164 results on '"Tim Baker"'
Search Results
2. Pelvic ultrasounds referred from the emergency department: Agreement between sonographer findings and radiologists' reports
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Michal Schneider, Ellen Kolsky, Luke Pontonio, Tim Baker, and Tamika Kelson
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medicine.medical_specialty ,business.industry ,Ultrasound ,Sonographer ,Medicine ,Medical physics ,Emergency department ,business - Published
- 2020
3. The epidemiology of emergency presentations for falls from height across Western Victoria, Australia
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Mustafa Khasraw, Lana J. Williams, Muhammad A. Sajjad, Alasdair Sutherland, Mark A. Kotowicz, Patricia M. Livingston, Julie A. Pasco, Susan Brumby, Sharon Hakkennes, Sharon L. Brennan-Olsen, Kara L Holloway-Kew, Trisha Dunning, Tim Baker, and Richard S. Page
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Adult ,Male ,medicine.medical_specialty ,Work activity ,Victoria ,Population ,Emergency Nursing ,03 medical and health sciences ,0302 clinical medicine ,Fall from height ,Health care ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,education ,Local government area ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Incidence ,Medical record ,Incidence (epidemiology) ,Age Factors ,030208 emergency & critical care medicine ,Middle Aged ,Geography ,Wounds and Injuries ,Accidental Falls ,Female ,Emergency Service, Hospital ,business ,Demography - Abstract
Background In order to implement intervention strategies to prevent falls from height, epidemiological data are needed. The aim of this study was to map emergency presentations for falls from height in residents aged ≥40 yr of the western region of Victoria, Australia. Methods Emergency presentations following a fall from height (≥1 m) were obtained from electronic medical records for 2014–2016 inclusive. For each Local Government Area, age-standardised incidence rates (per 10,000 population/year) were calculated. Results The age-standardised incidence rate was lowest in the Northern Grampians (3.4 95%CI 0.8–5.9), which has several main industries including health care, agriculture and manufacturing. The highest rates occurred in Corangamite (26.0 95%CI 19.9–32.0), Colac-Otway (23.7 95%CI 18.5–28.8) and Moyne (22.5 95%CI 16.8–28.3), which are sparsely populated (15,000–20,000 people each). Patterns were similar for men and women. Most falls occurred during “leisure” (38.0%), followed by “other work” (15.4%). Men were more likely than women to experience a fall from height while undertaking work activities. Many falls occurred in the home (53.2%). Conclusion Future research should inform strategies to prevent falls from height in the region. This could include specific locations such as the home or farm, and during leisure activities or work.
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- 2020
4. Hotel revenue management for the transient segment: taxonomy-based research
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Robert J. Harrington, Aysajan Eziz, and Tim Baker
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Decision support system ,Revenue management ,Operations research ,Computer science ,business.industry ,Vendor ,Tourism, Leisure and Hospitality Management ,Information system ,Strategic fit ,Price optimization ,Design science ,business ,Hospitality industry - Abstract
Purpose This paper aims to (1) organize the open literature on hotel revenue management systems, (2) compare practitioner systems in terms of functionality and (3) integrate (1)-(2) into research stream recommendations for the open literature with an empirical focus. Design/methodology/approach The authors use Nickerson’s taxonomy development method from the field of information systems to build the taxonomy. Findings New forecasting areas include developing a metric for the degree of strategic fit of a hotel’s pricing strategy and using it in conjunction with quantifications of online reviews for predictions. New price optimization avenues include determining whether a lack of congruence between customer perceptions of fairness and trust and pricing history has a detrimental effect on overall hotel performance and determining which combinations of flexible products, decision-maker risk aversion, nonparametric forecasting and reference effect optimization features work best in which situations. Originality/value This is the first study to combine vendor activities outside the technical realms of forecasting and price optimization with an emphasis on the choice modeling technical framework. This study points to several promising studies using qualitative methods, action research and design science.
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- 2020
5. Emergency and critical care services in Malawi: Findings from a nationwide survey of health facilities
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Eric Umar, Grace Mayamiko Chatsika, Tim Baker, Raphael Kazidule Kayambankadzanja, Andrew Likaka, and Samson Kwazizira Mndolo
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Malawi ,Resource (biology) ,Critical Care ,Critical Illness ,030231 tropical medicine ,Nationwide survey ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Health facility ,Surveys and Questionnaires ,Medicine ,Humans ,Quality of care ,Original Research ,Quality of Health Care ,Median score ,business.industry ,Critically ill ,030208 emergency & critical care medicine ,Secondary data ,General Medicine ,Health Services ,medicine.disease ,Health Care Surveys ,Critical illness ,Health Resources ,Medical emergency ,Emergency care ,Health Facilities ,business ,Emergency Service, Hospital - Abstract
BackgroundGlobally, critical illness causes up to 45 million deaths every year. The burden is highest in low-income countries such as Malawi. Critically ill patients require good quality, essential care in emergency departments and in hospital wards to avoid negative outcomes such as death. Little is known about the quality of care or the availability of necessary resources for emergency and critical care in Malawi. The aim of this study was to assess the availability of resources for emergency and critical care in Malawi using data from the Service Provision Assessment (SPA).MethodsWe conducted a secondary data analysis of the SPA – a nationwide survey of all health facilities. We assessed the availability of resources for emergency and critical care using previously developed standards for hospitals in low-income countries. Each health facility received an availability score, calculated as the proportion of resources that were present. Resource availability was sub-divided into the seven a-priori defined categories of drugs, equipment, support services, emergency guidelines, infrastructure, training and routines.ResultsOf the 254 indicators in the standards necessary for assessing the quality of emergency and critical care, SPA collected data for 102 (40.6%). Hospitals had a median resource availability score of 51.6% IQR (42.2-67.2) and smaller health facilities had a median of 37.5% (IQR 28.1-45.3). For the category of drugs, the hospitals’ median score was 62.0% IQR (52.4-81.0), for equipment 51.9% IQR (40.7-66.7), support services 33.3% IQR (22.2-77.8) and emergency guidelines 33.3% IQR (0-66.7). SPA did not collect any data for resources in the categories of infrastructure, training or routines. ConclusionHospitals in Malawi lack resources for providing emergency and critical care. Increasing data about the availability of resources for emergency and critical care and improving the hospital systems for the care of critically ill patients in Malawi should be prioritized.
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- 2020
6. Stark choices: exploring health sector costs of policy responses to COVID-19 in low-income and middle-income countries
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Sergio Torres-Rueda, Edwine Barasa, Angela Kairu, Henning Tarp Jensen, Nichola Kitson, Fiammetta Bozzani, Mark Jit, Matthew Quaife, Carl A. B. Pearson, Nichola R. Naylor, Sedona Sweeney, Mishal S Khan, Simon R Procter, Maryam Huda, Anna Vassall, Rosalind M Eggo, Marcus R. Keogh-Brown, Raza Zaidi, Nuru Saadi, Nicholas G Davies, and Tim Baker
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medicine.medical_specialty ,Medicine (General) ,Cost estimate ,media_common.quotation_subject ,Gross Domestic Product ,Infectious and parasitic diseases ,RC109-216 ,Gross domestic product ,R5-920 ,Epidemiology ,Per capita ,medicine ,health economics ,Humans ,Developing Countries ,Cost database ,media_common ,Original Research ,Health economics ,Public economics ,SARS-CoV-2 ,Health Policy ,Social distance ,Public Health, Environmental and Occupational Health ,COVID-19 ,Payment ,Policy ,Business - Abstract
ObjectivesCOVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19 clinical management in 79 LMICs under different epidemiological scenarios.MethodsWe used country-specific epidemiological projections from a dynamic transmission model to determine number of cases, hospitalisations and deaths over 1 year under four mitigation scenarios. We defined the health sector response for three base LMICs through guidelines and expert opinion. We calculated costs through local resource use and price data and extrapolated costs across 79 LMICs. Lastly, we compared cost estimates against gross domestic product (GDP) and total annual health expenditure in 76 LMICs.ResultsCOVID-19 clinical management costs vary greatly by country, ranging between ConclusionsWe present the first dataset of COVID-19 clinical management costs across LMICs. These costs can be used to inform decision-making on priority setting. Our results show that COVID-19 clinical management costs in LMICs are substantial, even in scenarios of moderate social distancing. Low-income countries are particularly vulnerable and some will struggle to cope with almost any epidemiological scenario. The choices facing LMICs are likely to remain stark and emergency financial support will be needed.
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- 2021
7. Viral Dynamics of SARS-CoV-2 Variants in Vaccinated and Unvaccinated Persons
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Joel T. Dudley, Gaurav Khullar, Caroline G. Tai, Joseph R. Fauver, Tim Baker, Christina D. Mack, Deverick J. Anderson, Nathan D. Grubaugh, Christopher E. Mason, Jessica Metti, Matthew MacKay, David D. Ho, Mallery I. Breban, Yonatan H. Grad, Anne E. Watkins, Stephen M Kissler, Radhika M. Samant, Daisy Salgado, and Rachel Baits
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Basketball ,business.industry ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,fungi ,General Medicine ,Viral kinetics ,Virology ,respiratory tract diseases ,body regions ,Viral dynamics ,Correspondence ,Medicine ,skin and connective tissue diseases ,business - Abstract
Study of SARS-CoV-2 Dynamics in the NBA A SARS-CoV-2 surveillance program conducted by the National Basketball Association identified 173 newly infected persons. The viral kinetics were systematica...
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- 2021
8. Drivers of degree of sophistication in hotel revenue management decision support systems
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Lizao Zhang, Byron Marlowe, Tim Baker, Robert J. Harrington, and Xun Xu
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Decision support system ,Revenue management ,Knowledge management ,Operating environment ,business.industry ,Strategy and Management ,media_common.quotation_subject ,Decision tree ,Market segmentation ,Tourism, Leisure and Hospitality Management ,Organizational structure ,Product (category theory) ,Business ,Sophistication ,media_common - Abstract
Revenue management (RM) practices enhance financial performance of businesses. This study answers two research questions: (a) How should the sophistication of hotel RM be measured? and (b) What are the internal and external indirect drivers of the level of sophistication of hotel RM? The level of sophistication is based on decision tree tests, which include four steps: data capture, data foundation, rigor of analysis, and techniques used, including pricing, inventory allocation, and product configuration. Via an empirical analysis, we determine five positive drivers of hotel RM sophistication: electronic word-of-mouth utilization, customer segmentation, organizational structure, differentiation strategy, and competitive environment. Our study provides hoteliers with guidelines for determining whether their RM system is at the right level of sophistication given their operating environment, and provides a roadmap for hotels to enhance RM sophistication through efforts to improve both internal and external drivers.
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- 2019
9. Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force
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Jan Bakker, A. B. Johan Groeneveld, Sheila Nainan Myatra, Massimo Antonelli, Sharon Einav, Martin W. Dünser, Glenn Hernandez, Flávia Ribeiro Machado, Anders Perner, Daniel De Backer, Tim Baker, Jean-Louis Teboul, Jean Louis Vincent, Sameer Jog, Maurizio Cecconi, M. Ignacio Monge García, Mervyn Mer, Jacques Duranteaum, Tim Harris, and Intensive Care
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Fluid administration ,medicine.medical_specialty ,Central Venous Pressure ,Advisory Committees ,Psychological intervention ,Blood Pressure ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Scientific evidence ,03 medical and health sciences ,0302 clinical medicine ,Operating theater ,Heart Rate ,Anesthesiology ,Intensive care ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Expert Testimony ,Monitoring, Physiologic ,business.industry ,Task force ,030208 emergency & critical care medicine ,Shock ,medicine.disease ,Fluid Therapy ,Medical emergency ,business - Abstract
An international team of experts in the field of fluid resuscitation was invited by the ESICM to form a task force to systematically review the evidence concerning fluid administration using basic monitoring. The work included a particular emphasis on pre-ICU hospital settings and resource-limited settings. The work focused on four main questions: (1) What is the role of clinical assessment to guide fluid resuscitation in shock? (2) What basic monitoring is required to perform and interpret a fluid challenge? (3) What defines a fluid challenge in terms of fluid type, ranges of volume, and rate of administration? (4) What are the safety endpoints during a fluid challenge? The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion. The panel identified significant gaps in the scientific evidence on fluid administration outside the ICU (excluding the operating theater). Globally, scientific communities and health care systems should address these critical gaps in evidence through research on how basic fluid administration in resource-rich and resource-limited settings can be improved for the benefit of patients and societies worldwide.
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- 2019
10. Cost-effectiveness of umeclidinium as add-on to ICS/LABA therapy in COPD: A UK perspective
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Tim Baker, Dhvani Shah, Afisi S. Ismaila, Maurice Driessen, Ian Naya, Andrew Briggs, and Nancy Risebrough
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Male ,Pulmonary and Respiratory Medicine ,Quinuclidines ,medicine.medical_specialty ,Exacerbation ,Cost effectiveness ,Cost-Benefit Analysis ,Muscarinic Antagonists ,Umeclidinium bromide ,Maintenance Chemotherapy ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Adrenergic beta-2 Receptor Agonists ,health care economics and organizations ,COPD ,biology ,business.industry ,Middle Aged ,Lama ,biology.organism_classification ,medicine.disease ,Androstadienes ,Treatment Outcome ,030228 respiratory system ,chemistry ,Delayed-Action Preparations ,Ics laba ,Disease Progression ,Fluticasone ,Drug Therapy, Combination ,Female ,Vilanterol ,Salmeterol ,business ,medicine.drug - Abstract
Introduction The cost-effectiveness of long-acting muscarinic antagonist (LAMA) umeclidinium bromide (UMEC) 62.5 μg as add-on therapy to other maintenance COPD treatments is unknown. Methods This analysis assessed the cost-effectiveness of the following in COPD: UMEC + fluticasone furoate/vilanterol 100/25 μg (FF/VI); UMEC + fluticasone propionate/salmeterol 250/50 μg (FP/SAL); and UMEC + several alternative choices of inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). The model was informed with direct and indirect data from previously published studies, with a UK perspective and a lifetime horizon. Sensitivity analyses were also performed. Results For the lifetime horizon, compared with FF/VI, FP/SAL and ICS/LABAs, addition of UMEC was associated with incremental costs per quality-adjusted life-years (QALY) of £4050, £7210 and £5780, respectively, and incremental costs per life year gain of £3380, £6020 and £4940. All UMEC-containing regimens resulted in numerically lower exacerbation rates versus comparator regimens over a lifetime horizon. Conclusions Addition of UMEC to various ICS/LABA treatments was associated with higher cost than ICS/LABA alone, but was cost-effective in most scenarios.
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- 2018
11. Essential Emergency and Critical Care – a consensus among global clinical experts
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Maria Jirwe, Alexandra Wharton-Smith, Tim Baker, Carl Otto Schell, Raphael Kazidule Kayambankadzanja, Claudia Hanson, Nobhojit Roy, Jamie Rylance, Alex Sanga, Jacquie Oliwa, Karima Khalid, Hendry R. Sawe, and John C. Marshall
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Coronavirus disease 2019 (COVID-19) ,Critically ill ,business.industry ,High mortality ,Delphi method ,medicine.disease ,Resource (project management) ,Pandemic ,Critical illness ,medicine ,Medical emergency ,business ,computer ,Delphi ,computer.programming_language - Abstract
BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and timely treatment of critically ill patients across all medical specialities. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsA Delphi process was conducted to seek consensus (>90% agreement) in a diverse panel of global clinical experts. The panel was asked to iteratively rate proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible EECC package of clinical processes plus a list of hospital resource requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 hospital readiness requirements. The essential diagnosis-specific care of critically ill COVID-19 patients has an additional 7 clinical processes and 9 hospital readiness requirements.ConclusionThe study has specified the content of the essential emergency and critical care that should be provided to all critically ill patients. Implementation of EECC could be an effective strategy to reduce preventable deaths worldwide. As critically ill patients have high mortality rates, especially where trained staff or resources are limited, even small improvements would have a large impact on survival. EECC has a vital role in the effective scale-up of oxygen and other care for critically ill patients in the COVID-19 pandemic. Policy makers should prioritise EECC, increase its coverage in hospitals, and include EECC as a component of universal health coverage.
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- 2021
12. Oxygen provision to severely ill COVID-19 patients at the peak of the 2020 pandemic in a Swedish district hospital
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Anna Hvarfner, Malin Enarsson, Ahmed Al-Djaber, Hampus Ekstrom, Tim Baker, Markus Castegren, and Carl Otto Schell
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Medical record ,medicine.medical_treatment ,Developing country ,District hospital ,Oxygen therapy ,Emergency medicine ,Pandemic ,Medicine ,Patient group ,business ,Cohort study - Abstract
Oxygen therapy is a low-cost and life-saving therapy for patients with COVID-19. Yet, it is a limited resource in many hospitals in low income countries and in the 2020 pandemic even hospitals in richer countries reported oxygen shortages. An accurate understanding of oxygen requirements is needed for capacity planning. The World Health Organization (WHO) estimates the average flow-rate of oxygen to severe COVID-19-patients to be 10 l/min. However, there is a lack of empirical hospital-based data about the oxygen provision to patients. This study aimed to estimate the oxygen provision to COVID-19 patients with severe disease in a Swedish district hospital. A retrospective, medical records-based cohort study was conducted in March to May 2020 in a Swedish district hospital. All adult patients with severe COVID-19 – those who received oxygen in the ward and had no ICU-admission during their hospital stay – were included. Data were collected on the oxygen flow-rates provided to the patients throughout their stay in hospital, and summary measures of oxygen provision calculated. One-hundred and twenty six patients were included. Their median age was 70 years and 43% were female. On admission, 27% had a peripheral oxygen saturation of ≤91% and 54% had a respiratory rate of ≥25/min. The mean oxygen flow-rate to patients while receiving oxygen therapy was 3.0 l/min (SD 2.9) and the mean total volume of oxygen provided per patient admission was 16,000 l (SD 23,000). In conclusion, the provision of oxygen to severely ill COVID-19-patients was lower than previously estimated. Further research is required before global estimates are adjusted. Article summary Strengths and limitations of this study First study to estimate oxygen provision to hospitalised patients with severe COVID-19 Use of a novel method for estimating oxygen provision to by summing up flow-rates throughout care. Patients with no-ICU decision were included but those eventually admitted to ICU (critical covid) were not included in the main analysis As there are currently several definitions in use to categorise patients as severe, a similar patient group may not be easy to delineate in other settings. Funding This work was supported by the Regional Research Council in Mid Sweden grant number RFR-931271. The funders had no role in the design of the study. Competing interests Dr. Baker reports a grant and personal fees from Wellcome Trust, and personal fees from UNICEF and the World Bank, all outside the submitted work. Data availability Anonymized data can be provided after contact with and provision of an approved research plan to the corresponding author.
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- 2021
13. Viral dynamics of SARS-CoV-2 variants in vaccinated and unvaccinated individuals
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Christina D. Mack, Anne E. Watkins, Mallery I. Breban, Yonatan H. Grad, Matthew MacKay, Stephen M Kissler, Nathan D. Grubaugh, Radhika M. Samant, Tim Baker, David D. Ho, Jessica Metti, Christopher E. Mason, Caroline G. Tai, Gaurav Khullar, Joseph R. Fauver, Rachel Baits, Deverick J. Anderson, Daisy Salgado, and Joel T. Dudley
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0301 basic medicine ,Transmission (medicine) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Alpha (ethology) ,Virology ,Anterior nares ,Clearance time ,Vaccination ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,Viral dynamics ,medicine ,030212 general & internal medicine ,business ,Clearance - Abstract
BackgroundThe alpha and delta SARS-CoV-2 variants have been responsible for major recent waves of COVID-19 despite increasing vaccination rates. The reasons for the increased transmissibility of these variants and for the reduced transmissibility of vaccine breakthrough infections are unclear.MethodsWe quantified the course of viral proliferation and clearance for 173 individuals with acute SARS-CoV-2 infections using longitudinal quantitative RT-PCR tests conducted using anterior nares/oropharyngeal samples (n = 199,941) as part of the National Basketball Association’s (NBA) occupational health program between November 28th, 2020, and August 11th, 2021. We measured the duration of viral proliferation and clearance and the peak viral concentration separately for individuals infected with alpha, delta, and non-variants of interest/variants of concern (non-VOI/VOC), and for vaccinated and unvaccinated individuals.ResultsThe mean viral trajectories of alpha and delta infections resembled those of non-VOI/VOC infections. Vaccine breakthrough infections exhibited similar proliferation dynamics as infections in unvaccinated individuals (mean peak Ct: 20.5, 95% credible interval [19.0, 21.0] vs. 20.7 [19.8, 20.2], and mean proliferation time 3.2 days [2.5, 4.0] vs. 3.5 days [3.0, 4.0]); however, vaccinated individuals exhibited faster clearance (mean clearance time: 5.5 days [4.6, 6.6] vs. 7.5 days [6.8, 8.2]).ConclusionsAlpha, delta, and non-VOI/VOC infections feature similar viral trajectories. Acute infections in vaccinated and unvaccinated people feature similar proliferation and peak Ct, but vaccinated individuals cleared the infection more quickly. Viral concentrations do not fully explain the differences in infectiousness between SARS-CoV-2 variants, and mitigation measures are needed to limit transmission from vaccinated individuals.
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- 2021
14. Unmet need of essential treatments for critical illness in Malawi
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Isaac Mbingwani, Samson Kwazizira Mndolo, Carl Otto Schell, Raphael Kazidule Kayambankadzanja, Tim Baker, and Markus Castegren
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Vital signs ,Glasgow Coma Scale ,Hypoxia (medical) ,Blood pressure ,Oxygen therapy ,Oropharyngeal airway ,Emergency medicine ,medicine ,medicine.symptom ,business ,Airway ,Oxygen saturation (medicine) - Abstract
BackgroundCritical illness is common throughout the world and has been the focus of a dramatic increase in attention in the COVID-19 pandemic. Severely deranged vital signs can identify critical illness, are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi.MethodsWe conducted a cross-sectional study with follow-up of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened.. Patients with hypoxia (oxygen saturation ResultsOf the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%).ConclusionThere was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.
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- 2021
15. Gender differences in female and male Australian Football injuries - A prospective observational study of emergency department presentations
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Georgina Hayden, Stephen D. Gill, Hugh Seward, Julian Stella, Matthew Ryan, Kate Kloot, Tom Reade, Tim Baker, Richard S. Page, and Nicole Lowry
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Thorax ,Male ,medicine.medical_specialty ,Adolescent ,Victoria ,Joint Dislocations ,Physical Therapy, Sports Therapy and Rehabilitation ,Football ,Lacerations ,Neck Injuries ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Concussion ,Injury prevention ,Epidemiology ,Soccer ,medicine ,Emergency medical services ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Prospective Studies ,Sex Distribution ,Brain Concussion ,business.industry ,Medical record ,Hand Injuries ,030229 sport sciences ,Emergency department ,Patella ,medicine.disease ,Athletic Injuries ,Female ,Shoulder Injuries ,business ,Emergency Service, Hospital - Abstract
Objectives To compare injury-profiles of females and males presenting to Emergency Departments (EDs) with an Australian Football injury. Design Prospective observational study. Methods All patients presenting to one of 10 EDs in Victoria, Australia, with an Australian Football injury were included in the study. Data were prospectively collected over a 10 month period, coinciding with a complete Australian Football season, including pre-season training and practice matches. Relevant information was extracted from patient medical records regarding injury-type, body part injured, investigations and treatments required. Female and male data were compared with chi-squared and Fisher’s exact tests. Results 1635 patients were included, of whom 242 (14.8%) were female. Females had a higher proportion of hand/finger injuries (34.3% v 23.4%), neck injuries (6.6% v 2.5%) and patella dislocations (2.9% v 0.6%). Males had a higher proportion of shoulder injuries (11.5% v 5.8%), skin lacerations (8.0% v 1.7%), and thorax/abdominal/pelvic injuries (5.7% v 2.1%). Concussion rates were similar between the genders, occurring in 14.1% of all patients. Anterior cruciate ligament injuries were infrequent (1.0%) and not significantly different between genders. Females received more imaging investigations (83.1% v 74.7%) and analgesia (62.4% v 48.5%). A higher proportion of males required admission to hospital (5.0% v 2.1%), usually for surgery. Conclusion Australian Football injury profiles differed between females and males. Gender-specific injury prevention and management programs would be indicated based on the study findings.
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- 2020
16. The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi
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Moses Lihaka, Tim Baker, Raphael Kazidule Kayambankadzanja, Wezzie Kumwenda, Mtisunge Kachingwe, Jaran Eriksen, Rebecca Lester, Sithembile Bilima, and Andreas Barratt-Due
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Adult ,Male ,medicine.medical_specialty ,Malawi ,Microbiological culture ,medicine.drug_class ,Antibiotic resistance ,health care facilities, manpower, and services ,Antibiotics ,wa_395 ,law.invention ,lcsh:Infectious and parasitic diseases ,Tertiary Care Centers ,Antimicrobial Stewardship ,03 medical and health sciences ,Drug Utilization Review ,0302 clinical medicine ,Medical microbiology ,law ,medicine ,Humans ,Blood culture ,lcsh:RC109-216 ,030212 general & internal medicine ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Ceftriaxone ,qv_350 ,030208 emergency & critical care medicine ,Middle Aged ,Intensive care unit ,Anti-Bacterial Agents ,Intensive Care Units ,Metronidazole ,Infectious Diseases ,wx_200 ,Emergency medicine ,ICU ,Africa ,Female ,business ,medicine.drug ,Research Article - Abstract
Background Antibiotic resistance is on the rise. A contributing factor to antibiotic resistance is the misuse of antibiotics in hospitals. The current use of antibiotics in ICUs in Malawi is not well documented and there are no national guidelines for the use of antibiotics in ICUs. The aim of the study was to describe the use of antibiotics in a Malawian ICU. Methods A retrospective review of medical records of all admissions to the main ICU in Queen Elizabeth Central Hospital in Blantyre, Malawi, between January 2017 and April 2019. Data were extracted from the ICU patient register on clinical parameters on admission, diagnoses, demographics and antibiotics both prescribed and given for all patients admitted to the ICU. Usage of antibiotics in the ICU and bacterial culture results from samples taken in the ICU and in the peri-ICU period, (from 5 days before ICU admission to 5 days after ICU discharge), were described. Results Six hundred-and-forty patients had data available on prescribed and received medications and were included in the analyses. Of these, 577 (90.2%) were prescribed, and 522 (81.6%) received an antibiotic in ICU. The most commonly used antibiotics were ceftriaxone, given to 470 (73.4%) of the patients and metronidazole to 354 (55.3%). Three-hundred-and-thirty-three (52.0%) of the patients received more than one type of antibiotic concurrently – ceftriaxone and metronidazole was the most common combination, given to 317 patients. Forty five patients (7.0%) were given different antibiotics sequentially. One-hundred-and-thirty-seven patients (21.4%) had a blood culture done in the peri-ICU period, of which 70 (11.0% of the patients) were done in the ICU. Twenty-five (18.3%) of the peri-ICU cultures were positive and eleven different types of bacteria were grown in the cultures, of which 17.2% were sensitive to ceftriaxone. Conclusion We have found a substantial usage of antibiotics in an ICU in Malawi. Ceftriaxone, the last-line antibiotic in the national treatment guidelines, is commonly used, and bacteria appear to show high levels of resistance to it, although blood culture testing is infrequently used. Structured antibiotic stewardship programs may be useful in all ICUs.
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- 2020
17. The UCL Ventura CPAP device for COVID-19
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Andy Cowell, Tim Baker, David Brealey, Rebecca J. Shipley, Mervyn Singer, and David A. Lomas
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Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,Pneumonia, Viral ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Intensive care ,Pandemic ,Viral therapy ,Medicine ,Intubation ,Humans ,030212 general & internal medicine ,Spotlight ,Pandemics ,Ventilators, Mechanical ,Continuous Positive Airway Pressure ,business.industry ,SARS-CoV-2 ,COVID-19 ,Equipment Design ,medicine.disease ,Oxygen ,030228 respiratory system ,Medical emergency ,business ,Coronavirus Infections - Abstract
At the beginning of the COVID-19 pandemic, UK national guidance recommended early intubation and ventilation to treat patients with COVID-19. However, multiple Chinese and Italian hospitals were already effectively utilising continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) to spare ventilator capacity and intensive care resource for the most seriously ill patients, with no obvious risk to their health-care workers from virus aerosolisation. At University College London Hospital (UCLH), London, UK, we thus challenged this guidance in view of the massive anticipated demand that would not be met with existing resources.
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- 2020
18. Establishment of a high-dependency unit in Malawi
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Henry C. Mwandumba, Patrick Kamalo, Sandra Antoine, Edna Nsomba, Tamara Phiri, Clara Ngoliwa, Tim Baker, James Chirombo, Kwazizira Samson Mndolo, Ben Morton, Ndaziona Peter Banda, Joel Gondwe, Chimota Phiri, Jane Mallewa, Marc Henrion, Jamie Rylance, Stephen B. Gordon, Leo Masamba, and Felix Limbani
- Subjects
Malawi ,Remote patient monitoring ,Critical Illness ,wa_395 ,Critical Care Nursing ,Care provision ,Unit (housing) ,lcsh:Infectious and parasitic diseases ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular disease ,Health care ,Pandemic ,wc_505 ,Medicine ,Humans ,lcsh:RC109-216 ,Hospital Design and Construction ,030212 general & internal medicine ,Referral and Consultation ,Quality of Health Care ,wa_105 ,lcsh:R5-920 ,Practice ,treatment ,business.industry ,Health Policy ,wb_26 ,Public Health, Environmental and Occupational Health ,COVID-19 ,HIV ,030208 emergency & critical care medicine ,medicine.disease ,3. Good health ,tuberculosis ,General partnership ,Life expectancy ,Medical emergency ,business ,lcsh:Medicine (General) ,Hospital Units ,Dependency (project management) - Abstract
Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country’s Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.
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- 2020
19. WITHDRAWN: The epidemiology of emergency presentations for falls across Western Victoria, Australia
- Author
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Susan Brumby, Muhammad A. Sajjad, Sharon L. Brennan-Olsen, Lana J. Williams, Alasdair Sutherland, Trisha Dunning, Richard S. Page, Svetha Venkatesh, Mark A. Kotowicz, Tim Baker, Sharon Hakkennes, Julie A. Pasco, Mustafa Khasraw, Patricia M. Livingston, and Kara L Holloway-Kew
- Subjects
medicine.medical_specialty ,business.industry ,Family medicine ,Epidemiology ,medicine ,MEDLINE ,Emergency Nursing ,business - Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.auec.2019.08.003. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
- Published
- 2020
20. Feeding practices and association of fasting and low or hypo glycaemia in severe paediatric illnesses in Malawi - a mixed method study
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Tim Baker, Fatsani Ngwalangwa, Josephine Langton, Queen Dube, Chawanangwa Chirambo, Helena Hildenwall, and Cecilia Lindsjö
- Subjects
Blood Glucose ,Pediatrics ,medicine.medical_specialty ,Malawi ,Adolescent ,Developing country ,Logistic regression ,Health facility ,Medicine ,Humans ,Child ,business.industry ,Feeding ,lcsh:RJ1-570 ,Infant, Newborn ,Infant ,Public Health, Global Health, Social Medicine and Epidemiology ,lcsh:Pediatrics ,Paediatric illnesses ,Odds ratio ,Fasting ,Sick child ,Focus group ,Confidence interval ,Hypoglycemia ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Cross-Sectional Studies ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Thematic analysis ,business ,Hypoglycaemia ,Research Article - Abstract
Background The presence of low or hypo glycaemia in children upon admission to hospital in low income countries is a marker for poor outcome. Fasting during illness may contribute to low blood glucose and caretakers’ feeding practices during childhood illnesses may thus play a role in the development of low or hypo glycaemia. This study aims to describe the caretaker’s feeding practices and association of fasting with low or hypo glycaemia in sick children in Malawi. Methods A mixed method approach was used combining quantitative cross-sectional data for children aged 0–17 years admitted to Queen Elizabeth Central Hospital (QECH), a tertiary hospital in Malawi, with qualitative focus group discussions conducted with caretakers of young children who were previously referred to QECH from the five health centres around QECH. Logistic regression was used to analyse the quantitative data and thematic content analysis was conducted for qualitative data analysis. Results Data for 5131 children who were admitted through the hospital’s Paediatric Accident and Emergency Department (A&E) were analysed whereof 2.1% presented with hypoglycaemia ( Conclusion Results suggests that caretakers understand the importance of feeding during illness and make efforts to intensify feeding a sick child but challenges occur when illness is severe leading to fasting. Fasting among children admitted to hospitals may serve as a marker of severe illness and determine those at risk of low and hypoglycaemia.
- Published
- 2020
21. Essential care of critical illness must not be forgotten in the COVID-19 pandemic
- Author
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Jamie Rylance, Karima Khalid, Dan Brun Petersen, Carl Otto Schell, Daniel F. McAuley, Tim Baker, John Marshall, Elizabeth Molyneux, Nobhojit Roy, Hendry R. Sawe, Samson Kwazizira Mndolo, and Lee A. Wallis
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Critical Care ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Critical Illness ,Pneumonia, Viral ,Article ,Betacoronavirus ,Pandemic ,medicine ,Viral therapy ,Humans ,Health planning ,Intensive care medicine ,Pandemics ,Quality of Health Care ,business.industry ,SARS-CoV-2 ,COVID-19 ,Civil Defense ,General Medicine ,Health Planning ,Critical illness ,Practice Guidelines as Topic ,business ,Coronavirus Infections - Published
- 2020
22. The Prevalence and Outcomes of Sepsis in Adult Patients in Two Hospitals in Malawi
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Markus Castegren, Felix Namboya, Samson Kwazizira Mndolo, Tamara Phiri, Carl Otto Schell, Tim Baker, Andy Bauleni, Grace Banda-Katha, and Raphael Kazidule Kayambankadzanja
- Subjects
Adult ,Male ,medicine.medical_specialty ,Malawi ,Adolescent ,030231 tropical medicine ,Vital signs ,MEDLINE ,HIV Infections ,Sepsis ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Virology ,Internal medicine ,medicine ,Humans ,Young adult ,Aged ,Aged, 80 and over ,Inpatients ,Adult patients ,business.industry ,Odds ratio ,Bacterial Infections ,Articles ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,Baseline characteristics ,Parasitology ,Female ,Risk of death ,business - Abstract
There are an estimated 19.4 million sepsis cases every year, many of them in low-income countries. The newly adopted definition of sepsis uses Sequential Organ Failure Assessment Score (SOFA), a score which is not feasible in many low-resource settings. A simpler quick-SOFA (qSOFA) based solely on vital signs score has been devised for identification of suspected sepsis. This study aimed to determine in-hospital prevalence and outcomes of sepsis, as defined as suspected infection and a qSOFA score of 2 or more, in two hospitals in Malawi. The secondary aim was to evaluate qSOFA as a predictor of mortality. A cross-sectional study of adult in-patients in two hospitals in Malawi was conducted using prospectively collected single-day point-prevalence data and in-hospital follow-up. Of 1,135 participants, 81 (7.1%) had sepsis. Septic patients had a higher hospital mortality rate (17.5%) than non-septic infected patients (9.0%, p = 0.027, odds ratio 2.1 [1.1-4.3]), although the difference was not statistically significant after adjustment for baseline characteristics. For in-hospital mortality among patients with suspected infection, qSOFA ≥ 2 had a sensitivity of 31.8%, specificity of 82.1%, a positive predictive value of 17.5%, and a negative predictive value of 91.0%. In conclusion, sepsis is common and is associated with a high risk of death in admitted patients in hospitals in Malawi. In low-resource settings, qSOFA score that uses commonly available vital signs data may be a tool that could be used for identifying patients at risk-both for those with and without a suspected infection.
- Published
- 2020
23. Effect on mortality of increasing the cutoff blood glucose concentration for initiating hypoglycaemia treatment in severely sick children aged 1 month to 5 years in Malawi (SugarFACT): a pragmatic, randomised controlled trial
- Author
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Josephine Langton, Tim Baker, Fatsani Ngwalangwa, Henderson Masanjala, Gaetano Marrone, Queen Dube, and Helena Hildenwall
- Subjects
Blood Glucose ,Male ,Pediatrics ,medicine.medical_specialty ,Malawi ,Referral ,030231 tropical medicine ,Population ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Cutoff ,Humans ,030212 general & internal medicine ,Hospital Mortality ,education ,Adverse effect ,education.field_of_study ,business.industry ,Infant ,General Medicine ,Emergency department ,Interim analysis ,Sick child ,Hypoglycemia ,Treatment Outcome ,Child, Preschool ,Female ,business - Abstract
Summary Background Low blood glucose concentrations are common in sick children who present to hospital in low-resource settings and are associated with increased mortality. The cutoff blood glucose concentration for the diagnosis and treatment of hypoglycaemia currently recommended by WHO (2·5 mmol/L) is not evidence-based. We aimed to assess whether increasing the cutoff blood glucose concentration for hypoglycaemia treatment in severely ill children at presentation to hospital improves mortality outcomes. Methods We did a pragmatic, randomised controlled trial at two referral hospitals in Malawi. Severely ill children aged 1 month to 5 years presenting to the emergency department with a capillary blood glucose concentration of between 2·5 mmol/L (3·0 mmol/L in severely malnourished children) and 5·0 mmol/L were randomly assigned (1:1) by a computer-generated randomisation sequence, stratified by study site and severe malnutrition, to receive either an immediate intravenous bolus of 10% dextrose at 5 mL/kg followed by a 24-h maintenance infusion of 10% dextrose at 100 mL/kg for the first 10 kg of bodyweight, 50 mL/kg for the next 10 kg, and 20 mL/kg for each subsequent kg of bodyweight (intervention group) or observation for a minimum of 60 min and standard care (control group). Participants and study personnel were not masked to treatment allocation. The primary outcome was all-cause in-hospital mortality, assessed on an intention-to-treat basis. Safety was also assessed in the intention-to-treat population. The study is registered with ClinicalTrials.gov , NCT02989675 . Findings Between Dec 5, 2016, and Jan 22, 2019, 10 947 children were screened, of whom 332 were randomly assigned, and 322 were included in the final analysis (n=162 in the control group and n=160 in the intervention group). The study was terminated after an interim analysis at 24% enrolment indicated futility. The median age of participants was 2·3 years (IQR 1·4–3·2), 65 (45%) were female, and the baseline characteristics of participants were similar between the two groups. The number of in-hospital deaths from any cause was 26 (16%) in the control group and 24 (15%) in the intervention group, with an absolute mortality difference of 1·0% (95% CI −6·9 to 9·0). Serious adverse events, including hypoglycaemia, hyperglycaemia, convulsions, reduced consciousness, and death, were reported in 47 (29%) children in the control group and 39 (24%) children in the intervention group. Interpretation Increasing the cutoff blood glucose concentration for hypoglycaemia treatment in severely sick children in Malawi from 2·5 mmol/L to 5·0 mmol/L did not reduce all-cause in-hospital mortality. Our findings do not support changing the cutoff for dextrose administration, and further research on the optimal management of severely ill children who present to the emergency department with low blood glucose concentrations is warranted. Funding Swedish Research Council and Stockholm Country Council.
- Published
- 2020
24. Have you <scp>SCAND MM</scp> e Please? A framework to prevent harm during acute hospitalisation of older persons: A retrospective audit
- Author
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Bernice Redley and Tim Baker
- Subjects
Male ,medicine.medical_specialty ,Victoria ,Health Services for the Aged ,Nursing assessment ,Psychological intervention ,Audit ,Critical Care Nursing ,03 medical and health sciences ,Nursing care ,0302 clinical medicine ,Acute care ,Humans ,Medicine ,030212 general & internal medicine ,Geriatric Assessment ,General Nursing ,Depression (differential diagnoses) ,Aged ,Retrospective Studies ,Aged, 80 and over ,030504 nursing ,business.industry ,Medical record ,General Medicine ,Hospitalization ,Cross-Sectional Studies ,Acute Disease ,Emergency medicine ,Delirium ,Female ,Patient Safety ,medicine.symptom ,0305 other medical science ,business - Abstract
Aims and objectives To test the mnemonic Have you SCAND MMe Please? as a framework to audit nursing care to prevent harms common to older inpatients. Background It is not known if acute hospital care comprehensively addresses eight interrelated factors that contribute to preventable harms common in older hospitalised patients. Design Retrospective audit of medical records. Methods A random selection of 400 medical records of inpatients over 65 years of age with an unplanned admission of longer than 72 hr in acute medical wards at four hospitals in Victoria, Australia, during 2011-12, was examined for frequency of documented evidence of assessments, interventions or new problems related to eight factors contributing to common preventable harms during hospitalisation. Results Assessments of skin integrity (94%-97%), mobility (95%-98%) and pain (93%-97%) were most often documented. Gaps in assessment of continence (4%-31%), nutrition (9%-49%), cognition (delirium, depression and dementia) (10%-24%) were most common. No patient record had evidence of all eight factors being assessed. Almost 80% of records had interventions documented for one or more factors that contribute to preventable harms. In almost 20% of patient records, a new preventable harm was documented during hospitalisation. Conclusions The mnemonic Have you SCAND MMe Please? brings together eight factors known to contribute to preventable harms common in older hospitalised patients. This framework was useful to identify gaps in assessment and interventions for factors that contribute to preventable harms during acute hospital care. Future research should test if the mnemonic can assist nurses with comprehensive harm prevention during acute hospitalisation. Relevance to clinical practice The mnemonic Have you SCAND MMe Please? represents eight factors that contribute to preventable harms common in older hospitalised patients. This framework provides a model for harm prevention to assist nurses to implement comprehensive harm prevention to improve quality of care and safety for older hospitalised patients.
- Published
- 2018
25. Sepsis in tropical regions: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine
- Author
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Pravin Amin, Shirish Prayag, Guy A. Richards, Mohd Basri Mat Nor, Steve McGloughlin, and Tim Baker
- Subjects
Risk ,medicine.medical_specialty ,Resuscitation ,Critical Care ,Advisory Committees ,Comorbidity ,Global Health ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,High morbidity ,0302 clinical medicine ,Antibiotic resistance ,Anti-Infective Agents ,Tropical Medicine ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Poverty ,Societies, Medical ,Septic shock ,business.industry ,Task force ,Tropics ,030208 emergency & critical care medicine ,medicine.disease ,Shock, Septic ,Malnutrition ,Early Diagnosis ,business - Abstract
Sepsis and septic shock in the tropics are caused by a wide array of organisms. These infections are encountered mainly in low and middle-income countries (LMIC) where a lack of infrastructure and medical facilities contribute to the high morbidity and mortality. Published sepsis guidelines are based on studies primarily performed in high income countries and as such recommendations may or may not be relevant to practice in the tropics. Failure to adhere to guidelines, particularly among non-intensive care specialists even in high-income countries, is an area of concern for sepsis management. Additionally, inappropriate use of antimicrobials has led to significant antimicrobial resistance. Access to rapid, low-cost, and accurate diagnostic tests is critical in countries where tropical diseases are prevalent to facilitate early diagnosis and treatment. Implementation of performance improvement programs may improve outcomes for patients with sepsis and the addition of resuscitation and treatment bundles may further reduce mortality. Associated co-morbidities such as malnutrition and HIV influence outcomes and must be considered.
- Published
- 2018
26. Personality characteristics and Six Sigma: a review
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Tim Baker and Phillip Wilson Witt
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Team composition ,021103 operations research ,Knowledge management ,Simultaneity ,Process (engineering) ,business.industry ,Strategy and Management ,media_common.quotation_subject ,05 social sciences ,Soft skills ,0211 other engineering and technologies ,Six Sigma ,02 engineering and technology ,General Business, Management and Accounting ,Locus of control ,Originality ,0502 economics and business ,Conceptual model ,Psychology ,business ,050203 business & management ,media_common - Abstract
Purpose From two bodies of literature, the purpose of this paper is to generate theory for an updated conceptual model of drivers of Six Sigma project success by integrating extant psychology theory and empirical general team project results with a history of eight recent Six Sigma projects and extant Six Sigma literature. The new theory emphasizes the need for project leads to process information simultaneously, as well as develop prioritization abilities. Also, the new theory reverses the relations of three existing theories from general team composition theory. The new theory suggests that Six Sigma belt trainers should focus more on soft skill development. Design/methodology/approach A literature review of the two bodies of literature previously mentioned. Findings Eight new propositions related to the success of Six Sigma projects are developed. Further, two new constructs, “project leader simultaneity of thought” and “prioritization ability” are suggested for further investigation. Originality/value The authors suggest a few practical implications: first a greater emphasis on soft skill training would be beneficial in Six Sigma belt training. A second new point of emphasis in belt training is developing greater internal locus of control in belt candidates. Third, the authors suggest that during the team member selection process a diversity of backgrounds would be beneficial to Six Sigma project success.
- Published
- 2018
27. Intensive care in severe malaria: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine
- Author
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Mohd Basri Mat Nor, Tim Baker, Guy A. Richards, Dilip R Karnad, and Pravin Amin
- Subjects
Adult ,Male ,ARDS ,medicine.medical_specialty ,Critical Care ,Advisory Committees ,030231 tropical medicine ,Plasmodium vivax ,Artesunate ,Hypoglycemia ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Antimalarials ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Tropical Medicine ,Intensive care ,parasitic diseases ,medicine ,Humans ,030212 general & internal medicine ,Child ,Intensive care medicine ,Societies, Medical ,Respiratory Distress Syndrome ,biology ,business.industry ,Plasmodium falciparum ,Acute Kidney Injury ,biology.organism_classification ,medicine.disease ,Artemisinins ,Malaria ,chemistry ,Cerebral Malaria ,Female ,Hyponatremia ,business - Abstract
Severe malaria is common in tropical countries in Africa, Asia, Oceania and South and Central America. It may also occur in travelers returning from endemic areas. Plasmodium falciparum accounts for most cases, although P vivax is increasingly found to cause severe malaria in Asia. Cerebral malaria is common in children in Africa, manifests as coma and seizures, and has a high morbidity and mortality. In other regions, adults may also develop cerebral malaria but neurological sequelae in survivors are rare. Acute kidney injury, liver dysfunction, thrombocytopenia, disseminated intravascular coagulopathy (DIC) and acute respiratory distress syndrome (ARDS) are also common in severe malaria. Metabolic abnormalities include hypoglycemia, hyponatremia and lactic acidosis. Bacterial infection may coexist in patients presenting with shock or ARDS and this along with a high parasite load has a high mortality. Intravenous artesunate has replaced quinine as the antimalarial agent of choice. Critical care management as per severe sepsis is also applicable to severe malaria. Aggressive fluid boluses may not be appropriate in children. Blood transfusions may be required and treatment of seizures and raised intracranial pressure is important in cerebral malaria in children. Mortality in severe disease ranges from 8 to 30% despite treatment.
- Published
- 2018
28. Lifetime Cost-effectiveness of Oral Semaglutide Versus Dulaglutide and Liraglutide in Patients With Type 2 Diabetes Inadequately Controlled With Oral Antidiabetics
- Author
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Nancy Risebrough, Tim Baker, Michael Radin, Lirong Zhang, Sarah N. Ali, and Tam Dang-Tan
- Subjects
Adult ,medicine.medical_specialty ,Cost effectiveness ,Cost-Benefit Analysis ,Recombinant Fusion Proteins ,Population ,Glucagon-Like Peptides ,Type 2 diabetes ,Placebo ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Pharmacology (medical) ,Prospective Studies ,education ,Glycated Hemoglobin ,Pharmacology ,education.field_of_study ,business.industry ,Liraglutide ,Semaglutide ,medicine.disease ,Immunoglobulin Fc Fragments ,Diabetes Mellitus, Type 2 ,Dulaglutide ,business ,medicine.drug - Abstract
Purpose To estimate the incremental cost-utility ratio of oral semaglutide (14 mg once daily) vs other glucagon-like peptide 1 receptor agonist treatments among adults with type 2 diabetes that was inadequately controlled with 1 to 2 oral antidiabetic drugs from a US payer perspective. Methods A state-transition model with a competing risk approach was developed for diabetic complications and risk of cardiovascular events based on the UK Prospective Diabetes Study Outcomes Model 1 equations. Baseline population characteristics reflect the PIONEER 4 trial (Efficacy and Safety of Oral Semaglutide Versus Liraglutide and Versus Placebo in Subjects With Type 2 Diabetes Mellitus) of oral semaglutide. Model comparators included subcutaneous semaglutide, dulaglutide, and liraglutide. Treatment effects (change in glycosylated hemoglobin, weight, and systolic blood pressure) were estimated by network meta-analysis. Drug, management, and event costs (in 2019 US dollars), survival after nonfatal events, and utilities were obtained from the literature. Costs and quality-adjusted life-year (QALY) outcomes were discounted at 3% annually over a lifetime horizon. Probabilistic and 1-way sensitivity analyses were performed. Findings Total estimated costs and QALYs were $144,065 and 12.98 for oral semaglutide, $145,721 and 12.96 for dulaglutide, $145,833 and 12.99 for SC semaglutide, and $149,428 and 12.97 for liraglutide, respectively. Oral semaglutide was less costly and more effective than dulaglutide and liraglutide but less costly than subcutaneous semaglutide with similar effectiveness. Oral semaglutide was favored versus subcutaneous semaglutide in 52.10% of model replications at a willingness-to-pay of $150,000 per QALY. Implications Oral semaglutide is predicted to offer health benefits similar to subcutaneous semaglutide and ahead of dulaglutide and liraglutide. Oral semaglutide is a cost-effective glucagon-like peptide 1 receptor agonist treatment option.
- Published
- 2021
29. Critical care of tropical disease in low income countries: Report from the Task Force on Tropical Diseases by the World Federation of Societies of Intensive and Critical Care Medicine
- Author
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Steve McGloughlin, Tim Baker, Pravin Amin, Karima Khalid, and Özlem Acicbe
- Subjects
medicine.medical_specialty ,Quality management ,Critical Care ,media_common.quotation_subject ,Advisory Committees ,Medically Underserved Area ,Developing country ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Hygiene ,Tropical Medicine ,Environmental health ,Outcome Assessment, Health Care ,medicine ,Humans ,030212 general & internal medicine ,Developing Countries ,Societies, Medical ,media_common ,business.industry ,Task force ,Mortality rate ,Tropical disease ,030208 emergency & critical care medicine ,medicine.disease ,Triage ,Intensive Care Units ,Tropical medicine ,business - Abstract
Tropical disease results in a great burden of critical illness. The same life-saving and supportive therapies to maintain vital organ functions that comprise critical care are required by these patients as for all other diseases. In low income countries, the little available data points towards high mortality rates and big challenges in the provision of critical care. Improving critical care in low income countries requires a focus on hospital design, training, triage, monitoring & treatment modifications, the basic principles of critical care, hygiene and the involvement of multi-disciplinary teams. As a large proportion of critical illness from tropical disease is in low income countries, the impact and reductions in mortality rates of improved critical care in such settings could be substantial.
- Published
- 2017
30. Encephalitis and myelitis in tropical countries: Report from the Task Force on Tropical Diseases by the World Federation of Societies of Intensive and Critical Care Medicine
- Author
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Pravin Amin, Tim Baker, Gisele Sampaio Silva, and Guy A. Richards
- Subjects
medicine.medical_specialty ,Pediatrics ,Critical Care ,Advisory Committees ,Encephalopathy ,Medically Underserved Area ,Myelitis ,Myelitis, Transverse ,Critical Care and Intensive Care Medicine ,Arbovirus ,Transverse myelitis ,03 medical and health sciences ,0302 clinical medicine ,Seizures ,Tropical Medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,030212 general & internal medicine ,Developing Countries ,Societies, Medical ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Spinal cord ,Intensive Care Units ,medicine.anatomical_structure ,Tropical medicine ,Immunology ,Encephalitis ,business ,030217 neurology & neurosurgery - Abstract
Tropical diseases are those that occur primarily or solely in the tropics, and as such include infectious diseases that are particularly prevalent in hot, humid conditions. The incidence of encephalitis in tropical countries is reported to be as high as 6.34/100,000/year. The term encephalitis implies inflammation of the brain and includes the presence of encephalopathy with two and more of the following features: fever, seizures and/or focal neurological findings; a cerebrospinal fluid pleocytosis; electroencephalographic findings or abnormal neuroimaging suggestive of encephalitis. Transverse myelitis (TM) is an inflammation of the spinal cord which has a wide variety of clinical presentations depending on the degree (severity of myelin and neuronal injury) and site of spinal cord involvement. In the present article we discuss the various forms of tropical, viral encephalitides and myelitis and the diagnosis and management.
- Published
- 2017
31. Viral hemorrhagic fever in the tropics: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine
- Author
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Guy A. Richards, Jorge Hidalgo, Tim Baker, Juan Ignacio Silesky Jiménez, and Pravin Amin
- Subjects
Crimean–Congo hemorrhagic fever ,medicine.medical_specialty ,Disease reservoir ,Hemorrhagic Fevers, Viral ,Critical Care ,viruses ,Advisory Committees ,030231 tropical medicine ,Medically Underserved Area ,Disease ,Critical Care and Intensive Care Medicine ,Dengue fever ,Viral hemorrhagic fever ,03 medical and health sciences ,0302 clinical medicine ,Tropical Medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,030212 general & internal medicine ,Lassa fever ,Intensive care medicine ,Developing Countries ,Societies, Medical ,Disease Reservoirs ,business.industry ,medicine.disease ,Intensive Care Units ,Hemorrhagic Fevers ,Immunology ,business ,Kyasanur forest disease - Abstract
Viral hemorrhagic fevers (VHFs) are a group of illnesses caused by four families of viruses namely Arenaviruses, Filoviruses, Bunyaviruses, and Flaviviruses. Humans are not the natural reservoir for any of these organisms and acquire the disease through vectors from animal reservoirs. In some conditions human to human transmission is possible increasing the risk to healthy individuals in the vicinity, more so to Health Care Workers (HCW). The pathogenesis of VHF, though poorly understood, varies according to the viruses involved. The resultant microvascular damage leads to increased vascular permeability, organ dysfunction and even death. The management is generally supportive but antiviral agents are of benefit in certain circumstances.
- Published
- 2017
32. The clinical usefulness of prognostic prediction models in critical illness
- Author
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Tim Baker and Martin Gerdin
- Subjects
Emergency Medical Services ,medicine.medical_specialty ,Critical Illness ,Prognostic prediction ,Disease ,Decision Support Techniques ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,Emergency medical services ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Models, Statistical ,Critically ill ,business.industry ,030208 emergency & critical care medicine ,Prognosis ,Intervention studies ,Identification (information) ,Emergency medicine ,Critical illness ,Risk Adjustment ,business ,Predictive modelling ,Hospital Rapid Response Team - Abstract
Critical illness is any immediately life-threatening disease or trauma and results in several million deaths globally every year. Responsive hospital systems for managing critical illness include quick and accurate identification of the critically ill patients. Prognostic prediction models are widely used for this aim. To be clinically useful, a model should have good predictive performance, often measured using discrimination and calibration. This is not sufficient though: a model also needs to be tested in the setting where it will be used, it should be user-friendly and should guide decision making and actions. The clinical usefulness and impact on patient outcomes of prediction models has not been greatly studied. The focus of research should shift from attempts to optimise the precision of models to real-world intervention studies to compare the performance of models and their impacts on outcomes.
- Published
- 2017
33. Unmet need of essential treatments for critical illness in Malawi
- Author
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Tim Baker, Raphael Kazidule Kayambankadzanja, Markus Castegren, Samson Kwazizira Mndolo, Isaac Mbingwani, and Carl Otto Schell
- Subjects
Male ,Malawi ,Viral Diseases ,Epidemiology ,Cross-sectional study ,medicine.medical_treatment ,Blood Pressure ,Vascular Medicine ,Medical Conditions ,Oxygen therapy ,Medicine and Health Sciences ,Coma ,Hypoxia ,Oxygen saturation (medicine) ,Multidisciplinary ,Middle Aged ,Hospitalization ,Chemistry ,Infectious Diseases ,Neurology ,Physical Sciences ,Medicine ,Female ,Hypotension ,medicine.symptom ,Research Article ,Chemical Elements ,Adult ,medicine.medical_specialty ,Anestesi och intensivvård ,Death Rates ,Critical Illness ,Science ,Vital signs ,Population Metrics ,medicine ,Humans ,Pandemics ,Aged ,Health Services Needs and Demand ,Anesthesiology and Intensive Care ,Population Biology ,business.industry ,Glasgow Coma Scale ,COVID-19 ,Biology and Life Sciences ,Covid 19 ,Cell Biology ,Hypoxia (medical) ,Oxygen ,Cross-Sectional Studies ,Blood pressure ,Emergency medicine ,business ,Airway - Abstract
Background Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. Methods We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation Results Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). Conclusion There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.
- Published
- 2021
34. Essential Emergency and Critical Care: a consensus among global clinical experts
- Author
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Samuel Akech, Mike English, Thomas G Weiser, Adam D Laytin, Niranjan Kissoon, Jaran Eriksen, Lovenish Bains, Fred Bulamba, Maria Jirwe, Jolene Moore, Mpoki Ulisubisya, Vincent Ioos, Kent Doi, Lee A Wallis, Kapil Dev Soni, Nobhojit Roy, Franco Diaz, Mulinda Nyirenda, Nicholas Risko, Hendry R Sawe, Jacob McKnight, Alexandra Wharton-Smith, Jamie Rylance, Monty Khajanchi, Gavin Wooldridge, Emmanuel Fru Nsutebu, Lisa Kurland, Peter Baker, John C Marshall, Kathryn Rowan, Usha Lalla, Balasubramanian Venkatesh, Cornelius Sendagire, Neill KJ Adhikari, Tim Baker, Brian Rice, Josephine Langton, Elisabeth Riviello, Fiona Muttalib, Francis Mupeta, Jacquie Oliwa, Stefan Swartling Peterson, Andrew G Smith, Lorna Guinness, Megan Cox, Wim Van Damme, John Kellett, Elizabeth M Molyneux, Richard Venn, Andrea B Pembe, Mervyn Mer, Ignacio Martin-Loeches, Raymond Towey, Lina Zhang, Blaise Pascal, Hiral A Shah, Carl Otto Schell, Karima Khalid, Paul D Sonenthal, Alex Sanga, Raphael K. Kayambankadzanja, Adam Asghar, Adrian J Holloway, Ahmed Rhassane El Adib, Alexia Michaelides, Alvaro Coronado Munoz, Amos Muzuka, Analía Fernández, Andreas Wellhagen, Anita Gadgil, Anna Hvarfner, Anuja Abayadeera, Aurélie Godard, Bargo Mahamat Yousif, Bhakti Sarang Ben Morton, Bharath Kumar, Tirupakuzhi Vijayaraghavan, Bobby King, C Louise Thwaites, Chian Wern Tai, Christian Owoo, Dan Brun Petersen, Daniel Tatay, David Lee Skinner, Denis Kinyua, Dhruva Ghosh, Diptesh Aryal, Donald Mlombwa, Duyen Thi, Hanh Bui, Edwin R Lugazia, Ellena Heyns, Ernesto Gerardo Moreno, Esther Banda Kanyangira, Furaha Nzanzu, Gibonce Mwakisambwe, Guy A Richards, Hala Ammar, Halinder S Mangat, Hasanein H Ghali, Hoi Ping Shum, Ibrahim Salim Abdullahi, Ingrid T von der Osten, James S Lee, Jane Kasozi Namagga, Jasmine Armour-Marshall, John Z Metcalfe, Jonas Blixt, Juan Gutierrez Mejia, Juan Ignacio Silesky-Jiménez, Karl Martin Kohne, Kazuhiro Yokobatake, Kristina E. Rudd, Kwame Asante Akuamoah-Boateng, Lars Irestedt, Lia I Losonczy, Margaret Nyaika, Markus Castegren, Matthew Loftus, Matti Reinikainen, Michael Jaung, Michael S Lipnick, Miklos Lipcey, Märit Amanda Halmin, Naman Shah, Natalie L Cobb, Nathan D Nielsen, Neville Vlok, Ntogwiachu Daniel Kobuh, Oscar Fernández Rostello, Patricia Duque, Paul Patrick Mwasapi, Petronella Bjurling-Sjöberg, Piedad Sarmiento, Pryanka Relan, Rebecca Silvers, Rehema Mlay, Rich Branson, Richard J Wang, Richard Kojan, Richard Peter Von Rahden, Rob Mac Sweeney, Rodrigo Genaro Arduini, Rodwell Gundo, Ruyumbu Sixtus, Samson Kwazizira Mndolo, Shada A. Rouhani, Siriel Nanzia Massawe, Steven A Webb, Sunkaru Touray, Susana Guido, Teresa Kortz, Theodoros Aslanidis, Traci A Wolbrink, V Theodore Barnett, Vijay Christopher Kannan, Waleed S Eldebsy, Wangari Waweru-Siika, Wezzie Kumwenda Mwafulirwa, William Obeng, Yasein Omer, and Zione Banda
- Subjects
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi ,Emergency Medical Services ,Medicine (General) ,Consensus ,Critical Care ,Coronavirus disease 2019 (COVID-19) ,Delphi method ,Nursing ,Infectious and parasitic diseases ,RC109-216 ,wa_530 ,wa_20_5 ,surgery ,03 medical and health sciences ,R5-920 ,0302 clinical medicine ,Resource (project management) ,Pandemic ,wc_505 ,Emergency medical services ,medicine ,Humans ,030212 general & internal medicine ,Health policy ,Original Research ,computer.programming_language ,SARS-CoV-2 ,business.industry ,Omvårdnad ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,COVID-19 ,Public Health, Global Health, Social Medicine and Epidemiology ,health policy ,030208 emergency & critical care medicine ,Health Care Service and Management, Health Policy and Services and Health Economy ,medicine.disease ,health services research ,wx_215 ,3. Good health ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Medical emergency ,business ,health systems ,computer ,Delphi - Abstract
BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.
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- 2021
35. Resource availability, utilisation and cost in the provision of critical care in Tanzania: a protocol for a systematic review
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Hiral A Shah, Karima Khalid, Carl Otto Schell, Lorna Guinness, August Kuwawenaruwa, Joseph Kazibwe, Srobana Ghosh, Phuong Bich Tran, and Tim Baker
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intensive & critical care ,Critical Care ,Critical Illness ,MEDLINE ,Nursing ,Tanzania ,Care provision ,Resource (project management) ,London ,Global health ,Humans ,health economics ,Medicine ,Health policy ,Health economics ,biology ,business.industry ,Omvårdnad ,Public Health, Global Health, Social Medicine and Epidemiology ,health policy ,General Medicine ,biology.organism_classification ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Review Literature as Topic ,Systematic review ,Research Design ,Emergency Medicine ,Human medicine ,business - Abstract
IntroductionCritical care is essential in saving lives of those that are critically ill, however, provision of critical care can be costly and heterogeneous across lower-resource settings. This paper describes the protocol for a systematic review of the literature that aims to identify the reported costs and resources available for the provision of critical care and the forms of critical care provision in Tanzania.Methods and analysisThe review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE, Embase and Global Health) will be searched to identify articles that report the forms of critical care, resources used in the provision of critical care in Tanzania, their availability and the associated costs. The search strategy will be developed from four key concepts; critical care provision, critical illness, resource use, Tanzania. The articles that fulfil the inclusion and exclusion criteria will be assessed for quality using the Reference Case for Estimating the Costs of Global Health Services and Interventions checklist. The extracted data will be summarised using descriptive statistics including frequencies, mean and median of the quantity and costs of resources used in the components of critical care services, depending on the data availability. This study will be carried out between February and November 2021.Ethics and disseminationThis study is a review of secondary data and ethical clearance was sought from and granted by the Tanzanian National Institute of Medical Research (reference: NIMR/HQ/R.8a/Vol. IX/3537) and London School of Hygiene and Tropical Medicine (ethics ref: 22866). We will publish the review in a peer-reviewed journal as an open access article in addition to presenting the findings at conferences and public scientific gatherings.PROSPERO registration numberThe protocol was registered with PROSPERO; registration number: CRD42020221923.
- Published
- 2021
36. High oxygen flow rates with the UCL Ventura CPAP device – Authors' reply
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David Brealey, Rebecca J. Shipley, Tim Baker, David A. Lomas, and Mervyn Singer
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Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,Continuous Positive Airway Pressure ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,COVID-19 ,chemistry.chemical_element ,Oxygen ,Virology ,chemistry ,High oxygen ,medicine ,Humans ,Continuous positive airway pressure ,business - Published
- 2021
37. Learning on the fly: How rural junior doctors learn during consultations with retrieval physicians
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Marcus P Kennedy, Tim Baker, and Koshila Kumar
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Medical education ,On the fly ,Critically ill ,business.industry ,education ,Clinical reasoning ,Coding (therapy) ,030208 emergency & critical care medicine ,Emergency department ,Focus group ,03 medical and health sciences ,0302 clinical medicine ,Emergency Medicine ,Medicine ,030212 general & internal medicine ,Clinical education ,business - Abstract
OBJECTIVE This study explores how rural junior doctors learn while consulting retrieval physicians about critically ill and injured patients, as well as the tensions characterising teaching and learning in this setting. METHODS Data were collected via three focus groups, involving rural junior doctors (n = 8), rural senior doctors (n = 3) and retrievalists (n = 3). The discussions were transcribed and subject to multistage coding. RESULTS Rural junior doctors believe they learn from interactions with retrieval physicians. Their learning was greatest when the retrieval physician explained his or her clinical reasoning and provided feedback. The level of stress was sometimes overwhelming and learning ceased. Both groups described limited time for teaching due to the medical needs of the patient and the needs of concurrent patients. Retrieval physicians were not certain that rural junior doctors wanted to learn. Rural junior doctors hold retrievalists in very high regard. CONCLUSION Support provided by retrievalists extends the abilities of the junior doctors and often results in learning. When junior doctors are extended too far, they become overwhelmed and learning ceases. Junior doctors would like the retrievalists to spend more time explaining their actions and providing feedback. Even when both retrievalists and junior doctors are interested in teaching, it may not occur due to misunderstandings and differences in status.
- Published
- 2017
38. Development of the Galaxy Chronic Obstructive Pulmonary Disease (COPD) Model Using Data from ECLIPSE: Internal Validation of a Linked-Equations Cohort Model
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Andrew Briggs, Maggie Tabberer, Tim Baker, Sebastian Gonzalez-McQuire, Hana Muellerova, Nancy Risebrough, Afisi S. Ismaila, Maureen P.M.H. Rutten-van Mölken, Christopher E. Colby, Mike Chambers, David A. Lomas, A. Exuzides, Nicholas Locantore, and Health Technology Assessment (HTA)
- Subjects
medicine.medical_specialty ,Delphi Technique ,Health Status ,Comorbidity ,Severity of Illness Index ,Health informatics ,Body Mass Index ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,Pharmacoeconomics ,0302 clinical medicine ,Double-Blind Method ,Quality of life ,medicine ,Humans ,Operations management ,030212 general & internal medicine ,Intensive care medicine ,COPD ,business.industry ,Health Policy ,Cohort model ,Health Services ,Models, Theoretical ,medicine.disease ,Bronchodilator Agents ,Respiratory Function Tests ,Quality-adjusted life year ,Models, Economic ,Socioeconomic Factors ,030228 respiratory system ,Disease Progression ,Quality of Life ,Quality-Adjusted Life Years ,Outcomes research ,business ,Biomarkers - Abstract
Background. The recent joint International Society for Pharmacoeconomics and Outcomes Research / Society for Medical Decision Making Modeling Good Research Practices Task Force emphasized the importance of conceptualizing and validating models. We report a new model of chronic obstructive pulmonary disease (COPD) (part of the Galaxy project) founded on a conceptual model, implemented using a novel linked-equation approach, and internally validated. Methods. An expert panel developed a conceptual model including causal relationships between disease attributes, progression, and final outcomes. Risk equations describing these relationships were estimated using data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study, with costs estimated from the TOwards a Revolution in COPD Health (TORCH) study. Implementation as a linked-equation model enabled direct estimation of health service costs and quality-adjusted life years (QALYs) for COPD patients over their lifetimes. Internal validation compared 3 years of predicted cohort experience with ECLIPSE results. Results. At 3 years, the Galaxy COPD model predictions of annual exacerbation rate and annual decline in forced expiratory volume in 1 second fell within the ECLIPSE data confidence limits, although 3-year overall survival was outside the observed confidence limits. Projections of the risk equations over time permitted extrapolation to patient lifetimes. Averaging the predicted cost/QALY outcomes for the different patients within the ECLIPSE cohort gives an estimated lifetime cost of £25,214 (undiscounted)/£20,318 (discounted) and lifetime QALYs of 6.45 (undiscounted/5.24 [discounted]) per ECLIPSE patient. Conclusions. A new form of model for COPD was conceptualized, implemented, and internally validated, based on a series of linked equations using epidemiological data (ECLIPSE) and cost data (TORCH). This Galaxy model predicts COPD outcomes from treatment effects on disease attributes such as lung function, exacerbations, symptoms, or exercise capacity; further external validation is required.
- Published
- 2017
39. Building a research-ready database of rural emergency presentations: The RAHDaR pilot study
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Tim Baker and Kate Kloot
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business.industry ,Low resource ,media_common.quotation_subject ,030208 emergency & critical care medicine ,medicine.disease ,Triage ,Mental health ,03 medical and health sciences ,Presentation ,0302 clinical medicine ,Emergency Medicine ,medicine ,030212 general & internal medicine ,Medical emergency ,business ,Paediatric patients ,media_common - Abstract
Objectives A small amount of data from rural emergency facilities is collated with large urban datasets, but there are no dedicated rural emergency datasets. Methods A network of 10 rural hospitals provided ongoing detailed emergency presentation data. Results Of 59 044 emergency presentations, 25 237 patients were managed entirely at the small local hospital, including 586 triage category 2 cardiac patients, 5663 paediatric patients and 310 mental health clients. Conclusions The RAHDaR dataset includes high-risk presentations managed entirely at low resource sites and, as further sites are added, will tackle the biases that can misrepresent the performance of small rural hospitals.
- Published
- 2018
40. Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi
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Chikondi H. A. Phiri, Helena Hildenwall, Tim Baker, Fatsani Ngwalangwa, Josephine Langton, and Queen Dube
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Male ,Pediatrics ,medicine.medical_specialty ,Malawi ,Adolescent ,Severe Acute Malnutrition ,Vital signs ,Tertiary referral hospital ,Intensive Care Units, Pediatric ,Severity of Illness Index ,Tertiary Care Centers ,Risk Factors ,Virology ,Severity of illness ,medicine ,Odds Ratio ,Humans ,Hospital Mortality ,Prospective Studies ,Prospective cohort study ,Child ,business.industry ,Infant, Newborn ,Infant ,Odds ratio ,Articles ,medicine.disease ,Malnutrition ,Infectious Diseases ,Logistic Models ,Child, Preschool ,Parasitology ,Female ,business ,Emergency Service, Hospital ,Cohort study - Abstract
In low-resource settings, many children are severely ill at arrival to hospital. The risk factors for mortality among such ill children are not well-known. Understanding which of these patients are at the highest risk could assist in the allocation of limited resources to where they are most needed. A cohort study of severely ill children treated in the resuscitation room of the pediatric emergency department at Queen Elizabeth Central Hospital in Malawi was conducted over a 6-month period in 2017. Data on signs and symptoms, vital signs, blood glucose levels, and nutritional status were collected and linked with in-hospital mortality data. The factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Data for 1,359 patients were analyzed and 118 (8.7%) patients died. The following factors were associated with mortality: presence of any severely deranged vital sign, unadjusted odds ratio (UOR) 2.6 (95% CI 1.7–4.0) and adjusted odds ratio (AOR) 3.2 (95% CI 2.0–5.0); severe dehydration, UOR 2.6 (1.4–5.1) and AOR 2.8 (1.3–6.0); hypoglycemia glycemia (< 5 mmol/L), UOR 3.6 (2.2–5.8) and AOR 2.7 (1.6–4.7); and severe acute malnutrition, UOR 5.8 (3.5–9.6) and AOR 5.7 (3.3–10.0). This study suggests that among severely sick children, increased attention should be given to those with hypo/low glycemia, deranged vital signs, malnutrition, and severe dehydration to avert mortality among these high-risk patients.
- Published
- 2019
41. Inability to Walk Predicts Death among Adult Patients in Hospitals in Malawi
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Raphael Kazidule Kayambankadzanja, Tim Baker, Grace Nsanjama, Samson Kwazizira Mndolo, Isaac Mbingwani, Carl Otto Schell, and Jamie Rylance
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medicine.medical_specialty ,Article Subject ,Concordance ,Vital signs ,03 medical and health sciences ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,Prospective cohort study ,Adult patients ,business.industry ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Public Health, Global Health, Social Medicine and Epidemiology ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Early warning score ,Triage ,Predictive value ,3. Good health ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Emergency medicine ,Emergency Medicine ,Risk of death ,business ,human activities ,Research Article - Abstract
Objective. Vital signs are often used in triage, but some may be difficult to assess in low-resource settings. A patient’s ability to walk is a simple and rapid sign that requires no equipment or expertise. This study aimed to determine the predictive performance for death of an inability to walk among hospitalized Malawian adults and to compare its predictive value with the vital signs-based National Early Warning Score (NEWS). Methods. It is a prospective cohort study of adult in-patients on selected days in two hospitals in Malawi. Patients were asked to walk five steps with close observation and their vital signs were assessed. Sensitivities, specificities, and predictive values for in-patient death of an inability to walk were calculated and an inability to walk was compared with NEWS. Results. Four-hundred and forty-three of the 1094 participants (40.5%) were unable to walk independently. In this group, 70 (15.8 %) died in-hospital compared to 16 (2.5%) among those who could walk: OR 7.4 (95% CI 4.3-13.0 p6 had sensitivity 70.9%, specificity 70.6%, PPV 17.1%, and NPV 96.6%. An inability to walk had a fair concordance with NEWS>6 (kappa 0.21). Conclusion. Inability to walk predicted mortality as well as NEWS among hospitalized adults in Malawi. Patients who were able to walk had a low risk of death. Walking ability could be considered an additional vital sign and may be useful for triage.
- Published
- 2019
42. Current challenges in the management of sepsis in icus in resource-poor settings and suggestions for the future
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Arjen M. Dondorp, Niranjan Kissoon, Shivakumar Iyer, Yoel Lubell, Rashan Haniffa, Pedro Póvoa, Jason Phua, Luigi Pisani, Arthur Kwizera, Ary Serpa Neto, Neill K. J. Adhikari, Elisabeth D. Riviello, Ignacio Martin-Loeches, Tim Baker, Randeep S. Jawa, N. T. Hoang Mai, Luciano Cesar Pontes Azevedo, Ndidiamaka Musa, Martin W. Dünser, Ganbold Lundeg, Jane Nakibuuka, Suchitra Ranjit, Shevin T. Jacob, C. Louise Thwaites, Janet V. Diaz, Binh Nguyen Thien, David Misango, Jacobus Preller, Srinivas Murthy, Sanjib Mohanty, Derek C. Angus, Alfred Papali, Daniel Talmor, Mervyn Mer, Rakesh Lodha, Emir Festic, Jonarthan Thevanayagam, Rajyabardhan Pattnaik, Marcus J. Schultz, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Centro de Estudos de Doenças Crónicas (CEDOC), Intensive Care Medicine, AII - Infectious diseases, Graduate School, ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, and ACS - Microcirculation
- Subjects
Adult ,medicine.medical_specialty ,Biomedical Research ,Critical Care ,Cost-Benefit Analysis ,MEDLINE ,Drug Resistance ,Developing country ,Critical Care and Intensive Care Medicine ,law.invention ,Global Burden of Disease ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,law ,Anesthesiology ,Intensive care ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Developing Countries ,Quality of Health Care ,Medicine(all) ,business.industry ,Infant, Newborn ,Infant ,030208 emergency & critical care medicine ,Health Care Costs ,Middle Aged ,medicine.disease ,Intensive care unit ,Intensive Care Units ,Child, Preschool ,Emergency medicine ,Practice Guidelines as Topic ,Health Resources ,business ,Health care quality - Abstract
Sepsis is a major reason for intensive care unit (ICU) admission, also in resource–poor settings. ICUs in low– and middle–income countries (LMICs) face many challenges that could affect patient outcome. The aim of this review is to describe differences between resource–poor and resource–rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high–income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease–specific and setting–specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost–effective in LMIC setting, more detailed evaluation at both at a macro– and micro–economy level is necessary. Sepsis management in resource–limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.
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- 2019
43. Hemodynamic assessment and support in sepsis and septic shock in resource-limited settings
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Tim Baker, Martin W. Dünser, Marcus J. Schultz, Rajyabardhan Pattnaik, Arjen M. Dondorp, David Misango, Intensive Care Medicine, AII - Infectious diseases, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
- Subjects
Mechanical ventilation ,Inotrope ,Resuscitation ,medicine.diagnostic_test ,Septic shock ,business.industry ,medicine.medical_treatment ,Capillary refill ,medicine.disease ,Sepsis ,Intensive care ,Shock (circulatory) ,Anesthesia ,medicine ,medicine.symptom ,business - Abstract
Recommendations for hemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking. In this chapter, we reviewed the literature and provided recommendations regarding hemodynamic assessment and support, taking into consideration aspects of efficacy and effectiveness, availability and feasibility, and affordability and safety. We suggest using capillary refill time, skin mottling scores, and skin temperature gradients and suggest passive leg raise test to guide fluid resuscitation. We recommend crystalloid solutions as the initial fluid of choice and recommend initial fluid resuscitation with 30 ml/kg in the first 3 h but with extreme caution in settings where there is lack of mechanical ventilation. Patients with severe malaria or severe dengue without hypotension should not receive fluid bolus therapy. We recommend against early start of vasopressors and suggest starting a vasopressor in patients with persistent hypotension after initial fluid resuscitation with at least 30 ml/kg, but earlier when there is lack of access to mechanical ventilation, and recommend using norepinephrine (noradrenaline) as first-line vasopressor. We suggest in patients with suspected bacterial sepsis starting an inotrope with persistence of plasma lactate >2 mmol/l or persistence of skin mottling or prolonged capillary refill time when plasma lactate cannot be measured and only after initial fluid resuscitation. We suggest the use of dobutamine as first-line inotrope, recommend administering vasopressors through a central venous line, and suggest administering vasopressors and inotropes via a central venous line using a syringe or infusion pump when available.
- Published
- 2019
44. Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital
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Sofia Engdahl Mtango, Ulrika Baker, Edwin Lugazia, Tim Baker, and Yvonne Johansson
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Male ,Critical Care and Emergency Medicine ,Medical Doctors ,Health Care Providers ,Nurses ,Tanzania ,Geographical Locations ,0302 clinical medicine ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Medical Personnel ,Referral and Consultation ,Multidisciplinary ,biology ,Rationing ,Hospitals ,Hospitalization ,Intensive Care Units ,Professions ,Health Resources ,Female ,Medical emergency ,Research Article ,Adult ,Referral ,Critical Care ,Attitude of Health Personnel ,Science ,Critical Illness ,MEDLINE ,Developing country ,Surgical and Invasive Medical Procedures ,Nursing ,03 medical and health sciences ,Admitting Department, Hospital ,Intensive care ,Physicians ,Humans ,business.industry ,Omvårdnad ,Patient Selection ,030208 emergency & critical care medicine ,Length of Stay ,biology.organism_classification ,medicine.disease ,Triage ,Health Care ,Health Care Facilities ,People and Places ,Africa ,Population Groupings ,business ,Qualitative research - Abstract
Background Intensive care is care for critically ill patients with potentially reversible conditions. Patient selection for intensive care should be based on potential benefit but since demand exceeds availability, rationing is needed. In Tanzania, the availability of Intensive Care Units (ICUs) is very limited and the practices for selecting patients for intensive care are not known. The aim of this study was to explore doctors’ experiences and perceptions of ICU referral and admission processes in a university hospital in Tanzania. Methods We performed a qualitative study using semi-structured interviews with fifteen doctors involved in the recent care of critically ill patients in university hospital in Tanzania. Inductive conventional content analysis was applied for the analysis of interview notes to derive categories and sub-categories. Results Two main categories were identified, (i) difficulties with the identification of critically ill patients in the wards and (ii) a lack of structured triaging to the ICU. A lack of critical care knowledge and communication barriers were described as preventing identification of critically ill patients. Triaging to the ICU was affected by a lack of guidelines for admission, diverging ideas about ICU indications and contraindications, the lack of bed capacity in the ICU and non-medical factors such as a fear of repercussions. Conclusion Critically ill patients may not be identified in general wards in a Tanzanian university hospital and the triaging process for the admission of patients to intensive care is convoluted and not explicit. The findings indicate a potential for improved patient selection that could optimize the use of scarce ICU resources, leading to better patient outcomes.
- Published
- 2018
45. Driving change: A partnership study protocol using shared emergency department data to reduce alcohol-related harm
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Anthony Shakeshaft, Andrew Walby, Michael Hall, Shannon Hyder, Diana Egerton-Warburton, Steven J. Bowe, Jonathan Shepherd, Gordian W O Fulde, Paul Preisz, Daniel Barker, Nadine Ezard, David G E Caldicott, Nicolas Droste, Kerri Coomber, Michael Sheridan, Petra K. Staiger, Christopher M. Doran, Alys Havard, Peter Miller, Julian Stella, Martyn Lloyd-Jones, Catherine D'Este, and Tim Baker
- Subjects
medicine.medical_specialty ,business.industry ,Information Dissemination ,Australia ,Human factors and ergonomics ,Poison control ,030208 emergency & critical care medicine ,Context (language use) ,Emergency department ,Triage ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,Injury prevention ,Emergency Medicine ,medicine ,Humans ,Multicenter Studies as Topic ,030212 general & internal medicine ,business ,Emergency Service, Hospital ,Alcohol-Related Disorders ,Randomized Controlled Trials as Topic - Abstract
Background\ud \ud Sharing anonymised ED data with community agencies to reduce alcohol‐related injury and assaults has been found effective in the UK. This protocol document outlines the design of an Australian multi‐site trial using shared, anonymised ED data to reduce alcohol‐related harm.\ud \ud \ud Design and Method\ud \ud Nine hospitals will participate in a 36 month stepped‐wedge cluster randomised trial. After a 9 month baseline period, EDs will be randomised in five groups, clustered on geographic proximity, to commence the intervention at 3 monthly intervals. ‘Last‐drinks’ data regarding alcohol use in the preceding 12 h, typical alcohol consumption amount, and location of alcohol purchase and consumption, are to be prospectively collected by ED triage nurses and clinicians at all nine EDs as a part of standard clinical process. Brief information flyers will be delivered to all ED patients who self‐report risky alcohol consumption. Public Health Interventions to be conducted are: (i) information sharing with venues (via letter), and (ii) with police and other community agencies, and (iii) the option for public release of ‘Top 5’ venue lists.\ud \ud \ud Outcomes\ud \ud Primary outcomes will be: (i) the number and proportion of ED attendances among patients reporting recent alcohol use; and (ii) the number and proportion of ED attendances during high‐alcohol hours (Friday and Saturday nights, 20.00–06.00 hours) assigned an injury diagnosis. Process measures will assess logistical and feasibility concerns, and clinical impacts of implementing this systems‐change model in an Australian context. An economic cost–benefit analysis will evaluate the economic impact, or return on investment.
- Published
- 2018
46. Initial destination hospital of paediatric prehospital patients in rural Victoria
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Kate Kloot, Susan Brumby, Scott Salzman, Tim Baker, and Sue Kilpatrick
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medicine.medical_specialty ,business.industry ,Staffing ,030208 emergency & critical care medicine ,Time critical ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Emergency medicine ,Emergency Medicine ,medicine ,Emergency medical services ,030212 general & internal medicine ,Medical emergency ,business ,Paediatric patients - Abstract
Objective The objective of this present study was to describe the initial destination hospital of paediatric patients transported by Ambulance Victoria paramedics within the South Western area of Victoria to determine the proportion of patients that bypassed their closest hospital. Methods All Ambulance Victoria primary ambulance transports for paediatric patients aged 1 month to 14 years in the Barwon South West region between 1 April 2008 and 28 February 2011 were reviewed. Each case was examined to determine the destination hospital location relative to the case scene location, and the overall nature of each case was grouped into one of seven categories (medical respiratory, medical cardiac, medical neurological, medical other, trauma time critical, and trauma non-time critical). Results There were 1191 cases identified, with 978 (82%) being taken to the closest hospital and 213 (18%) to a more distant facility. The average distance travelled from the scene to the destination hospital was 15.2 km, and almost 90% of patients transported to the nearest hospital were within 15 km of that hospital. Time critical trauma cases and respiratory-related medical cases had higher rates of transport to more distant hospitals as their initial destination (26% to non-closest and 23% to non-closest, respectively). Conclusion The patient's condition and their location relative to the larger medical facilities appear to influence the decision of destination hospital. Uncertainty regarding the availability of 24 h hospital services and staffing details may contribute to longer transfers.
- Published
- 2016
47. Early <scp>MRI</scp> versus conventional management in the detection of occult scaphoid fractures: what does it really cost? A rural pilot study
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Tamika Kelson, Tim Baker, and Rob Davidson
- Subjects
Adult ,Male ,Rural Population ,medicine.medical_specialty ,Adolescent ,Cost ,Cost-Benefit Analysis ,Pilot Projects ,Scaphoid fracture ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Fractures, Closed ,Study analysis ,Scaphoid Bone ,030222 orthopedics ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Australia ,Rural setting ,scaphoid ,Magnetic resonance imaging ,Original Articles ,Emergency department ,medicine.disease ,Magnetic Resonance Imaging ,Occult ,Scaphoid bone ,fracture ,Physical therapy ,Original Article ,Female ,Radiology ,Erratum ,business ,management ,MRI - Abstract
Introduction To compare the cost-effectiveness and patient impact between acute magnetic resonance imaging (MRI) management and conventional management in the diagnosis of occult scaphoid fractures in a rural setting. Methods Consecutive patients presenting to a rural emergency department (ED) with a suspected scaphoid fracture were randomly assigned to either conventional management (6) or acute MRI management (10) (3 patients were excluded from the study analysis). All healthcare costs were compared between the two management groups and potential impacts on the patients’ pain, mobility and lifestyle were also measured. Results There were no significant differences between the two groups at baseline. There was one (10%) scaphoid fracture in the MRI group and none in the conventional group (P = 0.42). A larger proportion of other fractures were diagnosed in the MRI group (20% (2) vs. 16.7% (1), P = 0.87), as well as less clinic attendances (1 (0–2.25) vs. 4 (2.25–5)) and diagnostic services (1 (1–1.25) vs. 2 (1–3)). Median management costs were $485.05 (AUD) (MRI) and $486.90 (AUD) (conventional). The MRI group had better pain and satisfaction scores as well as less time of immobilisation, treatment and time off work. Conclusion MRI dramatically reduces the amount of unnecessary immobilisation, time of treatment and healthcare usage in a rural setting. The two protocols are suggested to be equivalent financially. When potential societal costs, the amount of unnecessary immobilisation, low prevalence of true fractures and patient satisfaction are considered, acute MRI should be the management technique of choice. Further studies are still required to assess the best method for managing bone bruise within the scaphoid.
- Published
- 2016
48. Using GROW for a Better Coaching Conversation
- Author
-
Tim Baker
- Subjects
business.industry ,media_common.quotation_subject ,Pedagogy ,Conversation ,GROW model ,business ,Psychology ,Coaching ,media_common - Abstract
In this chapter, I explain the GROW model in detail and how it can be applied to conduct a positive coaching conversation.
- Published
- 2018
49. Ten Keys to a Better Delegation Conversation
- Author
-
Tim Baker
- Subjects
Key factors ,Delegation ,business.industry ,Computer science ,media_common.quotation_subject ,Internet privacy ,Conversation ,business ,media_common - Abstract
We’ll look at 10 key factors for successful delegation conversations in this chapter. Some of these vital aspects of delegation should be done (or not done) in the conversation itself, other factors should be considered before the delegation conversation, and others should be kept in mind as general principles. They’re all important considerations nevertheless.
- Published
- 2018
50. Conversation 1: The Coaching Conversation
- Author
-
Tim Baker
- Subjects
White (horse) ,Boss ,business.industry ,media_common.quotation_subject ,Media studies ,Face (sociological concept) ,Conversation ,Psychology ,business ,Coaching ,media_common - Abstract
Georgiou bounds into Catherine’s office unannounced and stressed. His face is as white as a ghost. Georgiou is seeking some advice from Catherine, his boss. Catherine adopts an open-door policy and encouraged her staff to ‘drop in’ when they needed too. This was one such occasion.
- Published
- 2018
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