns, so that scholars can make decisions affecting their futureresearch directions. The authors conclude that there is little correlation between age/rank of journal andfrequency of citations, with younger journals becoming established as key players within relatively shortperiods.

Rising Publication Delays Inflate Journal Impact Factors

Journal impact factors have become an important criterion to judge the quality of scientific publications over the years, influencing the evaluation of institutions and individual researchers worldwide. However, they are also subject to a number of criticisms. Here we point out that the calculation of a journal’s impact factor is mainly based on the date of publication of its articles in print form, despite the fact that most journals now make their articles available online before that date. We analyze 61 neuroscience journals and show that delays between online and print publication of articles increased steadily over the last decade. Importantly, such a practice varies widely among journals, as some of them have no delays, while for others this period is longer than a year. Using a modified impact factor based on online rather than print publication dates, we demonstrate that online-to-print delays can artificially raise a journal’s impact factor, and that this inflation is greater for longer publication lags. We also show that correcting the effect of publication delay on impact factors changes journal rankings based on this metric. We thus suggest that indexing of articles in citation databases and calculation of citation metrics should be based on the date of an article’s online appearance, rather than on that of its publication in print.

What are Scientific Leaders? The Introduction of a Normalized Impact Factor

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The perception of brazilian researchers concerning the factors that influence the citation of their articles: A study in the field of sustainability

With growing institutional pressure from the Brazilian government to increase the impact of research that it funds, Brazilian researchers are increasingly interested in discovering factors that affect the citation of their articles. The aim of the present article was to assess the perceptions of Brazilian sustainability researchers to identify factors that influence the impacts of their research. A survey was conducted with researchers in the field of sustainability and 89 questionnaires were completed. All of those researchers have articles or research projects in the field of sustainability (mixing environmental, social and/or economical) recorded in the Scielo or Lattes Curriculum Brazilian databases. Results suggest four factors that may explain the impact of article citations: (1) prestige of the author and the research network; (2) prestige of the means of publication and indexing; (3) accessibility and quality characteristics of the article; and (4) international nature of communication and scope of the study. Surprisingly, such factors were not statistically significant in explaining the citations of the participating researchers. These results show the need to consider other factors that can explain the impact of research, discovering the missing links. © 2013 Elsevier Inc.

Three-feature model to reproduce the topology of citation networks and the effects from authors' visibility on their h-index

Various factors are believed to govern the selection of references in citation networks, but a precise, quantitative determination of their importance has remained elusive. In this paper, we show that three factors can account for the referencing pattern of citation networks for two topics, namely "graphenes" and "complex networks", thus allowing one to reproduce the topological features of the networks built with papers being the nodes and the edges established by citations. The most relevant factor was content similarity, while the other two - in-degree (i.e. citation counts) and age of publication - had varying importance depending on the topic studied. This dependence indicates that additional factors could play a role. Indeed, by intuition one should expect the reputation (or visibility) of authors and/or institutions to affect the referencing pattern, and this is only indirectly considered via the in-degree that should correlate with such reputation. Because information on reputation is not readily available, we simulated its effect on artificial citation networks considering two communities with distinct fitness (visibility) parameters. One community was assumed to have twice the fitness value of the other, which amounts to a double probability for a paper being cited. While the h-index for authors in the community with larger fitness evolved with time with slightly higher values than for the control network (no fitness considered), a drastic effect was noted for the community with smaller fitness. (C) 2012 Elsevier Ltd. All rights reserved.