Biomedical subjects

Stephen Timmons

Publications and source records attributed to Stephen Timmons.

12 recordsLinked to original sources

PubMed2005

An evaluation of using a web-based statistics test to teach statistics to post-registration nursing students.

Part of evidence-based practice is an ability to appraise research. Studies have shown that understanding the statistical components of a study is an area some nursing students struggle with. This paper reports the implementation and evaluation of a web-based statistics test to teach statistics to post-registration nursing students. The evaluation used both the data from the web-based statistics test, to measure students' learning, and from a survey completed after the module, to examine students' attitudes. The survey included some qualitative elements. The evaluation demonstrated that this is a valid and acceptable method of improving knowledge and understanding of statistics within this group of students.

Adult↗

PubMed2005

Variation in outcomes in Veterans Affairs intensive care units with a computerized severity measure.

OBJECTIVE: To quantify the variability in risk-adjusted mortality and length of stay of Veterans Affairs intensive care units using a computer-based severity of illness measure. DESIGN: Retrospective cohort study. SETTING: A stratified random sample of 34 intensive care units in 17 Veterans Affairs hospitals. PARTICIPANTS: A consecutive sample of 29,377 first intensive care unit admissions from February 1996 through July 1997. INTERVENTIONS: Standardized mortality ratio (observed/expected deaths) and observed minus expected length of stay (OMELOS) with 95% confidence intervals were estimated for each unit using a hierarchical logistic (standardized mortality ratio) or linear (OMELOS) regression model with Markov Chain Monte Carlo simulation. We adjusted for patient characteristics including age, admission diagnosis, comorbid disease, physiology at admission (from laboratory data), and transfer status. MEASUREMENTS AND MAIN RESULTS: Mortality across the intensive care units for the 12,088 surgical and 17,289 medical cases averaged 11% (range, 2-30%). Length of stay in the intensive care units averaged 4.0 days (range, mean unit length of stay 3.0-5.9). Standardized mortality ratio of the intensive care units varied from 0.62 to 1.27; the standardized mortality ratio and 95% confidence interval were <1 for four intensive care units and >1.0 for seven intensive care units. OMELOS of the intensive care units ranged from -0.89 to 1.34 days. In a random slope hierarchical model, variation in standardized mortality ratio among intensive care units was similar across the range of severity, whereas variation in length of stay increased with severity. Standardized mortality ratio was not associated with OMELOS (Pearson's r = .13). CONCLUSIONS: We identified intensive care units whose indicators for mortality and length of stay differ substantially using a conservative statistical approach with a severity adjustment model based on data available in computerized clinical databases. Computerized risk adjustment employing routinely available data may facilitate research on the utility of intensive care unit profiling and analysis of natural experiments to understand process and outcome links and quality efforts.

Adolescent↗

PubMed2005

Operating theatre nurses: emotional labour and the hostess role.

Emotional labour has been established as a significant factor in nursing work, although no studies have been done looking at emotional labour specifically in an operating theatre nursing context. Theatre staff (17 nurses and three Operating Department Practitioners (technicians) were observed in practice over a period of nine months by one of the authors. Each of the staff was subsequently interviewed. The transcriptions of the observation fieldwork notes and the semistructured interviews were analysed for themes and content. The (predominantly female) nurses perceived that one of their responsibilities was 'looking after the surgeons'. We have described this as the 'hostess' role. This role consisted of two major areas of activity: 'keeping the surgeons happy' and 'not upsetting the surgeons'. Examples are given of how this was accomplished through talk and actions. The (predominantly male) operating department practitioners did not see this as part of their work. This 'hostess' role is a kind of emotional labour, but performed with coworkers rather than patients. Like other forms of emotional labour, it is strongly gendered. The emotional labour performed by the theatre nurses was necessary to maintain what has been called elsewhere the 'sentimental order'.

Adult↗

PubMed2005

The doctor-nurse relationship in the operating theatre.

This article examines the organisational culture in theatres, specifically the doctor-nurse relationship, based on the literature and the experience of one author (Anika Reynolds) on placement in theatres. The initial motivation for the study was noticing how well these doctors and nurses got on in a friendly, informal and efficient atmosphere. This relationship between the multidisciplinary team was especially surprising when compared with the experience of hospital wards. Why did such a difference exist?

Clinical Competence↗

PubMed2004

A disputed occupational boundary: operating theatre nurses and Operating Department Practitioners.

Traditionally, surgeons (and to a lesser extent anaesthetists) have been assisted primarily by nurses. This role has been threatened in recent years, in the UK NHS (and elsewhere), by a relatively new profession, that of the Operating Department Practitioner (ODP). The ODP profession is still in the process of establishing itself as a 'full' profession within UK health care. While occupational boundary disputes between professions are common in health care, it is unusual for them to become as overt as the dispute we will analyse in this paper. Drawing on fieldwork observations and interviews conducted in operating theatres, as well as documentary sources, we will show how this dispute arose, how it is manifested at both the micro and the macro level, and how both groups involved justify their positions, drawing on surprisingly similar rhetorical strategies. A further unusual feature of this dispute is the fact that, unlike many attempts by managers to substitute one type of labour for another, issues of cost are relatively unimportant, as both theatre nurses and ODPs earn similar salaries.

Attitude of Health Personnel↗

PubMed2004

Improving transition: a qualitative study examining the attitudes of young people with chronic illness transferring to adult care.

Transition is a process that attends to the medical, psychosocial and educational needs of young people as they transfer to adult-orientated care. With a growing population of adolescents surviving with chronic illness well into adulthood, it is remarkable that empirical research has paid little attention to transition. This qualitative study examined the attitudes of young people with chronic illness who were facing transition, considering what young people wanted from a transition service and the ways in which provision could be improved from a service-user's perspective. A purposive sample of seven adolescents (aged 14-17) attending a hospital youth club were interviewed. To increase the likelihood of successful transition, strategies need to be informal, flexible, highly individualized and prepare adolescents steadily for adult services.

Adolescent↗

PubMed2003

An educational panopticon? New technology, nurse education and surveillance.

This papers raises concerns about the use of new technology in nurse education. It is possible that new forms of computer-based learning and teaching carry with them the possibility of new kinds of 'panoptic' surveillance and control of students. We discuss how this is possible, and set this development within a wider social context. These forms of panoptic surveillance are, we believe, inimical to the underlying values and philosophy of nurse education. New technology does not necessarily have to be used in this way, and can be part of a liberating pedagogy. We would not propose that surveillance of students should never be used, but rather that its use should be considered and debated.

Diffusion of Innovation↗

PubMed2003

Nurses resisting information technology.

Resistance in the workplace, by nurses, has not been extensively studied from a sociological perspective. In this paper, nurses' resistance to the implementation and use of computer systems is described and analysed, on the basis of semistructured interviews with 31 nurses in three UK NHS hospitals. While the resistance was not "successful", in that it did not prevent the implementation of the systems, it nonetheless persisted. Resistance took a wide variety of forms, including attempts to minimise or "put off" use of the systems, and extensive criticism of the systems, though outright refusal to use them was very rare. Resistance was as much about the ideas and ways of working that the systems embodied as it was about the actual technology being used. The patterns of resistance can best be summed up by the phrase "resistive compliance".

Attitude of Health Personnel↗

PubMed2003

Automated intensive care unit risk adjustment: results from a National Veterans Affairs study.

CONTEXT: Comparison of outcome among intensive care units (ICUs) requires risk adjustment for differences in severity of illness and risk of death at admission to the ICU, historically obtained by costly chart review and manual data entry. OBJECTIVE: To accurately estimate patient risk of death in the ICU using data easily available in hospital electronic databases to permit automation. DESIGN AND SETTING: Cohort study to develop and validate a model to predict mortality at hospital discharge using multivariate logistic regression with a split derivation (17,731) and validation (11,646) sample formed from 29,377 consecutive first ICU admissions to medical, cardiac, and surgical ICUs in 17 Veterans' Health Administration hospitals between February 1996 and July 1997. MAIN OUTCOME MEASURES: Mortality at hospital discharge adjusted for age, laboratory data, diagnosis, source of ICU admission, and comorbid illness. RESULTS: The overall hospital death rate was 11.3%. In the validation sample, the model separated well between survivors and nonsurvivors (area under the receiver operating characteristic curve = 0.885). Examination of the observed vs. the predicted mortality across the range of mortality showed the model was well calibrated. CONCLUSIONS: Automation could broaden access to risk adjustment of ICU outcomes with only a small trade-off in discrimination. Broader use might promote valid evaluation of ICU outcomes, encouraging effective practices and improving ICU quality.

Adult↗

PubMed2002

Impact of different measures of comorbid disease on predicted mortality of intensive care unit patients.

BACKGROUND: Valid comparison of patient survival across ICUs requires adjustment for burden of chronic illness. The optimal measure of comorbidity in this setting remains uncertain. OBJECTIVES: To examine the impact of different measures of comorbid disease on predicted mortality for ICU patients. DESIGN: Retrospective cohort study. SUBJECTS: Seventeen thousand eight hundred ninety-three veterans from 17 geographically diverse VA Medical Centers and 43 ICUs were studied, admitted between February 1, 1996 and July 31, 1997. MEASURES: ICD-9-CM codes reflecting comorbid disease from hospital stays before and including the index hospitalization from local VA computer databases were extracted, and three measures of comorbid disease were then compared: (1) an APACHE-weighted comorbidity score using comorbid diseases used in APACHE, (2) a count of conditions described by Elixhauser, and (3) Elixhauser comorbid diseases weighted independently. Univariate analyses and multivariate logistic regression models were used to determine the contribution of each measure to in-hospital mortality predictions. RESULTS: Models using independently weighted Elixhauser comorbidities discriminated better than models using an APACHE-weighted score or a count of Elixhauser comorbidities. Twenty-three and 14 of the Elixhauser conditions were significant univariate and multivariable predictors of in-hospital mortality, respectively. In a multivariable model including all available predictors, comorbidity accounted for less (8.4%) of the model's uniquely attributable chi statistic than laboratory values (67.7%) and diagnosis (17.7%), but more than age (4.0%) and admission source (2.1%). Excluding codes from prior hospitalizations did not adversely affect model performance. CONCLUSIONS: Independently weighted comorbid conditions identified through computerized discharge abstracts can contribute significantly to ICU risk adjustment models.

APACHE↗

PubMed2002

Research fraud.

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Fraud↗

PubMedDate not supplied

The potential contribution of social science to information technology implementation in healthcare.

Information technology systems in hospitals and other healthcare settings have sometimes proved difficult to implement successfully. Some of the problems encountered in the implementation of information technology systems in healthcare can be explained by the use of techniques and theoretical approaches derived from the social sciences, notably sociology and anthropology. Research from a variety of countries and healthcare systems confirms the explicative value of these techniques and approaches. These techniques can also be used to inform better the process of design and implementation of computer systems. Although they have been successfully applied in several industries and spread across several countries, these techniques have not yet been widely used in healthcare. This article suggests how these approaches can be fruitfully applied to the design and implementation of IT systems in healthcare and how this might be achieved.

Delivery of Health Care↗