Staff Team Research Articles

Trust, belief and transitions: people’s experiences of multidisciplinary inpatient treatment for persistent physical symptoms. A qualitative study

Purpose People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease. Multidisciplinary treatment is recommended for people with severe difficulties and is provided in a small number of specialist centres in the UK. Only brief descriptions of this treatment are available, and the experiences of people receiving this treatment as an inpatient have not been explored. This study aimed to explore how people with persistent physical symptoms experience inpatient treatment from a specialist multidisciplinary team, and to identify which factors facilitated their engagement in the rehabilitation. Materials and Methods 18 people who had received inpatient multidisciplinary treatment for persistent physical symptoms participated in semi-structured interviews. The transcripts were analysed using reflexive thematic analysis. Results Participants’ experiences were influenced by whether they felt believed by the healthcare team, and whether they could place their own trust and belief in the staff team and the treatment approach. Their experiences involved a series of transitions; both in environment and understanding. Conclusions Improvements are possible for people receiving inpatient multidisciplinary treatment for severe PPS. Trusting relationships between patients and staff members take time to develop but play a major role in patients’ experiences of treatment.

Integrated Care in a Large Public System Improves Simple Kidney Stone Management.

In the Los Angeles County Department of Health Services-the second largest public health care system in the United States-clinical integration allows specialists and primary care providers to collaboratively provide specialty care. We used time-driven activity-based costing to compare patient burden and cost of kidney stone diagnosis, workup, and management with and without clinical integration. We interviewed and observed teams of physicians and staff to understand workflow practices and personnel, space, material, and device requirements for stone care in the 2 models. We created process maps that outline the entire arc of care and used time-driven activity-based costing to calculate the all-inclusive costs of kidney stone diagnosis, workup, and scheduling for surgical treatment. The total cost of kidney stone treatment per stone episode in the integrated pathway was $499.04, compared with $699.81 in the traditional, nonintegrated pathway, a difference of 29%. The number of steps needed to arrive at operating room scheduling was 11 with integration and 14 without it. Clinical integration resulted in more efficient and cost-effective care from patient, provider, and health system perspectives. Integrated care may improve access to specialty care and increase the value of care and reduce treatment burden on patients.

Very high-speed running (VHSR) profile in elite female football: An update.

The aim of the present study it's a providing an update of the profile of very high-speed running (VHSR) of professional female football players. In this study 23 official matches of the Spanish First Division of Women´s Football were analysed. A total of 15 players participated, who were classified according to their location on the matches played: central-corridor (CCP, n = 7), and lateral-corridor (LCP, n = 8). The variables recorded were: 1) Very High-Speed Running (VHSR), considering the accumulated distance, duration, and frequency, and the individual characteristics of the efforts (distance and duration); 2) Recovery between efforts (VHSRe) and; 3) VMAX. The results show that LCP described higher values in accumulative VHSR and VHSR by distance bands, with greater distances, durations and VMAX of VHSRe, with less recovery between efforts. There seems to be an evolutionary trend in the distribution of the efforts, with a higher % of efforts in the 10-20 m band. The results provide useful information that coaching staff of professional women's football teams could use to design specific very high-speed running training to optimize performance in competition.

Early Health Impacts of a Primary Care Consultation Model for People Served by Assertive Community Treatment teams.

The cardiometabolic health outcomes and life expectancy of people living with serious mental illness (SMI) continue to significantly flag behind that of the general population. This study explores the possibility of using the evidence-based Assertive Community Treatment (ACT) model and infrastructure to increase access to primary care and improve cardiometabolic outcomes of people with SMI. Four ACT teams in a large urban area received the services of a primary care consultant who was co-located at a Federally Qualified Health Center (FQHC), met regularly with ACT team clinicians to review a cardiometabolic registry of participants, and engaged participants in primary care services. Health screening rates, primary care utilization, and cardiometabolic outcomes-body mass index, blood pressure, hemoglobin A1c, cholesterol, and tobacco smoking status-were monitored over the course of a year. The efficacy of this integrated care model was also explored through focus groups with ACT team staff and participants. Significant improvements in screening rates were found for the ACT teams that received this integrated care intervention; however, only modest improvements in cardiometabolic outcomes were found. Future longitudinal, multi-site studies are needed to fully determine the impact of integrated care models on the physical health outcomes of this vulnerable population.

Impact of a trainee-led initiative to address PCP prophylaxis barriers.

319 Background: In a prior trainee-led QI initiative, we surveyed clinicians about Pneumocystis pneumonia (PCP) and assessed rates of appropriate prophylaxis. Through retrospective chart review, we found that 47% of eligible patients (n=140/297) received PCP prophylaxis between 5/2022 and 5/2023. Clinician-reported barriers included knowledge gaps, systems-related gaps, and unclear corticosteroid durations. In the current initiative, we built an order set to facilitate PCP prophylaxis prescription and created an automated approach to assess prophylaxis rates. We then re-evaluated perceived barriers to prescribing PCP prophylaxis. Methods: A multidisciplinary team of oncology fellows and QI staff was established at Johns Hopkins. A new PCP prophylaxis order set was implemented on 4/15/2023. An automated data query was developed to identify patients with solid malignancies who were eligible for PCP prophylaxis per ASCO/IDSA guidelines (≥20mg prednisone equivalents daily for ≥1 month). Patient data was collected between 4/15/2022 and 4/15/2024. Surveys were conducted in 5/2023 and 5/2024 to assess prescriber knowledge of, and attitudes toward, PCP prophylaxis. The survey was open to prescribers across oncology specialties. Results: 1,404 patients were eligible for PCP prophylaxis over the 2-year study period, with 19% (n=264) receiving prophylaxis. In the year before the order set, 21% (n=138) of eligible patients were prescribed prophylaxis. In the year after the order set, 17% (n=126) of eligible patients were prescribed prophylaxis. A survey conducted post order set implementation included 52 responses from 42% (n= 22) attending physicians, 35% (n=18) advanced practice providers, and 23% (n=12) residents/fellows. While 92% (n=48) of survey participants had prescribed PCP prophylaxis, 31% (n=16) knew the dose/duration of corticosteroids at which society guidelines recommend prophylaxis. Unclear corticosteroid duration, guideline knowledge, and concern about side-effects were the most commonly reported barriers to prescribing prophylaxis. Conclusions: Compared to the prior chart review approach, the automated query identified more than twice as many patients at risk for PCP. Strikingly, <25% of eligible patients were prescribed PCP prophylaxis. Prescription rates did not improve following implementation of the order set. However, the post order set survey found increased rates of guideline knowledge and identified unclear corticosteroid durations as the primary barrier to prophylaxis. Building on these findings, an additional PDSA cycle is ongoing including development of notification system alerting providers when PCP prophylaxis is recommended for their patients. Barriers to PCP prophylaxis. Barrier Number of Respondents (%) Pre Order Set Number of Respondents (%) Post Order Set Unclear Corticosteroid Duration 8 (11%) 10 (19%) Guideline Knowledge 11 (16%) 7 (13%) Lack of EMR Notification 6 (9%) 2 (4%)

Children’s and adolescents’ views of health and mental health concepts - A qualitative group interview study

BackgroundDefinitions and perceptions of health and mental health have not remained static over time. This is also true for statistics over Swedish children’s and adolescents’ health and mental health status. The majority of Swedish school-aged children and adolescents report good physical health and good life satisfaction. However, there are some warning signs when it comes to children’s and adolescents’ health and mental health status, for instance, an increased overweight or obesity in children and adolescents, as well as a higher proportion reporting psychological problems and stress. There is also a need for knowing more about the younger population’s voices in this matter. The aim was therefore to explore children’s and adolescent’s conceptualizations and perceptions of health in general, and mental health in particular.MethodsOpen semistructured group interviews with 44 Swedish children and adolescents (10–14 years old) recruited from four schools were conducted. The interviews were conducted between April 2022 and January 2023. Data were analyzed with qualitative content analysis.ResultsChildren’s and adolescents’ conceptualizations of health included aspects of both the body and the mind, with a focus on the latter. Mental health was expressed as a state of being, illustrated by various lived experiences of emotions, moods, and thoughts. The social world was ever present in their understanding of health, e.g., through the lenses of social and gender norms.ConclusionsThis study revealed children’s and adolescents’ recognition of health terms and their ability to observe nuances between mental health problems and everyday struggles. The participants discussed mental health problems to a greater extent than positive mental health. An implication of this study is the highlighted need to focus more on mental health promotion in future preventive programs. These findings might potentially influence how school staff and student health teams communicate with children and adolescents about these concepts.

Resisting to Exist and the Subtle Invisible Protest: Six Solution Focused Tactics about Challenging Behaviour

According to Young Minds, ‘everyone gets angry sometimes’. Their website offers a number of de-escalating strategies, including staying calm, managing responses, and setting limits to help young people who most deem resistive. Yet, Young Minds are not alone because such logical advice is ubiquitous in the literature about challenging behaviour despite the fact that in our experience when faced with high states of arousal, most young people tend to act first and deal with the consequences later. It is not that they are stupid or non-caring, but they are human, capable of great feats as well as stupidity. The same is true for any claims that solution focused (SF) conversations can put right the several decades of psychological theory suggesting resistance requires logic and better cognition. By giving the correct thinking skills, young people will walk away from risk, avoid physical confrontation, handle challenging situations like logical thinkers, and generally discount that the process of growing up is part of the challenge. It is with this in mind that over recent years in our current SF practice (with staff group supervision), we have examined the concept of ‘resistance’ and how it can be put to use as a process of collaboration. To do this, we have revisited SF theory that preoccupied many of its pioneers during the 1980s and 1990s and attempted to make it useful for the early 2020s for professionals having conversations with young people, who, in traditional models, are labelled challenging. We want to introduce key differences of solution focused practice and how our research started to formulate a 6D-SF model (details, dynamics, dimensions, dispositions, dislocations, descriptions) for contemplating how groups of professionals relate to each other and are triggered by challenging behaviour. We do not claim to have proof, logic, or exactness on our side, but we are happy to suggest how our resistance mirrors what many of the staff teams feel and describe when working through their work.

Reaching adolescents with health services: Systematic development of an adolescent health check-ups and wellbeing programme in Ghana (Y-Check, Ghana).

Routine health check-ups may improve adolescent health, but global guidelines are lacking. Phase 1 of the WHO-coordinated Y-Check Research Programme involved three African cities to co-produce a programme of adolescent health check-ups. We describe a systematic approach to developing a routine adolescent health check-ups and wellbeing programme (Y-Check) to contribute evidence on whether adolescent health check-ups should be part of routine health services in Ghana. Y-Check Phase 1 was conducted in four communities in Cape Coast Ghana, over two stages using a variety of methods: (a) needs assessment and landscape analysis on the health of adolescents (existing policies/programmes, school system, adolescent health conditions) was conducted through desk-review and interviews with key informants to identify the potential content, delivery strategy and settings for adolescent health check-ups in this context; (b) co-designing the Y-Check intervention framework through person-centred participatory workshops and a consensus-building workshop with multiple stakeholders, including adolescents (10-19 years) and their parents. The study was conducted between January 2020 and October 2020. The Y-Check intervention consists of two check-ups with content that is tailored to the needs of younger adolescents and older adolescents; delivered at both school and community settings by a team of trained staff in multiple steps involving up to four stations. Y-Check includes a referral system for adolescents with any problems that cannot be investigated or treated on-the-spot. Our systematic approach to co-producing Y-Check has resulted in an intervention whose content and structure is determined by the local context, and which was adjudged by multiple stakeholders to be likely to be both useful and acceptable, and which builds on best practice. As a logical next step, the Y-Check will be subjected to pilot testing and implementation research to rigorously evaluate the feasibility, acceptability, coverage, yield of previously undiagnosed conditions and cost of these health check-ups.

Aphasia and acute care: a qualitative study of healthcare provider perspectives

ABSTRACT Background Poor communication between patients with aphasia and healthcare providers has many adverse consequences. Training healthcare providers to support communication not only improves skill in communicating with people with aphasia, but also potentially avoids adverse incidents. However, families have reported negative communication experiences for their relatives with aphasia during early acute hospitalization and healthcare providers in acute hospitals have reported multiple barriers to managing people with aphasia. Aims To gather information from healthcare providers about their experiences and needs relative to managing people with aphasia in the acute hospital setting as part of a larger implementation project designed to 1) improve acute care staff communication with patients with aphasia, and 2) help staff provide support to families of people with aphasia. Methods Qualitative methods were employed to gather perspectives of stroke team staff regarding the management of aphasia in early acute care. Methods for collecting data from staff in a large metropolitan hospital in Ontario, Canada included open-ended surveys, observations on acute stroke units, interviews, and focus groups. Data were transcribed and analyzed to identify themes that defined staff experiences and needs relative to caring for people with aphasia in the acute setting. Results The overall finding was that staff found communication and caring for people with aphasia and their families in the acute context to be challenging and frustrating. Themes included identification of the following barriers: fast-paced context with competing priorities; limited staff familiarity with communication access or support; priority given to swallowing by speech-language pathologists; and difficulty in addressing the pressing need to provide support and information to family members of patients with aphasia. In addition, a pervasive need for communication with patients with aphasia as part of staff responsibilities was also identified as a theme. Conclusions Findings demonstrate the need for healthcare systems to support acute care staff in their efforts to provide care for people with aphasia. Finding effective ways to influence system change is a priority and is in line with the rationale for the larger implementation project designed to improve staff and patient/family experiences in acute care.

Organizational characteristics of highly specialized units for people with dementia and severe challenging behavior

BackgroundPeople with dementia and severe challenging behavior in the Netherlands can be temporarily admitted to highly specialized units when their behavior is not manageable in regular dementia special care units (DSCUs). With scarce evidence available for the treatment of these patients, treatment in these units is in a pioneering phase. To gain more insight into these units, this study investigated organizational characteristics, i.e. admission and discharge characteristics, staffing, the physical environment, and the management of severe challenging behavior.MethodsThree data collection methods were used: 1) a digital questionnaire to be completed by the unit manager, 2) an interview with the physician responsible for medical care and often another practitioner, and 3) an observation of the physical environment for which the OAZIS-dementia questionnaire was used. Descriptive analysis was used for quantitative data and thematic analysis for qualitative data, after which data was interpreted together. Thirteen units participated, with their sizes ranging from 10 to 28 places.ResultsPatients were mainly admitted from regular DSCUs, home or mental health care, and discharged to regular DSCUs. A multidisciplinary team comprising at least an elderly care physician or geriatrician, psychologist, and nursing staff member and other therapists as needed provided the treatment. Nursing staff hours per patient considerably differed among units. Nursing staff played a central role in the treatment. Competences such as reflectiveness on one’s own behavior, and being able to cope with stressful situations were described as relevant for nursing staff. Investing in a stable nursing staff team was described as important. The units varied in whether their work-up was more intuitive or methodological. In the diagnostic phase, observation together with an extensive analysis of the patient’s biography was essential. The units used a broad variety of interventions, and all paid attention to sensory stimuli. In the observation of the physical environment, the safety scored well and domesticity relatively low.ConclusionHighly specialized units show strong heterogeneity in organizational characteristics and management, which can be understood in the light of the pioneering phase. Despite this, similarities were found in nursing staff roles, frequent multidisciplinary evaluation, and attention to sensory stimuli.

The Evolving Nature of Threat and Violence Risk Assessment in College Counseling Centers

ABSTRACT This paper examines the historical and current contexts of threat assessment and violence risk in higher education, highlighting the evolving roles of college counseling centers in the threat assessment process for students displaying signs of concerning behaviors. Given research showing many college mental health professionals feel under-prepared for this work, we build foundational knowledge about the differing purposes of psychological evaluations and threat assessments, and provide recommendations for ways to continue to build and demonstrate understanding, competency and proficiency with threat assessments… Our review shares recent updates in the field regarding high-risk groups and the use of AI in assessment, and highlights the need for more attention to be given to training community members as well as counseling center staff and other members of campus teams involved in decision-making about students who threaten violence. We recommend the deliberate practice model of skill building to better prepare college mental health professionals when needing to respond under stress and pressure.

Exploring staff experiences of remote working in a new community rehabilitation team

Background/Aims Health services required significant adaptation during the COVID-19 pandemic. The remote community enhanced rehabilitation team was created during the pandemic in response to faster discharges. This service evaluation aimed to explore staff experiences of remote working when implementing this new community rehabilitation team. Methods Six members of the community enhanced rehabilitation team, including nursing and psychology staff, completed qualitative semi-structured interviews about staff experiences. The interviews explored experiences of delivering clinical care, providing and receiving team support and personal impacts of remote working. Data were analysed using thematic analysis via a critical-realist approach. Results Thematic analysis from the interview transcripts revealed five main themes: anxiety related to remote working practices during a global pandemic, work–life balance, developing relationships, limits to remote working and working towards a hybrid model. Conclusions Challenges and benefits of remote working were identified along with some mitigations. Moving forward, a hybrid working model would likely benefit both service users and staff.

Intraday Variation of Ankle Dorsiflexion in Short-Track Speed Skaters.

Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle. Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle. The 3 times repeated measures and the 2days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant. The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively.

Measuring and correcting staff variability in large-scale OSCEs

ContextObjective Structured Clinical Examinations (OSCEs) are an increasingly popular evaluation modality for medical students. While the face-to-face interaction allows for more in-depth assessment, it may cause standardization problems. Methods to quantify, limit or adjust for examiner effects are needed.MethodsData originated from 3 OSCEs undergone by 900-student classes of 5th- and 6th-year medical students at Université Paris Cité in the 2022-2023 academic year. Sessions had five stations each, and one of the three sessions was scored by consensus by two raters (rather than one). We report OSCEs' longitudinal consistency for one of the classes and staff-related and student variability by session. We also propose a statistical method to adjust for inter-rater variability by deriving a statistical random student effect that accounts for staff-related and station random effects.ResultsFrom the four sessions, a total of 16,910 station scores were collected from 2615 student sessions, with two of the sessions undergone by the same students, and 36, 36, 35 and 20 distinct staff teams in each station for each session. Scores had staff-related heterogeneity (p<10-15), with staff-level standard errors approximately doubled compared to chance. With mixed models, staff-related heterogeneity explained respectively 11.4%, 11.6%, and 4.7% of station score variance (95% confidence intervals, 9.5-13.8, 9.7-14.1, and 3.9-5.8, respectively) with 1, 1 and 2 raters, suggesting a moderating effect of consensus grading. Student random effects explained a small proportion of variance, respectively 8.8%, 11.3%, and 9.6% (8.0-9.7, 10.3-12.4, and 8.7-10.5), and this low amount of signal resulted in student rankings being no more consistent over time with this metric, rather than with average scores (p=0.45).ConclusionStaff variability impacts OSCE scores as much as student variability, and the former can be reduced with dual assessment or adjusted for with mixed models. Both are small compared to unmeasured sources of variability, making them difficult to capture consistently.

Measuring the relationship between reciprocity behaviour and technology readiness of nursing staff working in residential care and community nursing: A cross-sectional study.

The aim of this study is to measure how collaborative factors are associated with the technology readiness of nursing staff working in residential care and community nursing. The Reciprocity Instrument and Technology Readiness Index 2.0 were applied to measure this association. A cross-sectional survey was conducted between October 2020 and January 2021. The Technology Readiness Index 2.0 was translated into Dutch, administered together with the Reciprocity Instrument and linguistically validated. And 1660 Registered Nurses and Nursing Assistants received an invitation to the online survey. Descriptive statistics and regression analyses were used to analyse the data. A total of 475 nursing staff responded, a response rate of 28.6%. The following factors have a statistically significant association with technology readiness: age, education level, years of working experience, type of organization, reciprocity behaviour and conditions of reciprocity behaviour: digital communication usage to reach one another, multilayeredness and future perspective. This study shows that reciprocity behaviour is positively associated with technology readiness. The influencing factor reciprocity remains intact after the correction of the other factors that were measured. This confirms the relevance of collaborative factors that influence the technology adoption process of nursing staff working in residential care and community nursing. This study offers insights into how collaboration based on reciprocity behaviour positively impacts the technology readiness of nursing staff engaged in residential care and community nursing and could be used in the education of nursing staff and healthcare teams. Being aware of the impact that collaborative factors have on the adoption process of ICT among nursing staff could be used to support the desired preparatory activities as part of ICT implementation for healthcare managers, innovators, and nursing work groups charged with implementing technology in the healthcare process. The study has adhered to STROBE guidelines. No Patient or Public Contribution.

Engagement strategies adopted by the nursing information officer team in preparing nurses for the implementation of an integrated electronic health record.

This article explores the critical role the nursing information officer (NIO)'s team played in facilitating the transition to an electronic health record system (EHR) at two NHS trusts in London. The article highlights that with the increasing importance of digital leadership in nursing, it is necessary to prepare nursing staff for the implementation of an EHR to enhance patient care and staff experience. It discusses various methodologies the NIO's team adopted, including 'show and tells', demos, walkabouts, induction sessions, 'CopyCat' charting, and a 'change and engagement' document. These engagement strategies are aimed at addressing diverse learning needs, increasing nurses' confidence and ensuring effective use of the new EHR. The successful implementation of an EHR depends on collaborative efforts among nursing staff, leadership and NIO teams. This emphasises the importance of embracing digital transformation and innovative strategies in navigating healthcare technology complexities.

Interpreting and enacting ‘empowerment’ in sport for development: the perspectives of UK stakeholders on a partnership-based programme in Malawi

This article examines the interpretation and enactment of ‘empowerment’ in a transnational Sport for Development programme that involved a partnership between a UK university and local stakeholders and practitioners in Malawi. In addressing whether the programme was underpinned by a neoliberal or more radical, progressive variant of empowerment, we employed semi-structured interviews with three categories of UK actors: university senior managers; university staff involved in project delivery; and student-volunteers. The findings reveal conflicting perspectives and tensions among these groups. The project staff team sought to promote a radical variant of empowerment through the programme. However, this was constrained by the use of the programme to burnish the University brand in the context of a competitive higher education marketplace and a tendency on the part of student-volunteers to uncritically position themselves as ‘superior’ to Malawian participants and view their involvement in instrumental terms. These perspectives had far reaching implications on relations of power within the programme, the extent to which it functioned on a partnership basis and whose interests were prioritised in its delivery.

728 Laparoscopic Fundoplication as a Day Case Procedure - Patient Comprehension for a Successful Model

Abstract Aim The British Association of Day Surgery states that elective laparoscopic Nissen’s fundoplication procedures should be performed as a day case in 40% of patients. The purpose of the study was to design a model for laparoscopic fundoplication to increase the numbers done as a day case procedure. Method This was a retrospective study of all patients who underwent laparoscopic fundoplication from 2014 - 2019. We introduced patient information leaflets and awareness amongst the patients regarding the procedure following our initial audit in 2014. Further intervention in terms of the surgical team and theatre staff awareness to reach our goal by distributing surgery-oriented pamphlets and information. We re-audited to see if there were any improvements in 2016 and 2019 when compared to our previous cohort. A total of 104 patients were audited through the years. Results In 2019, 34.4 % patients regardless of hiatus hernia size were discharged on the same day; 48.2 % patients were discharged on the next day; 24.1% patients had a large hiatus hernia or gastric volvulus; 40.9% patients excluding large and complicated hiatus hernia were discharged on the same day; 75.8 % patients had intraoperative local anaesthetic inject at the operative field. Conclusions The main two factors which contributed to improvement of our results were Intraoperative injection of local anaesthetic medications to operative field and Patient information pamphlets. Also, when a patient is made aware of the procedure being a day case in advance, they are more prepared to return home the same day following the procedure.

POStoperative INTELLiVENT-adaptive support VEntilation in cardiac surgery patients (POSITiVE) II—study protocol of a randomized clinical trial

BackgroundOne single-center randomized clinical trial showed that INTELLiVENT-adaptive support ventilation (ASV) is superior to conventional ventilation with respect to the quality of ventilation in post-cardiac surgery patients. Other studies showed that this automated ventilation mode reduces the number of manual interventions at the ventilator in various types of critically ill patients. In this multicenter study in patients post-cardiac surgery, we test the hypothesis that INTELLiVENT-ASV is superior to conventional ventilation with respect to the quality of ventilation.Methods“POStoperative INTELLiVENT-adaptive support VEntilation in cardiac surgery patients II (POSITiVE II)” is an international, multicenter, two-group randomized clinical superiority trial. In total, 328 cardiac surgery patients will be randomized. Investigators screen patients aged > 18 years of age, scheduled for elective cardiac surgery, and expected to receive postoperative ventilation in the ICU for longer than 2 h. Patients either receive automated ventilation by means of INTELLiVENT-ASV or ventilation that is not automated by means of a conventional ventilation mode. The primary endpoint is quality of ventilation, defined as the proportion of postoperative ventilation time characterized by exposure to predefined optimal, acceptable, and critical (injurious) ventilatory parameters in the first two postoperative hours. One major secondary endpoint is ICU team staff workload, captured by the ventilator software collecting manual settings on alarms. Patient-centered endpoints include duration of postoperative ventilation and length of stay in ICU.DiscussionPOSITiVE II is the first international, multicenter, randomized clinical trial designed to confirm that POStoperative INTELLiVENT-ASV is superior to non-automated conventional ventilation and secondary to determine if this closed-loop ventilation mode reduces ICU team staff workload. The results of POSITiVE II will support intensive care teams in their choices regarding the use of automated ventilation in postoperative care of uncomplicated cardiac surgery patients.Trial registrationClinicaltrials.gov NCT06178510. Registered on December 4, 2023.

Practitioners’ perspective of non-contact injury risk factors and injury prevention programming in professional North American male soccer

ObjectiveTo evaluate non-contact injury prevention strategies of professional men's soccer clubs in elite North American league soccer. To understand the application, perceived effectiveness and barriers to implementation. DesignOnline cross-Sectional Study. SettingNorth American elite soccer teams. Participants96 medical and performance support staff of elite North American teams. Main outcome measureThe survey consisted of 20 questions and captured 1) practitioners' demographics; 2) perceptions of risk factors; 3) the use of assessment and monitoring strategies; and 4) perceptions of the implementation of injury prevention programmes’. ResultsInjury prevention programmes were perceived as ‘effective’ (Median 4, Interquartile range 4-4) and reduced injury rates (n = 94, 98%, 95 CI% 93 to 99). A range of potential risk factors were rated as “very important” (4.58 ± 0.52 Likert scale points; mean ± standard deviation). A multi-disciplinary approach to the design, application and monitoring of programmes was generally adopted. Competing training priorities (n = 75, 78%, 95 CI% 69 to 85) and game schedules (n = 71, 74%, 95 CI% 64 to 82) were the most prevalent barriers to injury prevention implementation. ConclusionsInjury prevention programmes were perceived as effective in reducing non-contact injuries. Managing the conflicting priorities between scheduling training, tactical and conditioning goals were considered the key barriers to desired implementation.