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Susan Williams

Publications and source records attributed to Susan Williams.

At least 19 recordsLinked to original sources
PubMed2006

Emergency department patient classification systems: A systematic review.

BACKGROUND: The emergency department is a dynamic environment with a high throughput of patients. The clinical stability of patients varies considerably. In order to provide optimal care for patients a responsive staffing pattern is required. There is a need for a valid and reliable, prospective, emergency department patient classification system to set adequate nurse staffing levels in the UK. AIMS AND OBJECTIVES: To conduct a systematic review of the literature and determine the validity, reliability, strengths and weaknesses of emergency department patient classification systems. METHODS: The following electronic databases were searched for years 1985-2004: MEDLINE; CINAHL; COCHRANE Library databases DARE, CDSR, CCTR, BioMedNet Reviews, National Research Register (NRR). Manual searches were also conducted and relevant references retrieved from those listed in key papers, reports, theses and dissertations. Studies were also retrieved by contacting researchers in the field. RESULTS: Twelve patient classification systems met all the inclusion criteria. Only three systems reported evidence of good validity and reliability: the ED Patient Needs Matrix developed in the US, the Conner's Tool (a modified version of the ED Patient Needs Matrix) developed in Australia and the Jones Dependency Tool developed in the UK. CONCLUSION: There are very few patient classification systems developed for use in the ED setting that have demonstrated good validity and reliability. The Jones Dependency Tool is a simple, easy to use prospective, patient classification system that has demonstrated good validity and reliability in the UK.

APACHE↗
PubMed2006

Patient dependency in the emergency department (ED): reliability and validity of the Jones Dependency Tool (JDT).

BACKGROUND: Rising patient demand in emergency departments is an international problem. Patient dependency (the degree of nursing care required) has major implications for nursing. Nurse skill mix and staffing levels can be addressed more effectively when dependency can be measured. A valid and reliable method of determining patient dependency in the emergency department in the United Kingdom is required. AIM: To test the validity, reliability and generalisability of the Jones Dependency Tool. METHODS: Six emergency departments across England were included. The sample was 140 adult patients from each site (n=840). Information was collected by nurses on: demographics, triage, chief complaint, vital clinical signs, nurse's own subjective rating of patient dependency, Jones Dependency Tool ratings and a comparative tool ratings. For a sub-sample of 40 patients, observation data were collected. RESULTS: There was a highly significant correlation between the Jones Dependency Tool scores and the nurses' subjective ratings of patient dependency (R=0.786,P<0.001). There was a significant correlation between triage rating and Jones Dependency Tool scores (R=0.58,P<0.001). The higher the dependency, the higher the proportion of patients with abnormal pulse rates (chi2=7.45,df=1,P=0.006), abnormal respiratory rates (chi2=15.683,df=1,P<0.001) and abnormal oxygen saturation (chi2=15.583,df=1,P<0.001). The higher the amount of time spent by nurses in direct care of patients the higher the patient's level of dependency (R=0,72,P<0.001). Length of time spent by nurses with patients was also significantly and positively correlated with the nurses' subjective ratings of patient dependency (R=0.49,P=0.001). There was a positive and significant correlation between Jones Dependency Tool scores and comparator scores (R=0.726,P<0.001). There was a good correlation between JDT scores measured over time (kappa=0.68) and good inter-rater reliability (kappa=0.75). CONCLUSIONS: The Jones Dependency Tool can be recommended as a valid and reliable tool for the measurement of patient dependency in the emergency department.

Activities of Daily Living↗
PubMed2006

Biological invasions: recommendations for U.S. policy and management.

The Ecological Society of America has evaluated current U.S. national policies and practices on biological invasions in light of current scientific knowledge. Invasions by harmful nonnative species are increasing in number and area affected; the damages to ecosystems, economic activity, and human welfare are accumulating. Without improved strategies based on recent scientific advances and increased investments to counter invasions, harm from invasive species is likely to accelerate. Federal leadership, with the cooperation of state and local governments, is required to increase the effectiveness of prevention of invasions, detect and respond quickly to new potentially harmful invasions, control and slow the spread of existing invasions, and provide a national center to ensure that these efforts are coordinated and cost effective. Specifically, the Ecological Society of America recommends that the federal government take the following six actions: (1) Use new information and practices to better manage commercial and other pathways to reduce the transport and release of potentially harmful species; (2) Adopt more quantitative procedures for risk analysis and apply them to every species proposed for importation into the country; (3) Use new cost-effective diagnostic technologies to increase active surveillance and sharing of information about invasive species so that responses to new invasions can be more rapid and effective; (4) Create new legal authority and provide emergency funding to support rapid responses to emerging invasions; (5) Provide funding and incentives for cost-effective programs to slow the spread of existing invasive species in order to protect still uninvaded ecosystems, social and industrial infrastructure, and human welfare; and (6) Establish a National Center for Invasive Species Management (under the existing National Invasive Species Council) to coordinate and lead improvements in federal, state, and international policies on invasive species. Recent scientific and technical advances provide a sound basis for more cost-effective national responses to invasive species. Greater investments in improved technology and management practices would be more than repaid by reduced damages from current and future invasive species. The Ecological Society of America is committed to assist all levels of government and provide scientific advice to improve all aspects of invasive-species management.

Animals↗
PubMed2005

Individual active treatment combined with group exercise for acute and subacute low back pain.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To compare two fast-access evidence-based interventions for the treatment of simple low back pain. SUBJECTS: People aged 18-65 with a new episode of simple back pain causing them to be off work or on modified work for less than 1 year. SETTING: A district general hospital using a consultation/treatment room and a rehabilitation gym. METHODS: One group received a back advice booklet and one session of advice and then followed the normal route of care as directed by their general practitioner. The other group received the back booklet and one session of advice and also a back program. The back program consisted of a full assessment, immediately followed by one individual treatment, and then exercise classes over 1 to 2 weeks. OUTCOME MEASURES: (1) Rate of return to work, (2) pain scores and health status, and (3) cost effectiveness of interventions versus the financial cost to the individual or employer. RESULTS: On average, those receiving the individual treatment and group exercise took 7 days less off work. This represented a 35% reduction in the amount of time taken off work since study entry. The estimated cost saving of providing the extra service of a simple back program ranged between 250 pound (367 US dollars, 300 euro) and 578 pound (850 US dollars, 694 euro) for each patient. CONCLUSION: The results indicate that the costs of this active back program are more than reimbursed as a consequence of earlier return to work.

Absenteeism↗
PubMed2005

Assessing bone loss on radiographs of the knee in osteoarthritis: a cross-sectional study.

OBJECTIVE: The only established system to grade subchondral bone attrition in knee osteoarthritis (OA) has low interobserver reliability. In this study, our aim was to convert this system into a reliable tool for the assessment of subchondral bone loss in knee OA. METHODS: Templates that were designed to outline the normal contours of the knee were overlaid onto conventional radiographs of a random sample of 100 knees of OA patients who were awaiting total knee replacement (TKR). Seventy-five films from individuals with chronic knee pain who were not awaiting TKR and 75 films from asymptomatic control subjects were also assessed. Bone loss was graded from 0 (no attrition) to 3 (severe attrition of >10 mm); other established radiologic features were also graded. Spearman's rho was used to determine the correlation of attrition scores with other features, and logistic regression was used to explore whether definite bone attrition was associated with night pain. RESULTS: The inter- and intraobserver reliability values were high for attrition scores and for the presence of definite attrition (score > or =2). Bone attrition was evident in 62% of films from patients awaiting TKR, in 9% of films from individuals with chronic knee pain who were not awaiting TKR, and in 1% of films from controls. In all groups, the correlation between attrition and other features was weak to moderate. There was a nonsignificant association between definite bone attrition and night pain. CONCLUSION: Bone attrition is an additional dimension of knee OA that can be measured reliably. Definite attrition may be associated with night pain.

Aged↗
PubMed2005

Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurysmal subarachnoid hemorrhage: a matched controlled cohort study.

OBJECTIVE: Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), which exhibit beneficial cerebrovascular effects by modulating inflammation and nitric oxide production, have not been evaluated in acute aneurysmal subarachnoid hemorrhage (SAH) patients. The effect of prior statin use on 14-day functional outcome and on prevention of vasospasm-induced delayed cerebral ischemia (DCI) or stroke during hospitalization was analyzed. METHODS: We conducted a 1:2 matched (age, admission Hunt and Hess grade, vascular disease/risk history) cohort study of 20 SAH patients on statins and 40 SAH controls. The primary outcome was functional outcome at 14 days (Modified Lawton Physical Self-Maintenance Scale and Barthel Index scale scores). Secondary outcomes were 14-day mortality, Modified Rankin Scale score, DCI, DCI supported by angiography/transcranial Doppler [TCD], cerebral infarctions of any type, and TCD highest mean velocity elevation. RESULTS: Statin users demonstrated a significant protective effect on 14-day Barthel Index scale and Modified Lawton Physical Self-Maintenance Scale scores (77 +/- 10 versus 39 +/- 8, P = 0.003; 12 +/- 7 versus 19 +/- 9, P = 0.03, respectively). Moreover, statin users demonstrated a significantly lower incidence of DCI and DCI supported by angiography/TCD (10% versus 43%, P = 0.02; 5% versus 35%, P = 0.01, respectively), cerebral infarctions of any type (25% versus 63%, P = 0.01), and baseline-to-final TCD highest mean velocity change of 50 cm/s or greater (18% versus 51%, P = 0.03). CONCLUSION: SAH statin users demonstrated significant improvement in 14-day functional outcome, a significantly lower incidence of DCI and cerebral infarctions of any type, as well as prevention of TCD highest mean velocity elevation. However, we did not find a significant statin impact on mortality or global outcome (Modified Rankin Scale) in this small sample. This study provides clinical evidence for the potential therapeutic benefit of statins after acute SAH.

Adult↗