Order Set Usage is Associated With Lower Hospital Mortality in Patients With Sepsis.

The Surviving Sepsis Campaign recommends standard operating procedures for patients with sepsis. Real-world evidence about sepsis order set implementation is limited. OBJECTIVES: To estimate the effect of sepsis order set usage on hospital mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Fifty-four acute care hospitals in the United States from December 1, 2020 to November 30, 2022 involving 104,662 patients hospitalized for sepsis. MAIN OUTCOMES AND MEASURES: Hospital mortality. RESULTS: The sepsis order set was used in 58,091 (55.5%) patients with sepsis. Initial mean sequential organ failure assessment score was 0.3 lower in patients for whom the order set was used than in those for whom it was not used (2.9 sd [2.8] vs 3.2 [3.1], p < 0.01). In bivariate analysis, hospital mortality was 6.3% lower in patients for whom the sepsis order set was used (9.7% vs 16.0%, p < 0.01), median time from emergency department triage to antibiotics was 54 minutes less (125 interquartile range [IQR, 68-221] vs 179 [98-379], p < 0.01), and median total time hypotensive was 2.1 hours less (5.5 IQR [2.0-15.0] vs 7.6 [2.5-21.8], p < 0.01) and septic shock was 3.2% less common (22.0% vs 25.4%, p < 0.01). Order set use was associated with 1.1 fewer median days of hospitalization (4.9 [2.8-9.0] vs 6.0 [3.2-12.1], p < 0.01), and 6.6% more patients discharged to home (61.4% vs 54.8%, p < 0.01). In the multivariable model, sepsis order set use was independently associated with lower hospital mortality (odds ratio 0.70; 95% CI, 0.66-0.73). CONCLUSIONS AND RELEVANCE: In a cohort of patients hospitalized with sepsis, order set use was independently associated with lower hospital mortality. Order sets can impact large-scale quality improvement efforts.

Mapping secondary data gaps for social simulation modelling: A case study of Syrian asylum migration to Europe.

Simulation models of social processes may require data that are not readily available, have low accuracy, are incomplete or biased. The paper presents a formal process for collating, assessing, selecting, and using secondary data as part of creating, validating, and documenting an agent-based simulation model of a complex social process, in this case, asylum migration to Europe. The process starts by creating an inventory of data sources, and the associated metadata, followed by assessing different aspects of data quality according to pre-defined criteria. As a result, based on the typology of available data, we are able to produce a thematic map of the area under study, and assess the uncertainty of key data sources, at least qualitatively. We illustrate the process by looking at the data on Syrian migration to Europe in 2011-21. In parallel, successive stages of the development of a simulation model allow for identifying key types of information which are needed as input into empirically grounded modelling analysis. Juxtaposing the available evidence and model requirements allows for identifying knowledge gaps that need filling, preferably by collecting additional primary data, or, failing that, by carrying out a sensitivity analysis for the assumptions made. By doing so, we offer a way of formalising the data collection process in the context of model-building endeavours, while allowing the modelling to be predominantly question-driven rather than purely data-driven. The paper concludes with recommendations with respect to data and evidence, both for modellers, as well as model users in practice-oriented applications.

We can study migration with computer simulation models. The data we need for that may not be available or be low quality. This paper is about how to use data in modelling. We suggest how to gather the data, check their quality, and use them in models. We show how to find out where we need more data, and how to gather them in an inventory. We use an example of migration from Syria to Europe to point to different problems. How much we know about the data can help us understand what we know and do not know about migration.

Preferences and intention of rural adolescents toward seeking help for mental health problems.

UNLABELLED: INTRODUCTION In Australia, rural adolescents still face barriers to obtaining professional psychological help due to poor availability and accessibility of services in rural areas when delay in seeking help for mental health problems can lead to poorer treatment outcomes. The aims of this study were to: investigate the preferences and intentions of rural Australian youth towards seeking help for mental health problems; determine predictors of help-seeking intention among rural adolescents; and verify results from previous qualitative research on the barriers to help-seeking in a rural context. METHOD: Participants were 201 adolescents recruited from 8 rural schools in the state of Victoria, Australia. Participants ranged in age from 11 to 18 years. Using the Accessibility and Remoteness Index of Australia (ARIA+), approximately 149 participants were classified as currently living in an inner regional area of Victoria, whereas 52 participants lived in an outer regional area. Participants completed an open-ended survey of help-seeking intention. RESULTS: Overall, 55.7% of the sample indicated that they would seek help for a mental health problem. The majority of participants, regardless of subgroup, indicated that they would seek help for a mental health problem from a school counsellor as their first choice. Gender differences were observed such that males had a higher preference for seeking help from a psychologist than females. Furthermore, older adolescents were more likely to prefer seeking help from a GP than younger participants. A multivariate analysis of help-seeking intentions revealed that ARIA was the only predictor of help-seeking intention; however, when extreme scores of depression and anxiety were also taken into account, these also predicted help-seeking intention. A content analysis of the barriers to help-seeking nominated by participants revealed that perceived limited availability of professional services in towns, perceived social proximity and fear of rural gossip, and difficulties associated with travelling to obtain help were the most significant concerns for these youth. CONCLUSIONS: These findings verify previous research on help-seeking among rural youth and reinforce that these young people face additional barriers to help-seeking by virtue of living in a rural environment. The availability of services for rural youth needs to be improved, as do young people's knowledge of service availability and access (especially travel options). It must be taken into account that rural adolescents of different ages and sex may differ in their help-seeking preferences. Finally, mental health promotion work with rural youth should consider the influence of rural culture on help-seeking intentions.

Australian rural adolescents' experiences of accessing psychological help for a mental health problem.

OBJECTIVE: This study aims to explore Australian rural adolescents' experiences of accessing help for a mental health problem in the context of their rural communities. DESIGN AND SETTING: A qualitative research design was used whereby university students who had sought help for a mental health problem during their adolescence were interviewed about their experiences. Interviews were conducted face-to-face at the university. MAIN OUTCOME MEASURES: A semi-structured interview schedule was designed around the study's main research questions. Audio-taped interviews were transcribed and thematically coded using a constant comparative method. PARTICIPANTS: Participants were first-year undergraduate psychology students between the ages of 17 and 21 years who sought help for a mental health issue during their adolescence and who at that time resided in a rural area. RESULTS: Participants highlighted various barriers to seeking help for mental health problems in the context of a rural community, including: social visibility, lack of anonymity, a culture of self-reliance, and social stigma of mental illness. Participants' access to help was primarily school-based, and participants expressed a preference for supportive counselling over structured interventions. Characteristics of school-based helpers that made them approachable included: 'caring', 'nonjudgemental', 'genuine', 'young', and able to maintain confidentiality. CONCLUSIONS: The findings support previous research that reveals barriers to help seeking for mental health problems that are unique to the culture of rural communities. The study raises questions about the merit of delivery of primary mental health care to young people via GPs alone and suggests that school-based counsellors be considered as the first step in a young person's access to mental health care.

The mydriatic effect of multiple doses of tropicamide.

PURPOSE: We investigated whether two drops of 0.5% tropicamide produced a wider pupillary dilation when compared with a single drop and saline control in subjects with dark-colored irides. METHODS: Twelve young adult subjects with dark irides and who were free from ocular disease participated in the study. One eye of each subject, selected at random, was designated as experimental and the fellow eye as control. A single drop of 0.5% tropicamide was instilled in the lower cul-de-sac of each eye in turn. Immediately after, a second drop of 0.5% tropicamide was instilled in the experimental eye and a single drop of unpreserved saline into the control eye. A double-masked experimental protocol was followed. Digital images of both pupils of each subject were taken at baseline (predrug instillation) and then every 5 minutes up to 30 minutes postdrug instillation and at 40, 50, and 60 minutes. The images were subsequently viewed on a PC monitor, and pupil size was measured using a calibrated millimeter scale. RESULTS: Pupil diameter increased as a function of time for both conditions reaching a maximum between 20 and 30 minutes after drop instillation. Pupil diameter was greater under the experimental condition compared with the control (analysis of variance p < 0.001). Pupil diameter reached at least 6 mm under both the experimental and control conditions. CONCLUSION: In young healthy subjects, compared with a single drop of tropicamide, two drops were associated with a greater degree of pupillary dilation on average over the 60-minute study period. However, the magnitude of the difference was small and not clinically significant. A single drop of tropicamide produced a pupillary diameter of at least 6 mm, which should be sufficient for the conduct of a thorough dilated fundus examination.