RESUMEN
AIM: Posthumous electronic healthcare data (PHCD) are ubiquitous and increasing in volume. Despite their potential utility and value, no empirically-derived, publicly-generated information exists to guide what uses society may view as acceptable. This study explores the attitude and perceptions of Aotearoa New Zealanders to PHCD utilisation. METHODS: Focus groups explored topics focused around PHCD utilisation, including family access, consent models, infrastructure, anonymity, governance, and commercialisation. Data were transcribed and general thematic analysis utilised to explore themes and topics. RESULTS: Sixty-seven people participated across 12 focus groups (mean=50 minutes). Participants indicated conditional support for a centralised, Government-managed PHCD repository allowing controlled, no-cost access for healthcare and research purposes. Public benefit from data was important. Participants prioritised any benefits being preferentially directed to family, then Aotearoa New Zealanders, then others. Commercialisation from data use was viewed as likely and acceptable. Maori PHCD was considered preferably managed by Maori. Participants struggled to define appropriate levels of family access, anonymity, and consent models. CONCLUSIONS: This study delivers the first empirical evidence of social license for PHCD utilisation, providing guidance for establishing trustworthy data governance. Further exploration of the subject is warranted to guide development of frameworks to utilise PHCD in Aotearoa New Zealand.
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Atención a la Salud , Nativos de Hawái y Otras Islas del Pacífico , Actitud , Instituciones de Salud , Humanos , Nueva ZelandaRESUMEN
Postnatal depression (PND) is a mood disorder with potentially devastating effects to the individual on many levels. It can affect cognitive functioning, motivation, and self-esteem. The person can socially withdraw from their immediate familial or social circle. It can affect bonding and quality time between the mother and baby. There are many effective therapeutic treatments used for the treatment of PND such as cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT). This study using a single-case study trial with 15 participants investigates the clinical usefulness of combining CBT with virtual reality (VR). Results show that the combination of CBT with VR is an effective treatment for PND. In addition, VR can enhance awareness, decision-making, and self-appreciation within the individual and can also have real-life applications. This study also shows that the combination of VR and CBT is feasible, while the use of such a technology is well accepted.
Asunto(s)
Terapia Cognitivo-Conductual , Depresión Posparto , Realidad Virtual , Intervención en la Crisis (Psiquiatría) , Depresión Posparto/terapia , Femenino , Humanos , Resultado del TratamientoRESUMEN
AIM: The Acute Physiological and Chronic Health Evaluation (APACHE) II score is a popular illness severity scoring system for intensive care units. Scoring systems such as the APACHE II allow researchers and clinicians to quantify patient illness severity with a greater degree of accuracy and precision, which is critical when evaluating practice patterns and outcomes, both within or between intensive care units. The study aims to: assess changes in APACHE II scores and hospital-standardised mortality ratio at our ICU over a nine year period from 1 January 1997 to 31 December 2005; assess for changes in the performance of the APACHE II scoring system in predicting patient hospital mortality over the same period; and assess for any clinical subgroups in which APACHE II scoring was particularly inaccurate or imprecise. METHODS: Retrospective audit of a single centre relational database, with evaluation of the APACHE II scoring system by year through discrimination (ability to discriminate between the patients who will die or survive at hospital discharge) using receiver operating characteristic (ROC) curves, and calibration (ability to predict mortality rate over classes of risk) using goodness-of-fit as assessed by the Hosmer-Lemeshow statistic. RESULTS: Data from 7703 patients were available for analysis. There was a decrease in overall hospital mortality, from approximately 19% at the beginning of the period of observation to approximately 12% at the end. There was also a decrease in the hospital standardised mortality ratio from 0.94 (95%CI 0.82-1.06) to 0.66 (95%CI 0.55-0.76). In general, both the APACHE II score and risk of death model performed adequately in each year with ROC curve AUCs of >0.8, albeit with progressively poorer performance over time and 'model fade' that approached statistical significance. There was progressively poorer calibration with the APACHE II risk of death model as indicated by the Hosmer-Lemeshow statistic, with a statistically significant difference between the predicted and observed mortality from 2003 onwards. Overall, there was moderately poor model performance in the diagnostic groups with the largest number of patients (sepsis and post-surgical complications). CONCLUSION: This study shows the progressively worse performance of the APACHE II illness severity scoring system over time due to 'model fade'. This is especially so in common diagnostic categories, making this a clinically relevant finding. Future approaches to illness severity scoring should be tested and compared, such as re-estimating coefficients of the APACHE II diagnostic categories or using locally developed ones, moving to later evolutions of the system such as the APACHE III or APACHE IV, or developing novel artificial intelligence approaches.