Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
88
result(s) for
"Juul, Jesper"
Sort by:
The Art of Failure
A gaming academic offers a \"fascinating\" exploration of why we play video games--despite the unhappiness we feel when we fail at them ( Boston Globe ) We may think of video games as being \"fun,\" but in The Art of Failure , Jesper Juul claims that this is almost entirely mistaken.
eBook
Quantitative evaluation of patients’ digital capability evaluated in an emergency department setting: a cross-sectional study
ObjectivesThe main aim of the study was (1) to assess digital literacy among acutely admitted patients in an ED, (2) to provide quantitative data relating to the ‘inverse information law’. We hypothesised that a large proportion of acutely admitted patients are digitally incapable, and there is a link between age, frailty, hospital admittances and digital incapability.DesignThis study is a single-centre, cross-sectional, prospective case-controlled questionnaire study. Clinical Frailty Scale (CFS), gender and age were collected from the patients’ electronic medical reports. Information regarding smartphone usage, ability to access public mail/communication, educational level, living situation and number of admittances the last year were patient-reported bedside. Subsequently, ability to use a digital platform was tested.SettingA secondary care ED in Denmark, with a high level of broadband penetration, allows easy digital access.ParticipantsA total of 588 patients were assessed for eligibility, hereof 468 patients were included. Inclusion criteria were age above 18 years, admitted for treatment of an internal medicine or surgical problem, triaged non-emergent in a stable condition, informed oral and written consent.Main outcome measuresThe proportions of acutely admitted patients who were digitally capable versus incapable whether there is a link between age, frailty, hospital admittances and digital incapability.ResultsAmong patients included, 57% (n=265) had high digital literacy, while 43% (n=203) had low literacy Δ%=14. The high digital capability group was significantly younger by 23% (15.3, 20.5) p<0.001 and had lower CFS than the low digital capability group 2.3 versus 4.2 (1.7, 2.3) p<0.001. The low digital capability group had 1.6-fold more admittances the previous year (0.5, 1.2) p<0.001.ConclusionsThe proportion of digitally illiterate patients is high (43%), and they are older, frailer and have more hospital admittances and less high education than digitally literate patients. There is a significant digital divide that needs to be considered in health care.
Journal Article
Plasma neutrophil gelatinase-associated lipocalin as a single test rule out biomarker for acute kidney injury: A cross-sectional study in patients admitted to the emergency department
Acute kidney injury (AKI) is a syndrome with high mortality and morbidity in part due to delayed recognition based on changes in creatinine. A marker for AKI based on a single measurement is needed and therefore the performance of a single measurement of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict AKI in patients admitted to the emergency department was tested.
Samples from the Triage study which included 6005 consecutive adult patients admitted to the emergency department were tested for pNGAL. The optimal cutoff for pNGAL was determined by the AUC and compared to AKI based on creatinine using different estimations of the premorbid kidney function.
In 4833 patients, two or more plasma creatinine (pCr) measurements were available allowing the detection of AKI. The highest prevalence of AKI (10%) was found when defining AKI as an increase in pCr ≥26.5 μmol/L from the prior year's mean pCr. At these conditions the AUC for pNGAL to predict AKI was 85% giving an optimal cutoff of 142.5 ng/mL with a negative predictive value of 0.96, a positive predictive value of 0.35, a specificity of 0.87 and a sensitivity of 0.70.
The study illustrates that the value of a single measurement of pNGAL is primarily in excluding AKI whereas it`s poorer in predicting the presence of AKI. When diagnosing AKI with pCr the optimal baseline pCr level is the mean of available pCr (mb-pCr) measurements from up to a year prior to the current event.
Journal Article
A longitudinal prospective study investigating serial measurements of plasma neutrophil gelatinase-associated lipocalins (NGAL) for the prediction of chronic kidney disease and acute kidney injury in emergency department patients
Background and hypothesis
Acute kidney injury (AKI) and chronic kidney disease (CKD) are associated with high morbidity. Current diagnostic markers, e.g., creatinine (Cr) and estimated glomerular filtration rate (eGFR), lack precision in early kidney disease detection. Neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as a more sensitive biomarker for kidney injury. This study examined the effectiveness of plasma NGAL (pNGAL) as biomarker for CKD and AKI prediction in an emergency department (ED) setting and for predicting the presence of CKD and AKI in future admissions (readmission). The performance was compared to that of C-reactive protein (CRP).
Methods
A prospective longitudinal study was conducted at North Zealand University Hospital in Denmark, including 925 patients admitted to the ED. pNGAL and CRP were measured at admission, with follow-up pNGAL measurements for hospitalized patients. CKD and AKI were defined according to KDIGO guidelines. Receiver operating characteristic (ROC) analyses assessed the sensitivity, specificity, and predictive value of pNGAL and CRP, for AKI and CKD, at both admission and readmission.
Results and conclusion
pNGAL is useful for ruling out AKI and CKD, especially at admission, but its low PPV limit its diagnostic accuracy, particularly at readmission. It is more effective as a screening tool rather than a standalone diagnostic marker. Higher predictive performance was observed for pNGAL compared to CRP. For serial pNGAL measurements, CKD patients exhibited higher initial levels at admission, but these differences diminished by day four, with considerable variability observed thereafter.
Journal Article
Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel
Background
Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by employing a multifaceted approach consisting of systematically fast-tracking patients who are mostly not in need of a hospital stay as assessed by an initial nurse and treated by decision competent physicians.
Methods
Data from 120,901 patients registered in a secondary care ED from the 4t
th
quarter of 2021 to the 1st quarter of 2024 was drawn from the electronic health record’s data warehouse using the SAP Web Intelligence tool and processed in the Python programming language. Crowding was compared before and after ED transformation from a uniform department into a high flow (α) and a low flow (β) section with patient placement in gurneys/chairs or beds, respectively. Patients putatively not in need of hospitalization were identified by nurse, placed in in the α setting and assessed and treated by decision competent physicians. Incidence of crowding, number of patients admitted per day and readmittances within 72 h following ED admission before and after changes were determined. Values are number of patients, mean ± SEM and mean differences with 95% CIs. Statistical significance was ascertained using Student’s two tailed t-test for unpaired values.
Results
Before and after ED changes crowding of 130% amounted to 123.8 h and 19.3 h in the latter. This is a difference of -104.6 ± 23.9 h with a 95% CI of -159.9 to -49.3, Δ% -84 (
p
= 0.002).
There was the same amount of patients / day amounting to 135.8 and 133.5 patients / day Δ% = -1.7 patients 95% CI -6.3 to 1.6 (
p
= 0.21).
There was no change in readmittances within 72 h before and after changes amounting to 9.0% versus 9.5%, Δ% = 0.5, 95%, CI -0.007 to 1.0 (
p
> 0.052).
Conclusion
It appears feasible to abate crowding with unchanged patient admission and without an increase in readmittances by fast-track assessment and treatment of patients who are not in need of hospitalization.
Journal Article
Pulmonary artery pressure as a method for assessing hydration status in an anuric hemodialysis patient – a case report
Background
Setting the dry weight and maintaining fluid balance is still a difficult challenge in dialysis patients. Overhydration is common and associated with increased cardiac morbidity and mortality. Pulmonary hypertension is associated with volume overload in end-stage renal dysfunction patients. Thus, monitoring pulmonary pressure by a CardioMEMS device could potentially be of guidance to physicians in the difficult task of assessing fluid overload in hemodialysis patients.
Case presentation
61-year old male with known congestive heart failure deteriorated over 3 months’ time from a state with congestive heart failure and diuresis to a state of chronic kidney disease and anuria. He began a thrice/week in-hospital hemodialysis regime. As he already had implanted a CardioMEMS device due to his heart condition, we were able to monitor invasive pulmonary artery pressure during the course of dialysis sessions. To compare, we estimated overhydration by both bioimpedance and clinical assessment. Pulmonary artery pressure correlated closely with fluid drainage during dialysis and inter-dialytic weight gain. The patient reached prescribed dry weight but remained pulmonary hypertensive by definition. During two episodes of intradialytic systemic hypotension, the patient still had pulmonary hypertension by current definition.
Conclusion
This case report observes a close correlation between pulmonary artery pressure and fluid overload in a limited amount of observations. In this case we found pulmonary artery pressure to be more sensitive towards fluid overload than bioimpedance. The patient remained pulmonary hypertensive both as he reached prescribed dry weight and experienced intradialytic hypotensive symptoms. Monitoring pulmonary artery pressure via CardioMEMS could hold great potential as a real-time guidance for fluid balance during hemodialysis, though adjusted cut-off values for pulmonary pressure for anuric patients may be needed. Further studies are needed to confirm the findings of this case report and the applicability of pulmonary pressure in assessing optimal fluid balance.
Journal Article
A casual revolution : reinventing video games and their players
We used to think that video games were mostly for young men, but with the success of the Nintendo Wii, and the proliferation of games in browsers, cell phone games, and social games video games changed changed fundamentally in the years from 2000 to 2010. These new casual games are now played by men and women, young and old. Players need not possess an intimate knowledge of video game history or devote weeks or months to play. At the same time, many players of casual games show a dedication and skill that is anything but casual. In A Casual Revolution, Jesper Juul describes this as a reinvention of video games, and of our image of video game players, and explores what this tells us about the players, the games, and their interaction. With this reinvention of video games, the game industry reconnects with a general audience. Many of todays casual game players once enjoyed Pac-Man, Tetris, and other early games, only to drop out when video games became more time-consuming and complex. Juul shows that it is only by understanding what a game requires of players, what players bring to a game, how the game industry works, and how video games have developed historically that we can understand what makes video games fun and why we choose to play (or not to play) them. Summary reprinted by permission of MIT Press
eBook
Virtual Reality: Fictional all the Way Down (and that’s OK)
Are virtual objects real? I will claim that the question sets us up for the wrong type of conclusion: Chalmers (2017) argues that a virtual calculator (like other entities) is a real calculator when it is “organizationally invariant” with its non-virtual counterpart—when it performs calculation. However, virtual reality and games are defined by the fact that they always selectively implement their source material. Even the most detailed virtual car will still have an infinite range of details which are missing (gas, engines, pistons, fuel, chemical reactions, molecules, atoms). This means that even the most detailed virtual object will still have fictional aspects. Rather than argue that virtual objects are, or aren’t, real, it is preferable to think of overlaps and continuities between the fictional and the real, where even the most painstakingly detailed virtual reality implementation of a non-virtual object is still
: a human process of selection and interpretation. Virtual reality should therefore not be philosophically understood just as a technological implementation on a trajectory to perfection, but as a cultural artifact which derives its value in part from its simplification and difference from its source material.
Journal Article