Delivery of evidence-based critical care practices across the United Kingdom: A UK-wide multi-site service evaluation in adult units.

Background: The ICU Liberation Bundle was developed to improve outcomes for patients admitted to critical care. Despite a lack of Bundle adoption in the UK, the individual evidence-based practices (EBPs) within the bundle are defined as standards of care by the UK Intensive Care Society. There are limited data on the delivery of these EBPs.

Clinician assessment of kidney function from plasma creatinine values during critical illness: A scenario-based international multi-professional survey.

Purpose: During critical illness interpretation of serum creatinine is affected by non-steady state conditions, reduced creatinine generation, and altered distribution. We evaluated healthcare professionals' ability to adjudicate underlying kidney function, based on simulated creatinine values.

Methods: We developed an online survey, incorporating 12 scenarios with simulated trajectories of creatinine based on profiles of muscle mass, GFR and fluid balance using bespoke kinetic modelling.

Clinical context and communication in shared decision-making about major surgery: Findings from a qualitative study with colorectal, orthopaedic and cardiac patients.

Increasing numbers of older people undergo major surgery in the United Kingdom (UK), with many at high risk of complications due to age, co-morbidities or frailty. This article reports on a study of such patients and their clinicians engaged in shared decision-making. Shared decision-making is a collaborative approach that seeks to value and centre patients' preferences, potentially addressing asymmetries of knowledge and power between clinicians and patients by countering medical authority with greater patient empowerment.

Supporting effective shared decision-making in surgical context: Why framing of choices matters for high-risk patients and clinicians.

Aim: In the context of high-risk surgery, shared decision-making (SDM) is important. However, the effectiveness of SDM can be hindered by misalignment between patients and clinicians in their expectations of postoperative outcomes. This study investigated the extent and the effects of this misalignment, as well as its amenability to interventions that encourage perspective-taking.

Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study.

Background: Little is known about the opportunities for shared decision-making when older high-risk patients are offered major surgery. This study examines how, when, and why clinicians and patients can share decision-making about major surgery.

Methods: This was a multi-method qualitative study, combining video recordings of preoperative consultations, interviews, and focus groups (33 patients, 19 relatives, 36 clinicians), with observations and documentary analysis in clinics in five hospitals in the UK undertaking major orthopaedic, colorectal, and/or cardiac surgery.

Surgery in older patients: learning from shared decision-making in intensive care.

An increasing number of older patients are having surgical treatments. Similar to older patients admitted to intensive care, they present with additional problems including multimorbidity, frailty, and cognitive impairment. In both intensive care and surgical settings, comprehensive assessment can inform targeted interventions and shared decision-making.

Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study.

Background: Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed.

Perioperative Care Pathways in Low- and Lower-Middle-Income Countries: Systematic Review and Narrative Synthesis.

Background: Safe and effective care for surgical patients requires high-quality perioperative care. In high-income countries (HICs), care pathways have been shown to be effective in standardizing clinical practice to optimize patient outcomes. Little is known about their use in low- and middle-income countries (LMICs) where perioperative mortality is substantially higher.

Hospital-level evaluation of the effect of a national quality improvement programme: time-series analysis of registry data.

Background And Objectives: A clinical trial in 93 National Health Service hospitals evaluated a quality improvement programme for emergency abdominal surgery, designed to improve mortality by improving the patient care pathway. Large variation was observed in implementation approaches, and the main trial result showed no mortality reduction. Our objective therefore was to evaluate whether trial participation led to care pathway implementation and to study the relationship between care pathway implementation and use of six recommended implementation strategies.

Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project.

Background: Acute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy.

Divergent Protein Kinase A isoforms co-ordinately regulate conidial germination, carbohydrate metabolism and virulence in Aspergillus fumigatus.

The genome of Aspergillus fumigatus encodes two isoforms of the catalytic subunit of the cAMP-dependent Protein Kinase (PKA). Although deletion of the class I isoform, pkaC1, leads to an attenuation of virulence, the function of the class II subunit, PkaC2, was previously uninvestigated. In this report, we demonstrate that both isoforms act in concert to support various physiologic processes that promote the virulence of this pathogen.

Aspergillus fumigatus RasA regulates asexual development and cell wall integrity.

The Ras family of proteins is a large group of monomeric GTPases. Members of the fungal Ras family act as molecular switches that transduce signals from the outside of the cell to signaling cascades inside the cell. A.

Fiber-optic delivery of high-peak-power Q-switched laser pulses for in-cylinder flow measurement.

A bundle of optical fibers was constructed to deliver Q-switched frequency-doubled Nd:YAG laser pulses for the purpose of particle image velocimetry. Data loss that is due to fiber speckle was reduced by ensuring that each fiber was different in length by more than the coherence length of the laser being delivered. Hence, their speckle patterns will overlap but not interfere, producing more even illumination that is shown to reduce data loss.