A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Publiken kommer och går men tv-tablån består : En intervjustudie av fem tablåplanerares syn på tv-tablåns utformning, genusmedvetenhet och framtid.

Syftet med denna uppsats är att undersöka hur tablåplanerare ser på den svenska tv-tablån, dess utformning och dess framtid samt hur kanalerna förhåller sig till jämställdhet vid tablåplanering. För att göra detta möjligt har vi utfört fem kvalitativa intervjuer med tablåplanerare från stora kanaler i Sverige. Valet av kvalitativ intervju grundar sig i att få djupare förståelse och inblick i informanternas kunskaper om tablåplanering samt dess innehåll och mening. Metoden som användes vid analys av transkriberad text från intervjuerna var tematiserad analysmetod. Genom att sortera texterna efter teman kunde vi finna mönster från informanternas svar som sedan kunde jämföras mot varandra. Denna uppsats har resulterat i en insyn i hur tablåplanerarna arbetar; de följer tittarsiffror, granskar nya program, konkurrensbevakar och följer publikens efterfrågan. Denna studie visar även på att det finns bristande genusmedvetenhet hos de undersökta svenska tv-kanalerna. Framtiden för tv-tablån är oviss med tablåplanerarna menar att tv-tablån kommer överleva, dock måste en omställning ske på grund av att tittarmönstret förändras

Tillgång och eftertanke : Om tillgänglighetens påverkan på upplevelsen av musik

I denna rapport har tillgänglighetens påverkan på upplevelsen vid musiklyssning undersökts. Inspiration har till största del hämtats från tidigare forskning inom musikpsykologi. Insamling av empiri gjordes genom ett lyssningstest där två olika grupper fick höra ett och samma stycke musik på två olika vis. Ena gruppen fick musiken uppspelad från en dator och blev informerade om att musiken de skulle höra fanns tillgänglig, gratis, på internet. Den andra gruppen fick höra samma musik men uppspelad från kassett. De fick veta att musiken inte fanns tillgänglig på internet och att de bara skulle få höra musiken en gång, sen aldrig mer. Efter de hört musiken fyllde samtliga informanter i en enkät för att beskriva sin upplevelse. Den sammanställda datan visar på att upplevelsen såg något annorlunda ut mellan grupperna.

Generalized pseudo-likelihood estimates for markov random fields on lattice

In this paper we generalize Besag's pseudo-likelihood function for spatial statistical models on a region of a lattice. The correspondingly defined maximum generalized pseudo-likelihood estimates (MGPLEs) are natural extensions of Besag's maximum pseudo-likelihood estimate (MPLE). The MGPLEs connect the MPLE and the maximum likelihood estimate. We carry out experimental calculations of the MGPLEs for spatial processes on the lattice. These simulation results clearly show better performances of the MGPLEs than the MPLE, and the performances of differently defined MGPLEs are compared. These are also illustrated by the application to two real data sets.

Modeling dialogue with mixed initiative in design space exploration

Exploration with a generative formalism must necessarily account for the nature of interaction between humans and the design space explorer. Established accounts of design interaction are made complicated by two propositions in Woodbury and Burrow's Keynote on design space exploration. First, the emphasis on the primacy of the design space as an ordered collection of partial designs (version, alternatives, extensions). Few studies exist in the design interaction literature on working with multiple threads simultaneously. Second, the need to situate, aid, and amplify human design intentions using computational tools. Although specific research and practice tools on amplification (sketching, generation, variation) have had success, there is a lack of generic, flexible, interoperable, and extensible representation to support amplification. This paper addresses the above, working with design threads and computer-assisted design amplification through a theoretical model of dialogue based on Grice's model of rational conversation. Using the concept of mixed initiative, the paper presents a visual notation for representing dialogue between designer and design space formalism through abstract examples of exploration tasks and dialogue integration.

Prototype Generation from Ontology Charts

Semantic Analysis is a business analysis method designed to capture system requirements. While these requirements may be represented as text, the method also advocates the use of Ontology Charts to formally denote the system's required roles, relationships and forms of communication. Following model driven engineering techniques, Ontology Charts can be transformed to temporal Database schemas, class diagrams and component diagrams, which can then be used to produce software systems. A nice property of these transformations is that resulting system design models lend themselves to complicated extensions that do not require changes to the design models. For example, resulting databases can be extended with new types of data without the need to modify the database schema of the legacy system. Semantic Analysis is not widely used in software engineering, so there is a lack of experts in the field and no design patterns are available. This make it difficult for the analysts to pass organizational knowledge to the engineers. This study describes an implementation that is readily usable by engineers, which includes an automated technique that can produce a prototype from an Ontology Chart. The use of such tools should enable developers to make use of Semantic Analysis with minimal expertise of ontologies and MDA.

Information Flow for ALGOL-like Languages

In this paper we present an approach to information flow analysis for a family of languages. We start with a simple imperative language. We present an information flow analysis using a flow logic. The paper contains detailed correctness proofs for this analysis. We next extend the analysis to a restricted form of Idealised Algol, a call-by-value higher-order extension of the simple imperative language (the key restriction being the lack of recursion). The paper concludes with a discussion of further extensions, including a probabilistic extension of Idealised Algol.

Frequency distribution of TATA box and extension sequences on human promoters

TATA box is one of the most important transcription factor binding sites. But the exact sequences of TATA box are still not very clear yet. In this study, we conducted a dedicated analysis on the frequency distribution of TATA Box and its extension sequences on human promoters. Sixteen TATA elements derived from TATA Box motif, TATAWAWN, were classified into three distribution patterns: peak, bottom-peak and bottom. Fourteen TATA extension sequences (up to two base extensions) were predicted to be the new TATA Box elements because of their high motif factors, which indicate their statistical significance. Statistical analysis on the promoters of mouse, zebrafish and drosophila melanogaster verified seven of these elements. It was also observed that the distribution of TATA elements on the promoters of housekeeping genes are very similar with their distribution on the promoters of tissue specific genes in human.

Interaction among agents that plan

The development of practical agent languages has progressed significantly over recent years, but this has largely been independent of distinct developments in aspects of multiagent cooperation and planning. For example, while the popular AgentSpeak(L) has had various extensions and improvements proposed, it still essentially a single-agent language. In response, in this paper, we describe a simple, yet effective, technique for multiagent planning that enables an agent to take advantage of cooperating agents in a society. In particular, we build on a technique that enables new plans to be added to a plan library through the invocation of an external planning component, and extend it to include the construction of plans involving the chaining of subplans of others. Our mechanism makes use of plan patterns that insulate the planning process from the resulting distributed aspects of plan execution through local proxy plans that encode information about the preconditions and effects of the external plans provided by agents willing to cooperate. In this way, we allow an agent to discover new ways of achieving its goals through local planning and the delegation of tasks for execution by others, allowing it to overcome individual limitations.

Extending Agent Languages for Autonomy

BDI agent languages provide a useful abstraction for complex systems comprised of interactive autonomous entities, but they have been used mostly in the context of single agents with a static plan library of behaviours invoked reactively. These languages provide a theoretically sound basis for agent design but are very limited in providing direct support for autonomy and societal cooperation needed for large scale systems. Some techniques for autonomy and cooperation have been explored in the past in ad hoc implementations, but not incorporated in any agent language. In order to address these shortcomings we extend the well known AgentSpeak(L) BDI agent language to include behaviour generation through planning, declarative goals and motivated goal adoption. We also develop a language-specific multiagent cooperation scheme and, to address potential problems arising from autonomy in a multiagent system, we extend our agents with a mechanism for norm processing leveraging existing theoretical work. These extensions allow for greater autonomy in the resulting systems, enabling them to synthesise new behaviours at runtime and to cooperate in non-scripted patterns.

Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.