AARC Clinical Practice Guidelines: Phase 4

Hess, Dean

doi:10.4187/respcare.08624

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…Retrospective designs are considered inferior to prospective studies for numerous reasons. First of all, the quality of the data depends highly on the quality and accuracy of the documentation ( 74 ). This can be especially problematic for variables that lack a clear definition, e.g., “negative attitude toward staff”, which may be interpreted differently when assessed by different clinicians.…”

Section: Discussionmentioning

confidence: 99%

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system

Machetanz,

Hofmann,

Möhrke

et al. 2023

Front. Psychiatry

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BackgroundSuffering from schizophrenia spectrum disorder (SSD) has been well-established as a risk factor for offending. However, the majority of patients with an SSD do not show aggressive or criminal behavior. Yet, there is little research on clinical key features distinguishing offender from non-offender patients. Previous results point to poorer impulse control, higher levels of excitement, tension, and hostility, and worse overall cognitive functioning in offender populations. This study aimed to detect the most indicative distinguishing clinical features between forensic and general psychiatric patients with SSD based on the course of illness and the referenced hospitalization in order to facilitate a better understanding of the relationship between violent and non-violent offenses and SSD.MethodsOur study population consisted of forensic psychiatric patients (FPPs) with a diagnosis of F2x (ICD-10) or 295.x (ICD-9) and a control group of general psychiatric patients (GPPs) with the same diagnosis, totaling 740 patients. Patients were evaluated regarding their medical (and, if applicable, criminal) history and the referenced psychiatric hospitalization. Supervised machine learning (ML) was used to exploratively evaluate predictor variables and their interplay and rank them in accordance with their discriminative power.ResultsOut of 194 possible predictor variables, the following 6 turned out to have the highest influence on the model: olanzapine equivalent at discharge from the referenced hospitalization, a history of antipsychotic prescription, a history of antidepressant, benzodiazepine or mood stabilizer prescription, medication compliance, outpatient treatment(s) in the past, and the necessity of compulsory measures. Out of the seven algorithms applied, gradient boosting emerged as the most suitable, with an AUC of 0.86 and a balanced accuracy of 77.5%.DiscussionOur study aimed to identify the most influential illness-related predictors, distinguishing between FPP and GPP with SSD, thus shedding light on key differences between the two groups. To our knowledge, this is the first study to compare a homogenous sample of FPP and GPP with SSD regarding their symptom severity and course of illness using highly sophisticated statistical approaches with the possibility of evaluating the interplay of all factors at play.

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Section: Discussionmentioning

confidence: 99%

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system

Machetanz,

Hofmann,

Möhrke

et al. 2023

Front. Psychiatry

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“…The digital and automated methods used in this study improved data accuracy and standardised the data collection process. It is also difficult to control for bias and confounders in retrospective studies (Hess, 2004). The novel approach to data collection used in this study provided access to a wide range of demographic and clinical confounders.…”

Section: Methodsmentioning

confidence: 99%

Identifying and Understanding Risk Factors for Instability and Adverse Events Associated With Chest Physiotherapy in Ventilated Children

2019

CMR

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BackgroundChest physiotherapy is a treatment option for ventilated children. Evidence supporting treatment effectiveness is limited and the safety profile is unknown.This study aimed to identify and understand risk factors for physiological instability and adverse events associated with chest physiotherapy in ventilated children. MethodsThis was a convergent mixed methods study.Work package 1: Explanatory sequential study to describe current physiotherapy practice and explore decision making, utilising an anonymous questionnaire, semi-structured interviews, focus groups, and document analysis. Work package 2:Retrospective single-centre study, using high-resolution data and electronic patient records. Mechanically ventilated children, aged 0-4 years, receiving chest physiotherapy were included. The primary outcome was oxygen saturation index (OSI). Incidence of adverse events (change ≥0.3) in the 60 minutes post-physiotherapy was investigated. ResultsThe questionnaire was sent to 26/27 (96%) UK paediatric intensive care units, with a response rate of 61% (72/118). Sixteen physiotherapist interviews and two focus groups (n=7) were completed. Twenty-nine organisational documents were analysed. The most frequently used techniques were position changes, saline instillation, manual hyperinflations and chest wall vibrations. Variation in practice included the personnel involved in treatments. Clinical decision making was described as complex, iterative, and collaborative, with experience and expertise important factors. OSI data were available for 247 patients. OSI adverse event rates were between 7.4%-9.3%. The highest rate was recorded in the 5 minutes immediately post-ARDS Acute respiratory distress syndrome ASL Airway surface liquid BD Twice daily CAQDAS Computer assisted qualitative data analysis software CF Cystic Fibrosis CICU Cardiac intensive care unit CO2 Carbon dioxide COPD Chronic obstructive pulmonary disease COVID19 Severe acute respiratory syndrome coronavirus 2 2019 pandemic CPB Cardiopulmonary bypass CPT Chest physiotherapy CS Closed suction CVVH Continuous veno-venous haemofiltration CWV Chest wall vibrations CXR Chest x-ray

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“…One long-standing example of pursuing ideal respiratory care is the assembly and dissemination of clinical practice guidelines that are based on the best available evidence and that also help to identify gaps in knowledge to frame key questions for further study. 6 Another example has been the development of respiratory care or RT-driven protocols, [7][8][9][10][11] pioneered by Judy Tietsort and George Burton in the 1990s 7 and then refined and studied by several other groups, [9][10][11] including in 2 randomized controlled trials 9,10 that concordantly support the efficacy of respiratory care protocols in enhancing the allocation of care with an associated lower cost of care (Table 1).…”

Section: In Search Of the Holy Grail Of Respiratory Carementioning

confidence: 99%

In Search of the Holy Grail of Respiratory Care

Stoller

2022

Respir Care

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AARC Clinical Practice Guidelines: Phase 4

Cited by 8 publications

References 8 publications

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system

Identifying and Understanding Risk Factors for Instability and Adverse Events Associated With Chest Physiotherapy in Ventilated Children

In Search of the Holy Grail of Respiratory Care

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