Dorothy Breen
University College Cork, Anaesthesia/Intensive Care, Faculty Member
Background We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international,... more
Background We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and ...
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BackgroundUp to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to... more
BackgroundUp to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).MethodsThis is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics an...
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Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital... more
Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults...
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The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This... more
The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate ...
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To quantify cumulative effective dose of intensive care unit (ICU) patients attributable to diagnostic imaging. This was a prospective, interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center.... more
To quantify cumulative effective dose of intensive care unit (ICU) patients attributable to diagnostic imaging. This was a prospective, interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center. Demographic and clinical data including age, gender, date of ICU admission, primary reason for ICU admission, APACHE II score, length of stay, number of days intubated, date of death or discharge, and re-admission data was collected on all patients admitted over a 1-year period. The overall radiation exposure was quantified by the cumulative effective radiation dose (CED) in millisieverts (mSv) and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board. Pediatric patients were selected for subgroup-analysis. A total of 2737 studies were performed in 421 patients. The total CED was 1704 mSv with a median CED of 1.5 mSv (IQR 0.04-6.6 mSv). Total CED in pediatric patients was 74.6 mSv with a median...
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The aim of this study was to compare the short and long axis approaches to ultrasound guided right internal jugular vein cannulation with respect to indicators of success. Patients undergoing cardiac surgery requiring central venous... more
The aim of this study was to compare the short and long axis approaches to ultrasound guided right internal jugular vein cannulation with respect to indicators of success. Patients undergoing cardiac surgery requiring central venous cannulation (99 patients) were randomised to undergo either long or short axis ultrasound guided cannulation of the right internal jugular vein by a skilled anaesthetist. First pass success, number of needle passes, procedural taken and complications were documented for each procedure. The right internal jugular vein was successfully cannulated in all 99 patients. The first pass success rate was significantly higher in the short axis 98% group compared to the long axis group 78% [48:1 (98%) versus 39:11 (78%) p <0.006]. Procedural time was comparable in both the groups [39.6 (18.4) versus 46.9 (42.4)]. Fewer needle redirections were required in the short axis group [1.02 (0.02) versus 1.24 (0.56) p <0.004]. Carotid artery puncture only occurred in ...
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This paper describes the development of a technology architecture that not only supports the technical performance assessment of a medical simulator but also facilitates a validated competence based assessment system in one selected... more
This paper describes the development of a technology architecture that not only supports the technical performance assessment of a medical simulator but also facilitates a validated competence based assessment system in one selected anaesthetic procedure i.e. spinal anaesthesia. Based on extensive mapping of the competencies required for the performance of this procedure, a system architecture is proposed utilising a specifically designed anaesthetic simulator, a learning management system and back-end assessment logic. The overall system is designed to assess the agreed spinal anaesthetic competencies i.e. patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and system-based practice, as defined by the
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Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations... more
Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-...
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Background : In recent years there has been a move towards a competencybased model for assessing the performance of practical procedures in clinical medicine rather than the traditional assumption that competency is achieved with... more
Background : In recent years there has been a move towards a competencybased model for assessing the performance of practical procedures in clinical medicine rather than the traditional assumption that competency is achieved with increasing experience. For such an assessment to be valid, the necessary competencies comprising that skill must be identifi ed. Our aim was to map the individual competencies necessary to perform a given procedural skill using spinal anaesthesia as the example, and to explore the relationship of individual competencies with each other. Methods : In the fi rst part of the study an extensive hierarchical task analysis ( HTA ) was undertaken to determine the competencies necessary for the performance of spinal anaesthesia. Secondly, the concept of competencybased knowledge space theory (Cb KST ) was applied to the map. Cb KST is based on the principle that acquisition of a specifi c skill is usually preceded by a number of dependent or prerequisite skills. Re...
AIM The aim of this study was to compare the short and long axis approaches to ultrasound guided right internal jugular vein cannulation with respect to indicators of success. METHODS Patients undergoing cardiac surgery requiring central... more
AIM The aim of this study was to compare the short and long axis approaches to ultrasound guided right internal jugular vein cannulation with respect to indicators of success. METHODS Patients undergoing cardiac surgery requiring central venous cannulation (99 patients) were randomised to undergo either long or short axis ultrasound guided cannulation of the right internal jugular vein by a skilled anaesthetist. First pass success, number of needle passes, procedural taken and complications were documented for each procedure. RESULTS The right internal jugular vein was successfully cannulated in all 99 patients. The first pass success rate was significantly higher in the short axis 98% group compared to the long axis group 78% [48:1 (98%) versus 39:11 (78%) p <0.006]. Procedural time was comparable in both the groups [39.6 (18.4) versus 46.9 (42.4)]. Fewer needle redirections were required in the short axis group [1.02 (0.02) versus 1.24 (0.56) p <0.004]. Carotid artery punctu...
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Background: Acutely deteriorating patients are entitled to the best possible care which includes early recognition and timely appropriate intervention to reduce adverse events, unnecessary admissions to intensive care and/or cardiac... more
Background: Acutely deteriorating patients are entitled to the best possible care which includes early recognition and timely appropriate intervention to reduce adverse events, unnecessary admissions to intensive care and/or cardiac arrest. Aim: To reduce the number of poor outcomes for surgical patients with a National Early Warning Score (NEWS) score ≥7 in our institution by 50%. A poor outcome was defined as: 1. Cardiac arrest 2. NEWS >7 not improving after 72 hours 3. Transfer to ICU >6 hours Methods: Surgical inpatients from a variety of surgical specialties (general, vascular, breast, colorectal, hepatobiliary, and plastic surgery) in a large university teaching hospital were included. Quality improvement tools were used to generate regular dialogue with the clinical teams, resulting in the concept of the surgical safety huddle being proposed. Deteriorating patients were highlighted at the daily huddle and a plan of early intervention was implemented. An incremental appr...
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This paper describes the development of a technology architecture that not only supports the technical performance assessment of a medical simulator but also facilitates a validated competence based assessment system in one selected... more
This paper describes the development of a technology architecture that not only supports the technical performance assessment of a medical simulator but also facilitates a validated competence based assessment system in one selected anaesthetic procedure i.e. spinal anaesthesia. Based on extensive mapping of the competencies required for the performance of this procedure, a system architecture is proposed utilising a specifically designed anaesthetic simulator, a learning management system and back-end assessment logic. The overall system is designed to assess the agreed spinal anaesthetic competencies i.e. patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and system-based practice, as defined by the Accreditation Council for Graduate Medical Education.
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Background Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate... more
Background Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. Methods Prospective cohort study of patients aged >65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessm...
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Background The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods International,... more
Background The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs...
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Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new onset type 1 diabetes mellitus (T1DM). Children have a higher rate of neurological complications from DKA when compared to adults. The... more
Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new onset type 1 diabetes mellitus (T1DM). Children have a higher rate of neurological complications from DKA when compared to adults. The differential for sudden focal neurological deterioration in the setting of DKA is cerebral oedema followed by ischaemic and haemorrhagic stroke. Spontaneous intracranial haemorrhages can present with non-specific features frequently, for example, impaired consciousness, even when biochemical parameters are improving in the setting of DKA. We report the case of a girl with new onset T1D who presented in severe DKA and subsequently developed intracerebral parenchymal and subarachnoid haemorrhages. Our patient is unique in that no focal neurological or neuropsychological deficits have been found at 1-year follow up, compared to the literature which suggests poor outcomes. Our case contrasts with these previous cases as none of the other case reports demonstrat...
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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low... more
Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome cri...
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Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care)... more
Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survi...
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The aim of this study was to compare the short and long axis approaches to ultrasound guided right internal jugular vein cannulation with respect to indicators of success. Patients undergoing cardiac surgery requiring central venous... more
The aim of this study was to compare the short and long axis approaches to ultrasound guided right internal jugular vein cannulation with respect to indicators of success. Patients undergoing cardiac surgery requiring central venous cannulation (99 patients) were randomised to undergo either long or short axis ultrasound guided cannulation of the right internal jugular vein by a skilled anaesthetist. First pass success, number of needle passes, procedural taken and complications were documented for each procedure. The right internal jugular vein was successfully cannulated in all 99 patients. The first pass success rate was significantly higher in the short axis 98% group compared to the long axis group 78% [48:1 (98%) versus 39:11 (78%) p <0.006]. Procedural time was comparable in both the groups [39.6 (18.4) versus 46.9 (42.4)]. Fewer needle redirections were required in the short axis group [1.02 (0.02) versus 1.24 (0.56) p <0.004]. Carotid artery puncture only occurred in ...
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Pasteurella multocida is a normal oral commensal in animals. Animal bites are often complicated by severe wound infection due to P. multocida, but systemic infection is rare. We report a patient with bacteremic pneumonia successfully... more
Pasteurella multocida is a normal oral commensal in animals. Animal bites are often complicated by severe wound infection due to P. multocida, but systemic infection is rare. We report a patient with bacteremic pneumonia successfully treated with ceftriaxone and ciprofloxacin. We also review the clinical isolates of P. multocida reported by a major teaching hospital laboratory over a 10-year period. There were 23 patients, comprising the present case, 17 patients with wound infections following animal bites, one case of neonatal meningitis and associated maternal vaginal carriage of P. multocida, and three sputum isolates of doubtful significance.
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During the recent influenza A (H1N1) pandemic, due to severe respiratory failure many patients required treatment with alternative ventilator modalities including High Frequency Oscillatory Ventilation (HFOV). We present four such... more
During the recent influenza A (H1N1) pandemic, due to severe respiratory failure many patients required treatment with alternative ventilator modalities including High Frequency Oscillatory Ventilation (HFOV). We present four such patients treated with HFOV at an academic, tertiary referral hospital in Ireland. We detail outcomes of clinical examination, pulmonary function testing, quality of life assessment and radiographic appearance on CT Thorax at follow-up at 6 months. Further clinical assessment and pulmonary function testing were performed at median 19 months (range 18-21 months) post-discharge. At initial review all patients were found to have reduced gas transfer (median predicted DLCO 74%) with preservation of lung volumes and normal spirometrical values at 6 months (median FVC 5.42L [101% predicted] and FEV14.5L [101.2% predicted] respectively), with improvements in gas transfer (median predicted DLCO 83%)at subsequent testing. Post-inflammatory changes on CT thorax at 6 ...
Research Interests: Quality of life, Treatment Outcome, Ireland, Irish medical history, Humans, and 13 moreFemale, Male, Follow-up studies, Risk factors, Middle Aged, Spirometry, Adult, Risk Factors, Pneumothorax, University Hospitals, Severity of Illness Index, Respiratory insufficiency, and Medical and Health Sciences
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ObjectiveThis study aimed to determine the effectiveness of a proficiency-based progression (PBP) training approach to clinical communication in the context of a clinically deteriorating patient.DesignThis is a randomised controlled trial... more
ObjectiveThis study aimed to determine the effectiveness of a proficiency-based progression (PBP) training approach to clinical communication in the context of a clinically deteriorating patient.DesignThis is a randomised controlled trial with three parallel arms.SettingThis study was conducted in a university in Ireland.ParticipantsThis study included 45 third year nursing and 45 final year medical undergraduates scheduled to undertake interdisciplinary National Early Warning Score (NEWS) training over a 3-day period in September 2016.InterventionsParticipants were prospectively randomised to one of three groups before undertaking a performance assessment of the ISBAR (Identification, Situation, Background, Assessment, Recommendation) communication tool relevant to a deteriorating patient in a high-fidelity simulation facility. The groups were as follows: (i) E, the Irish Health Service national NEWS e-learning programme only; (ii) E+S, the national e-learning programme plus standa...
Aims: This review aims to determine the effect of adult Early Warning Systems education on nurses' knowledge, confidence and clinical performance.
Aims: This review aims to determine the effect of adult Early Warning Systems education on nurses’ knowledge, confidence and clinical performance. Background: Early Warning Systems support timely identification of clinical deterioration... more
Aims: This review aims to determine the effect of adult Early Warning Systems education on nurses’ knowledge, confidence and clinical performance.
Background: Early Warning Systems support timely identification of clinical deterioration and prevention of avoidable deaths. Several educational programmes have been designed to help nurses recognize and manage deteriorating patients. Little is known as to the effectiveness of these programmes.
Design: Systematic review.
Data sources: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Psychology and Behavioral Science Collection, SocINDEX and the UK & Ireland Reference Centre, EMBASE, the Turning Research Into Practice database, the Cochrane Central Register of Controlled Trials (CENTRAL) and Grey Literature sources were searched between October and November 2015.
Review methods: This is a quantitative systematic review using Cochrane methods. Studies published between January 2011 - November 2015 in English were sought. The risk of bias, level of evidence and the quality of evidence per outcome were assessed.
Results: Eleven articles with 10 studies were included. Nine studies addressed clinical performance, four addressed knowledge and two addressed confidence. Knowledge, vital signs recording and Early Warning Score calculation were improved in the short term. Two interventions had no effect on nurses’ response to clinical deterioration and use of communication tools.
Conclusion: This review highlights the importance of measuring outcomes using standardized tools and valid and reliable instruments. Using longitudinal designs, researchers are encouraged to investigate the effect of Early Warning Systems educational programmes. These can include interactive e-learning, on-site interdisciplinary Early Warning Scoring systems training sessions and simulated scenarios.
Background: Early Warning Systems support timely identification of clinical deterioration and prevention of avoidable deaths. Several educational programmes have been designed to help nurses recognize and manage deteriorating patients. Little is known as to the effectiveness of these programmes.
Design: Systematic review.
Data sources: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Psychology and Behavioral Science Collection, SocINDEX and the UK & Ireland Reference Centre, EMBASE, the Turning Research Into Practice database, the Cochrane Central Register of Controlled Trials (CENTRAL) and Grey Literature sources were searched between October and November 2015.
Review methods: This is a quantitative systematic review using Cochrane methods. Studies published between January 2011 - November 2015 in English were sought. The risk of bias, level of evidence and the quality of evidence per outcome were assessed.
Results: Eleven articles with 10 studies were included. Nine studies addressed clinical performance, four addressed knowledge and two addressed confidence. Knowledge, vital signs recording and Early Warning Score calculation were improved in the short term. Two interventions had no effect on nurses’ response to clinical deterioration and use of communication tools.
Conclusion: This review highlights the importance of measuring outcomes using standardized tools and valid and reliable instruments. Using longitudinal designs, researchers are encouraged to investigate the effect of Early Warning Systems educational programmes. These can include interactive e-learning, on-site interdisciplinary Early Warning Scoring systems training sessions and simulated scenarios.
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Recent studies suggest that noninvasive positive pressure ventilation (NPPV) administered by nasal or oronasal mask avoids the need for endotracheal intubation, rapidly improves vital signs, gas exchange, and sense of dyspnea, and may... more
Recent studies suggest that noninvasive positive pressure ventilation (NPPV) administered by nasal or oronasal mask avoids the need for endotracheal intubation, rapidly improves vital signs, gas exchange, and sense of dyspnea, and may reduce mortality in selected patients with acute respiratory failure, but few controlled trials have been done. The present study used a randomized prospective design to evaluate the possible benefits of NPPV plus standard therapy versus standard therapy alone in patients with acute respiratory failure. Patients to receive NPPV were comfortably fitted with a standard nasal mask connected to a BiPAP ventilatory assist device (Respironics, Inc., Murrysville, PA) in the patient flow-triggered/time-triggered (S/T) mode, and standard therapy consisted of all other treatments deemed necessary by the primary physician, including endotracheal intubation. The need for intubation was reduced from 73% in the standard therapy group (11 of 15 patients) to 31% in the NPPV group (5 of 16 patients, p &lt; 0.05). Among chronic obstructive pulmonary disease (COPD) patients, the reduction was even more striking, with 8 of 12 (67%) control patients requiring intubation compared with 1 of 11 (9%) NPPV patients (p &lt; 0.05). Heart and respiratory rates were significantly lower in the NPPV group than in control patients within 1 h, and PaO2 was significantly improved in the NPPV group for the first 6 h. Dyspnea scores and maximal inspiratory pressures were better in the NPPV than in control patients at 6 h, and nurses and therapists spent similar amounts of time at the bedside for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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This paper describes the development of a technology architecture that not only supports the technical performance assessment of a medical simulator but also facilitates a validated competence based assessment system in one selected... more
This paper describes the development of a technology architecture that not only supports the technical performance assessment of a medical simulator but also facilitates a validated competence based assessment system in one selected anaesthetic procedure i.e. spinal anaesthesia. Based on extensive mapping of the competencies required for the performance of this procedure, a system architecture is proposed utilising a specifically
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To identify the determinants of learning for one medical procedural skill, spinal anaesthesia, by eliciting the opinions of anaesthetists in Ireland and Hungary. This objective is one component of a research project, Medical Competence... more
To identify the determinants of learning for one medical procedural skill, spinal anaesthesia, by eliciting the opinions of anaesthetists in Ireland and Hungary. This objective is one component of a research project, Medical Competence Assessment Procedure (MedCAP) funded by the EU Leonardo da Vinci Lifelong Learning Programme. An electronic survey was circulated to anaesthetists in Hungary and Ireland. The survey was designed to identify and prioritise determinants of learning. Primary analysis was performed using the proportions of respondents that either agreed or strongly agreed with each question. A secondary analysis was performed comparing responses from Ireland with those from Hungary. A total of 180 of the 810 anaesthetists surveyed responded in Ireland, and 69 out of 225 responded in Hungary. In both countries, more than 90 per cent agreed or strongly agreed that acquisition of baseline knowledge, clinical demonstration, trainee motivation, feedback to the trainee, trainer motivation and communication skills were important determinants of learning. However, a greater proportion of Hungarian compared with Irish anaesthetists indicated that training should follow a problem-based approach [60/63 (95%) versus 54/124 (43%)]. A greater proportion of Irish anaesthetists indicated that trainee self-awareness was an important determinant of learning [89/122 (73%) versus 22/64 (34%)]. Anaesthetists in Ireland and Hungary believe that learning spinal anaesthesia is determined by factors related to the trainee (motivation, knowledge), the trainer (motivation, communication) and the training programme (feedback, demonstration prior to clinical performance). Differences between respondents from the two countries were identified in regard to attitudes towards problem-based learning and self-awareness. These findings can be used to inform the design of training programmes and simulators.
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Search by Subject Search using Medical Subject Headings (&amp;lt; b&amp;gt; MeSH&amp;lt;/b&amp;gt;), a controlled vocabulary for indexing life sciences content.&amp;lt; br/&amp;gt; Note that some records do not... more
Search by Subject Search using Medical Subject Headings (&amp;lt; b&amp;gt; MeSH&amp;lt;/b&amp;gt;), a controlled vocabulary for indexing life sciences content.&amp;lt; br/&amp;gt; Note that some records do not have MeSH. These include Patents and the latest PubMed and PubMed Central records.