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- 2019
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 4. |
- Hillier, Ladeana W, et al.
(författare)
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Sequence and comparative analysis of the chicken genome provide unique perspectives on vertebrate evolution
- 2004
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Ingår i: Nature. - 0028-0836 .- 1476-4687. ; 432:7018, s. 695-716
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Tidskriftsartikel (refereegranskat)abstract
- We present here a draft genome sequence of the red jungle fowl, Gallus gallus. Because the chicken is a modern descendant of the dinosaurs and the first non-mammalian amniote to have its genome sequenced, the draft sequence of its genome--composed of approximately one billion base pairs of sequence and an estimated 20,000-23,000 genes--provides a new perspective on vertebrate genome evolution, while also improving the annotation of mammalian genomes. For example, the evolutionary distance between chicken and human provides high specificity in detecting functional elements, both non-coding and coding. Notably, many conserved non-coding sequences are far from genes and cannot be assigned to defined functional classes. In coding regions the evolutionary dynamics of protein domains and orthologous groups illustrate processes that distinguish the lineages leading to birds and mammals. The distinctive properties of avian microchromosomes, together with the inferred patterns of conserved synteny, provide additional insights into vertebrate chromosome architecture.
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- MacDonald, Valerie, et al.
(författare)
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Developing and Testing an International Audit of Nursing Quality Indicators for Older Adults With Fragility Hip Fracture
- 2018
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Ingår i: Orthopedic Nursing. - : Lippincott Williams & Wilkins. - 0744-6020 .- 1542-538X. ; 37:2, s. 115-121
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fragility hip fracture in older adults often has poor outcomes, but these outcomes can be improved with attention to specific quality care indicators. PURPOSE: The International Collaboration of Orthopaedic Nursing (ICON) developed an audit process to identify the extent to which internationally accepted nursing quality care indicators for older adults with fragility hip fracture are reflected in policies, protocols, and processes guiding acute care. METHODS: A data abstraction tool was created for each of 12 quality indicators. Data were collected using a mixed-methods approach with unstructured rounds. A rationale document providing evidence for the quality indicators and a user evaluation form were included with the audit tool. A purposeful sample of 35 acute care hospitals representing 7 countries was selected. RESULTS: Thirty-five hospitals (100%) completed the survey. Respondents viewed the content as relevant and applicable for the defined patient population. Although timing and frequency of implementation varied among and within countries, the identified quality indicators were reflected in the majority of policies, protocols, or processes guiding care in the hospitals surveyed. CONCLUSION: Developing and testing an audit of nurse-sensitive quality indicators for older adults with fragility hip fracture demonstrate international consensus on common core best practices to ensure optimal acute care.
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- Palmer, Victoria J., et al.
(författare)
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The Participatory Zeitgeist : An explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement
- 2019
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Ingår i: Medical Humanities. - : BMJ Publishing Group Ltd. - 1468-215X .- 1473-4265. ; 45:3, s. 247-257
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Tidskriftsartikel (refereegranskat)abstract
- Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitgeist - the spirit of our times in quality improvement. The rationale for this new spirit of participation relates to voice and engagement (those with lived experience should be engaged in processes of development, redesign and improvements), empowerment (engagement in codesign and coproduction has positive individual and societal benefits) and advancement (quality of life and other health outcomes and experiences of services for everyone involved should improve as a result). This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services. Little information exists about the underlying mechanisms of change; the entities, processes and structures that underpin MH ECO and similar EBCD studies. To address this, we identified eight possible mechanisms from an assessment of the activities and outcomes of MH ECO and a review of existing published evaluations. The eight mechanisms, recognition, dialogue, cooperation, accountability, mobilisation, enactment, creativity and attainment, are discussed within an 'explanatory theoretical model of change' that details these and ideal relational transitions that might be observed or not with MH ECO or other EBCD studies. We critically appraise the sociocultural and political movement in coproduction and draw on interdisciplinary theories from the humanities - narrative theory, dialogical ethics, cooperative and empowerment theory. The model advances theoretical thinking in coproduction beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome. Trial registration number: The Australian and New Zealand Clinical Trials Registry, ACTRN12614000457640 (results).
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