Publications by authors named "C Joyce"

741 Publications

Assessment of Interpretation Modality and Patient Comprehension in Spanish-speaking Limited English Proficiency (LEP) Patients Presenting to the Emergency Department.

J Health Care Poor Underserved 2021 ;32(4):2143-2153

Background: Provider-patient language discrepancies with limited English proficiency (LEP) patients can lead to misunderstandings about diagnoses and follow-up care.

Objectives: To assess interpretation modalities used in the emergency department (ED) in terms of patient satisfaction and understanding of discharge diagnosis.

Methods: Spanish-speaking LEP patients completed a survey assessing overall satisfaction and discharge diagnosis comprehension. Modalities included in-person (interpreter or physician/nurse), remote (phone or video), or combination. Differences in proportions with correctly identified diagnoses were compared by modality using Fisher's exact test.

Results: Patients preferred a Spanish-speaking staff member (52%) or in-person interpreter (33%) over other modalities. Almost 74% of surveyed patients accurately described their discharge diagnosis. Diagnostic accuracy was increased among patients using remote modalities alone compared with in-person alone or combination (p=.02).

Conclusion: Taking into account patient preferences and diagnostic accuracy, this study suggests the utility of having different interpreter modalities available for Spanish-speaking LEP ED patients.
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http://dx.doi.org/10.1353/hpu.2021.0187DOI Listing
January 2021

What Determines the Arterial Partial Pressure of Carbon Dioxide on Venovenous Extracorporeal Membrane Oxygenation?

ASAIO J 2021 Nov 17. Epub 2021 Nov 17.

From the Department of Intensive Care, Princess Alexandra Hospital, Brisbane, Queensland, Australia University of Queensland, Brisbane, Queensland, Australia Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia Monash University, Melbourne, Victoria, Australia Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom Department of Adult Intensive Care, Royal Brompton and Harefield NHS foundation trust, London, United Kingdom Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia Queensland University of Technology, Brisbane, Queensland, Australia.

Rapid reductions in PaCO2 during extracorporeal membrane oxygenation (ECMO) are associated with poor neurologic outcomes. Understanding what factors determine PaCO2 may allow a gradual reduction, potentially improving neurologic outcome. A simple and intuitive arithmetic expression was developed, to describe the interactions between the major factors determining PaCO2 during venovenous ECMO. This expression was tested using a wide range of input parameters from clinically feasible scenarios. The difference between PaCO2 predicted by the arithmetic equation and PaCO2 predicted by a more robust and complex in-silico mathematical model, was <10 mm Hg for more than 95% of the scenarios tested. With no CO2 in the sweep gas, PaCO2 is proportional to metabolic CO2 production and inversely proportional to the "total effective expired ventilation" (sum of alveolar ventilation and oxygenator ventilation). Extracorporeal blood flow has a small effect on PaCO2, which becomes more important at low blood flows and high recirculation fractions. With CO2 in the sweep gas, the increase in PaCO2 is proportional to the concentration of CO2 administered. PaCO2 also depends on the fraction of the total effective expired ventilation provided via the oxygenator. This relationship offers a simple intervention to control PaCO2 using titration of CO2 in the sweep gas.
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http://dx.doi.org/10.1097/MAT.0000000000001604DOI Listing
November 2021

"I'm still here, but no one hears you": a qualitative study of young women's experiences of persistent distress post family-based treatment for adolescent anorexia nervosa.

J Eat Disord 2021 Nov 12;9(1):151. Epub 2021 Nov 12.

Chair of Mental Health, School of Medicine, Translational Health Research Institute, Western Sydney University, Penrith, Australia.

Background: Family-based treatment (FBT) is the current treatment of choice for adolescent AN based on positive outcomes that include weight restoration in around two-thirds of adolescents. Nevertheless around a quarter drop-out from treatment, particularly in the earlier phases, and a notable proportion of treated adolescents are reported to experience ongoing psychological distress during and post-treatment. This study explores the under-researched experiences of these adolescents.

Method: Fourteen participants from Australia, New Zealand and the United Kingdom were interviewed about their experiences of FBT. An inductive thematic analysis of interview transcript data generated key themes related to their experiences, identity negotiations and the discursive materials these used to construct these.

Results: The participants identified working as a family unit as key to their recovery, highlighting the importance of family therapy interventions for adolescent AN. However, they perceived an almost exclusive focus on weight restoration in the first phase of FBT was associated with experiences that included a relative neglect of their psychological distress and a loss of voice. Key within these experiences were processes whereby the adolescent engaged in identity negotiation and (re)claiming of their voice and implicit in their family standing with them in the treatment was that their life was worth saving. What was noted as most helpful was when therapists advocated and took into consideration their unique needs and preferences and tailored treatment interventions to these.

Conclusions: There is a need to develop and research treatments that address, from the outset of treatment, the adolescents' psychological distress (including as experienced in the context of their weight restoration). This should be with priority accorded to the adolescent's voice and identity negotiations, as they and their families take steps to address the physical crisis of AN and in doing so, support more holistic and durable recovery.
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http://dx.doi.org/10.1186/s40337-021-00496-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8588656PMC
November 2021

Emerging Cybersecurity Threats in Radiation Oncology.

Adv Radiat Oncol 2021 Nov-Dec;6(6):100796. Epub 2021 Sep 20.

Division of Radiation Oncology, University of Tennessee Medical Center, Knoxville, Tennessee.

Purpose: Modern image guided radiation therapy is dependent on information technology and data storage applications that, like any other digital technology, are at risk from cyberattacks. Owing to a recent escalation in cyberattacks affecting radiation therapy treatments, the American Society for Radiation Oncology's is inaugurating a new special manuscript category devoted to cybersecurity issues.

Methods And Materials: We conducted a review of emerging cybersecurity threats and a literature review of cyberattacks that affected radiation oncology practices.

Results: In the last 10 years, numerous attacks have led to an interruption of radiation therapy for thousands of patients, and some of these catastrophic incidents have been described as being worse than the coronavirus disease of 2019 impact on centers in New Zealand.

Conclusions: Cybersecurity threats continue to evolve, making combatting these attacks more difficult for health care organizations and requiring a change in strategies, tactics, and culture around cyber security in health and radiation oncology. We recommend an assume breach mentality (threat-informed defense posture) and adopting a cloud-first and zero-trust security strategy. A reliance on computer-driven technology makes radiation oncology practices more vulnerable to cyberattacks. Health care providers should increase their resilience and cyber security maturity. The increase in the diversity of these attacks demands improved preparedness and collaboration between oncologic treatment centers both nationwide and internationally to protect patients.
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http://dx.doi.org/10.1016/j.adro.2021.100796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555435PMC
September 2021

Reliability and Minimal Detectable Change of Sprint Times and Force-Velocity-Power Characteristics.

J Strength Cond Res 2021 Oct 27. Epub 2021 Oct 27.

School of Health Sciences, The University of Notre Dame Australia, Fremantle, Australia; Department of Health and Biostatistics, Swinburne University of Technology, Melbourne, Australia; Center for Exercise and Sport Science Research, Edith Cowan University, Perth, Australia; and Sport, Exercise, and Physiotherapy, University of Salford, Salford, Greater Manchester, United Kingdom.

Abstract: Edwards, T, Banyard, HG, Piggott, B, Haff, GG, and Joyce, C. The reliability and minimal detectable change of sprint times and force-velocity-power characteristics. J Strength Cond Res XX(X): 000-000, 2021-Research has not yet provided critical information for practitioners to determine the minimal detectable change (MDC) in sprint times or force-velocity-power characteristics. Therefore, the aim of this study was to establish the interday reliability and MDC of sprint times and sprint force-velocity-power characteristics in junior Australian football (AF) players. Seventeen players were assessed using a radar device that recorded instantaneous velocity during 3 maximal 30-m sprint accelerations performed on 2 nonconsecutive days. Sprint force, velocity, and power characteristics were derived through inverse dynamics applied to the raw velocity-time data. Relative and absolute reliability was determined by calculating the intraclass correlation coefficient (ICC), coefficient of variation (CV), and MDC. Data analysis was assessed for (a) the first trial, (b) the best trial (the fastest 30-m split time), (c) the average of the first 2 trials, and (d) the average of all 3 trials from each testing session. The main findings were (a) absolute theoretical maximum force (F0), theoretical maximal velocity (V0), absolute and relative maximum power (Pmax), maximum ratio of force (RFmax), maximum velocity (Vmax), and all sprint distance times (5-30 m) displayed acceptable reliability (CV < 10% and ICC >0.75) and 2) the average of 2 and 3 trials was the best method of establishing reliable sprint times and force-velocity-power characteristics between sessions. This study provides important information for practitioners to determine the MDC in sprint times and force-velocity-power characteristics that allow coaches to identify true changes in performance.
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http://dx.doi.org/10.1519/JSC.0000000000004161DOI Listing
October 2021
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