title: Evidence-based practice in Interventional Radiology: A mixed methods study exploring how evidence is incorporated into practice with a particular focus on blood glucose requirements for vascular patients with peripheral artery disease undergoing peripheral angioplasty.

authors: Linton, Delia Rose

abstract: Background: Evidence-based practice was established to align patient care with the best available evidence.  At Waikato Hospital, vascular patients undergoing peripheral angioplasty are required to have a pre-procedural blood glucose level of less than 11 mmol/L.  However, there is no guideline outlining this requirement or the underlying evidence supporting this criterion, the absence of which has led to confusion amongst staff.  This research project seeks to explore how evidence for pre-procedural blood glucose requirements for vascular patients undergoing peripheral angioplasty is incorporated into practice and how the evidence is disseminated to relevant services.
Participants: The quantitative phase reviewed the clinical records of vascular patients (n=93) who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  Due to incomplete datasets, a total of 50 patient clinical records were included in analysis.  The qualitative phase involved interviews with health professionals (n=9) involved in the care of vascular patients undergoing peripheral angioplasty.  
Methods: This mixed-methods two-phase research project involved an initial retrospective clinical records audit of vascular patients diagnosed with diabetes mellitus who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  A regression analysis was undertaken to determine the correlation between the change in creatinine levels and (i) patient diagnoses and (ii) pre-procedural blood glucose levels.  Qualitative data were gathered through semi-structured interviews with health professionals.  These interviews were analysed using a general inductive method of inquiry to identify key overarching themes. 
Findings: There was no observed statistically significant association using ANOVA between the change in creatinine levels and patient diagnoses (p=0.31) or pre-procedural blood glucose levels in vascular patients following a peripheral angioplasty (p=0.14).  Although a one-unit increase in pre-procedural blood glucose levels was observed to result in an associated increase of 3.5 mg/dL in creatinine levels, this was not statistically significant (p=0.25).  Analysis of the qualitative interview data from interviews with health professionals produced three themes relating to the implementation of evidence-based practice: (i) Dissemination of evidence; (ii) Balancing practicality with evidence in healthcare delivery; and (iii) Enhancing evidence-based practice in clinical contexts.        
Conclusion: Although the research reported a relationship between raised pre-procedure blood glucose and creatinine levels, it was not statistically significant.  More meaningful results arose, however, from the stakeholder interviews, which indicated a lack of communication and support around the rationale for the pre-procedural blood glucose cut-off value.  It appeared that such miscommunication would be absent through the investment into staff education and the development of a clinical guideline.

text: Evidence-based practice in Interventional Radiology: A mixed methods study exploring how evidence is incorporated into practice with a particular focus on blood glucose requirements for vascular patients with peripheral artery disease undergoing peripheral angioplasty. Background: Evidence-based practice was established to align patient care with the best available evidence.  At Waikato Hospital, vascular patients undergoing peripheral angioplasty are required to have a pre-procedural blood glucose level of less than 11 mmol/L.  However, there is no guideline outlining this requirement or the underlying evidence supporting this criterion, the absence of which has led to confusion amongst staff.  This research project seeks to explore how evidence for pre-procedural blood glucose requirements for vascular patients undergoing peripheral angioplasty is incorporated into practice and how the evidence is disseminated to relevant services.
Participants: The quantitative phase reviewed the clinical records of vascular patients (n=93) who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  Due to incomplete datasets, a total of 50 patient clinical records were included in analysis.  The qualitative phase involved interviews with health professionals (n=9) involved in the care of vascular patients undergoing peripheral angioplasty.  
Methods: This mixed-methods two-phase research project involved an initial retrospective clinical records audit of vascular patients diagnosed with diabetes mellitus who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  A regression analysis was undertaken to determine the correlation between the change in creatinine levels and (i) patient diagnoses and (ii) pre-procedural blood glucose levels.  Qualitative data were gathered through semi-structured interviews with health professionals.  These interviews were analysed using a general inductive method of inquiry to identify key overarching themes. 
Findings: There was no observed statistically significant association using ANOVA between the change in creatinine levels and patient diagnoses (p=0.31) or pre-procedural blood glucose levels in vascular patients following a peripheral angioplasty (p=0.14).  Although a one-unit increase in pre-procedural blood glucose levels was observed to result in an associated increase of 3.5 mg/dL in creatinine levels, this was not statistically significant (p=0.25).  Analysis of the qualitative interview data from interviews with health professionals produced three themes relating to the implementation of evidence-based practice: (i) Dissemination of evidence; (ii) Balancing practicality with evidence in healthcare delivery; and (iii) Enhancing evidence-based practice in clinical contexts.        
Conclusion: Although the research reported a relationship between raised pre-procedure blood glucose and creatinine levels, it was not statistically significant.  More meaningful results arose, however, from the stakeholder interviews, which indicated a lack of communication and support around the rationale for the pre-procedural blood glucose cut-off value.  It appeared that such miscommunication would be absent through the investment into staff education and the development of a clinical guideline.

year: 2023

title: Towards automated configuration of stream clustering algorithms

authors: Carnein, Matthias

subjects: computer science

abstract: Clustering is an important technique in data analysis which can reveal hidden patterns and unknown relationships in the data. A common problem in clustering is the proper choice of parameter settings. To tackle this, automated algorithm configuration is available which can automatically find the best parameter settings. In practice, however, many of our today’s data sources are data streams due to the widespread deployment of sensors, the internet-of-things or (social) media. Stream clustering aims to tackle this challenge by identifying, tracking and updating clusters over time. Unfortunately, none of the existing approaches for automated algorithm configuration are directly applicable to the streaming scenario. In this paper, we explore the possibility of automated algorithm configuration for stream clustering algorithms using an ensemble of different configurations. In first experiments, we demonstrate that our approach is able to automatically find superior configurations and refine them over time.

text: Towards automated configuration of stream clustering algorithms Clustering is an important technique in data analysis which can reveal hidden patterns and unknown relationships in the data. A common problem in clustering is the proper choice of parameter settings. To tackle this, automated algorithm configuration is available which can automatically find the best parameter settings. In practice, however, many of our today’s data sources are data streams due to the widespread deployment of sensors, the internet-of-things or (social) media. Stream clustering aims to tackle this challenge by identifying, tracking and updating clusters over time. Unfortunately, none of the existing approaches for automated algorithm configuration are directly applicable to the streaming scenario. In this paper, we explore the possibility of automated algorithm configuration for stream clustering algorithms using an ensemble of different configurations. In first experiments, we demonstrate that our approach is able to automatically find superior configurations and refine them over time.

year: 2019

title: Exploring patient experiences and power dynamics in an acute general surgical ward: A mixed methods study exploring patient and staff
perceptions of the inpatient experience at Waikato Hospital

authors: Drake, Emma Rose

subjects: Nursing

abstract: Background: Alongside health outcomes, patient experiences are considered crucial in identifying the quality of a health care setting. General surgery comprise the largest range of pathologies and accounts for the highest number of patient discharges of any surgical specialty. As a way to address the power imbalance between healthcare staff and patients, patient-centred models of care are increasingly being adopted and implemented within hospitals including surgery. This study aims to investigate the current experiences of acutely admitted patients in a general surgical ward at Waikato Hospital, including opportunities for and challenges to improvement initiatives. Furthermore, the study examines relevant staff members perspectives of the inpatient experience and seeks to determine the efficacy of a proposed intervention focusing on empowering patients and their families.
Methods: The study was a mixed method design involving two phases. Phase I obtained qualitative data from semi-structured interviews with six patients and twelve staff members. Themes which emerged from the qualitative data in phase I were used to inform the development of phase II, as well as to inform a proposed patient self- assessment intervention. Phase II obtained quantitative data through Likert scale response surveys provided to acute patients on, or near to, their day of discharge from the surgical ward over a two month period.
Results: A total of six patients and 12 healthcare staff (senior registered nurses, n=3; surgical registered nurse managers, n=2; surgical fellows, n=2; surgical registrar, n=1; dietitian, n=1; social worker, n=1; occupational therapist, n=1; and physiotherapist n=1) were involved in phase I. A total of 53 surveys were returned from patients in Phase II (63.1% response rate). Qualitative data from phase I was analysed using a general inductive approach. This revealed three themes including power and control concerns for patients, the hierarchy of the health care team and the surrounding stressors of the organisation and environment. Analysis of the quantitative data collected descriptive statistics and calculated chi-squares. Of note were the statistically significant differences particularly between patients of Māori ethnicity comparatively to non-Māori, and according to gender and reason in hospital. There were no statistically significant differences for patients according to age group.
Conclusion: This study identified both the experiences of patients and staff in an acute general surgical context. The study found that the proposed patient self- assessment intervention was not immediately recommended. This was due to the current recommendations from patients who identified their strong preference was for face-to-face communication with staff. It was also due to staff members identification of a perceived inability to consistently provide person-centred care which corresponded with the patient self-assessment data. Acute general surgical care needs of patients were perceived by staff as taking precedent and current workplace stressors, including staffing and skill mix deficits and perceived lack of staff wellbeing supports, were strong inhibitors for staff to provide their preferred capacity of patient-centred care.

text: Exploring patient experiences and power dynamics in an acute general surgical ward: A mixed methods study exploring patient and staff
perceptions of the inpatient experience at Waikato Hospital Background: Alongside health outcomes, patient experiences are considered crucial in identifying the quality of a health care setting. General surgery comprise the largest range of pathologies and accounts for the highest number of patient discharges of any surgical specialty. As a way to address the power imbalance between healthcare staff and patients, patient-centred models of care are increasingly being adopted and implemented within hospitals including surgery. This study aims to investigate the current experiences of acutely admitted patients in a general surgical ward at Waikato Hospital, including opportunities for and challenges to improvement initiatives. Furthermore, the study examines relevant staff members perspectives of the inpatient experience and seeks to determine the efficacy of a proposed intervention focusing on empowering patients and their families.
Methods: The study was a mixed method design involving two phases. Phase I obtained qualitative data from semi-structured interviews with six patients and twelve staff members. Themes which emerged from the qualitative data in phase I were used to inform the development of phase II, as well as to inform a proposed patient self- assessment intervention. Phase II obtained quantitative data through Likert scale response surveys provided to acute patients on, or near to, their day of discharge from the surgical ward over a two month period.
Results: A total of six patients and 12 healthcare staff (senior registered nurses, n=3; surgical registered nurse managers, n=2; surgical fellows, n=2; surgical registrar, n=1; dietitian, n=1; social worker, n=1; occupational therapist, n=1; and physiotherapist n=1) were involved in phase I. A total of 53 surveys were returned from patients in Phase II (63.1% response rate). Qualitative data from phase I was analysed using a general inductive approach. This revealed three themes including power and control concerns for patients, the hierarchy of the health care team and the surrounding stressors of the organisation and environment. Analysis of the quantitative data collected descriptive statistics and calculated chi-squares. Of note were the statistically significant differences particularly between patients of Māori ethnicity comparatively to non-Māori, and according to gender and reason in hospital. There were no statistically significant differences for patients according to age group.
Conclusion: This study identified both the experiences of patients and staff in an acute general surgical context. The study found that the proposed patient self- assessment intervention was not immediately recommended. This was due to the current recommendations from patients who identified their strong preference was for face-to-face communication with staff. It was also due to staff members identification of a perceived inability to consistently provide person-centred care which corresponded with the patient self-assessment data. Acute general surgical care needs of patients were perceived by staff as taking precedent and current workplace stressors, including staffing and skill mix deficits and perceived lack of staff wellbeing supports, were strong inhibitors for staff to provide their preferred capacity of patient-centred care.

year: 2022