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  1. Article ; Online: Readers' negative or neutral responses to the webcast video editorial entitled "how to prevent the obese from becoming 'obeser'--stop eating".

    Emerson, Mary

    MedGenMed : Medscape general medicine

    2005  Volume 7, Issue 1, Page(s) 41

    MeSH term(s) Disease Progression ; Humans ; Obesity/diet therapy ; Obesity/physiopathology ; Weight Gain
    Language English
    Publishing date 2005
    Publishing country United States
    Document type Comment ; Letter
    ISSN 1531-0132
    ISSN (online) 1531-0132
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Book: Greek sanctuaries

    Emerson, Mary

    an introduction

    2007  

    Author's details Mary Emerson
    Language English
    Size XI, 172 S.
    Publisher Bristol Classical Press
    Publishing place Bedminster
    Document type Book
    ISBN 1853996890 ; 9781853996894
    Database Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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  3. Article ; Online: Implementation of a Digitally Enabled Care Pathway (Part 2): Qualitative Analysis of Experiences of Health Care Professionals.

    Connell, Alistair / Black, Georgia / Montgomery, Hugh / Martin, Peter / Nightingale, Claire / King, Dominic / Karthikesalingam, Alan / Hughes, Cían / Back, Trevor / Ayoub, Kareem / Suleyman, Mustafa / Jones, Gareth / Cross, Jennifer / Stanley, Sarah / Emerson, Mary / Merrick, Charles / Rees, Geraint / Laing, Christopher / Raine, Rosalind

    Journal of medical Internet research

    2019  Volume 21, Issue 7, Page(s) e13143

    Abstract: Background: One reason for the introduction of digital technologies into health care has been to try to improve safety and patient outcomes by providing real-time access to patient data and enhancing communication among health care professionals. ... ...

    Abstract Background: One reason for the introduction of digital technologies into health care has been to try to improve safety and patient outcomes by providing real-time access to patient data and enhancing communication among health care professionals. However, the adoption of such technologies into clinical pathways has been less examined, and the impacts on users and the broader health system are poorly understood. We sought to address this by studying the impacts of introducing a digitally enabled care pathway for patients with acute kidney injury (AKI) at a tertiary referral hospital in the United Kingdom. A dedicated clinical response team-comprising existing nephrology and patient-at-risk and resuscitation teams-received AKI alerts in real time via Streams, a mobile app. Here, we present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the care pathway.
    Objective: The aim of this study was to qualitatively evaluate the impact of mobile results viewing and automated alerting as part of a digitally enabled care pathway on the working practices of users and their interprofessional relationships.
    Methods: A total of 19 semistructured interviews were conducted with members of the AKI response team and clinicians with whom they interacted across the hospital. Interviews were analyzed using inductive and deductive thematic analysis.
    Results: The digitally enabled care pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end-of-life care due to the earlier detection and alerting of deterioration. However, the shift toward early detection also highlighted resource constraints and some clinical uncertainty about the value of intervening at this stage. The real-time availability of information altered communication flows within and between clinical teams and across professional groups.
    Conclusions: Digital technologies allow early detection of adverse events and of patients at risk of deterioration, with the potential to improve outcomes. They may also increase the efficiency of health care professionals' working practices. However, when planning and implementing digital information innovations in health care, the following factors should also be considered: the provision of clinical training to effectively manage early detection, resources to cope with additional workload, support to manage perceived information overload, and the optimization of algorithms to minimize unnecessary alerts.
    MeSH term(s) Female ; Health Personnel/psychology ; Humans ; Male ; Qualitative Research ; Telemedicine/methods
    Language English
    Publishing date 2019-07-15
    Publishing country Canada
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/13143
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions.

    Connell, Alistair / Montgomery, Hugh / Martin, Peter / Nightingale, Claire / Sadeghi-Alavijeh, Omid / King, Dominic / Karthikesalingam, Alan / Hughes, Cian / Back, Trevor / Ayoub, Kareem / Suleyman, Mustafa / Jones, Gareth / Cross, Jennifer / Stanley, Sarah / Emerson, Mary / Merrick, Charles / Rees, Geraint / Laing, Chris / Raine, Rosalind

    NPJ digital medicine

    2019  Volume 2, Page(s) 67

    Abstract: We developed a digitally enabled care pathway for acute kidney injury (AKI) management incorporating a mobile detection application, specialist clinical response team and care protocol. Clinical outcome data were collected from adults with AKI on ... ...

    Abstract We developed a digitally enabled care pathway for acute kidney injury (AKI) management incorporating a mobile detection application, specialist clinical response team and care protocol. Clinical outcome data were collected from adults with AKI on emergency admission before (May 2016 to January 2017) and after (May to September 2017) deployment at the intervention site and another not receiving the intervention. Changes in primary outcome (serum creatinine recovery to ≤120% baseline at hospital discharge) and secondary outcomes (30-day survival, renal replacement therapy, renal or intensive care unit (ICU) admission, worsening AKI stage and length of stay) were measured using interrupted time-series regression. Processes of care data (time to AKI recognition, time to treatment) were extracted from casenotes, and compared over two 9-month periods before and after implementation (January to September 2016 and 2017, respectively) using pre-post analysis. There was no step change in renal recovery or any of the secondary outcomes. Trends for creatinine recovery rates (estimated odds ratio (OR) = 1.04, 95% confidence interval (95% CI): 1.00-1.08,
    Language English
    Publishing date 2019-07-31
    Publishing country England
    Document type Journal Article
    ISSN 2398-6352
    ISSN (online) 2398-6352
    DOI 10.1038/s41746-019-0100-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs.

    Connell, Alistair / Raine, Rosalind / Martin, Peter / Barbosa, Estela Capelas / Morris, Stephen / Nightingale, Claire / Sadeghi-Alavijeh, Omid / King, Dominic / Karthikesalingam, Alan / Hughes, Cían / Back, Trevor / Ayoub, Kareem / Suleyman, Mustafa / Jones, Gareth / Cross, Jennifer / Stanley, Sarah / Emerson, Mary / Merrick, Charles / Rees, Geraint /
    Montgomery, Hugh / Laing, Christopher

    Journal of medical Internet research

    2019  Volume 21, Issue 7, Page(s) e13147

    Abstract: Background: The development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because ... ...

    Abstract Background: The development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response.
    Objective: We sought to test this hypothesis by evaluating the impact of a digitally enabled intervention on clinical outcomes and health care costs associated with AKI in hospitalized patients.
    Methods: We developed a care pathway comprising automated AKI detection, mobile clinician notification, in-app triage, and a protocolized specialist clinical response. We evaluated its impact by comparing data from pre- and postimplementation phases (May 2016 to January 2017 and May to September 2017, respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analyzed using segmented regression analysis. The primary outcome was recovery of renal function to ≤120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert, progression of AKI stage, transfer to renal/intensive care units, hospital re-admission within 30 days of discharge, dependence on renal replacement therapy 30 days after discharge, and hospital-wide cardiac arrest rate. Time taken for specialist review of AKI alerts was measured. Impact on health care costs as defined by Patient-Level Information and Costing System data was evaluated using difference-in-differences (DID) analysis.
    Results: The median time to AKI alert review by a specialist was 14.0 min (interquartile range 1.0-60.0 min). There was no impact on the primary outcome (estimated odds ratio [OR] 1.00, 95% CI 0.58-1.71; P=.99). Although the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR 0.55, 95% CI 0.38-0.76; P<.001), DID analysis with the comparator site was not significant (OR 1.13, 95% CI 0.63-1.99; P=.69). There was no impact on other secondary clinical outcomes. Mean health care costs per patient were reduced by £2123 (95% CI -£4024 to -£222; P=.03), not including costs of providing the technology.
    Conclusions: The digitally enabled clinical intervention to detect and treat AKI in hospitalized patients reduced health care costs and possibly reduced cardiac arrest rates. Its impact on other clinical outcomes and identification of the active components of the pathway requires clarification through evaluation across multiple sites.
    MeSH term(s) Delivery of Health Care/economics ; Female ; Humans ; Male ; Telemedicine/methods ; Treatment Outcome
    Language English
    Publishing date 2019-07-15
    Publishing country Canada
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1438-8871
    ISSN (online) 1438-8871
    ISSN 1438-8871
    DOI 10.2196/13147
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Service evaluation of the implementation of a digitally-enabled care pathway for the recognition and management of acute kidney injury.

    Connell, Alistair / Montgomery, Hugh / Morris, Stephen / Nightingale, Claire / Stanley, Sarah / Emerson, Mary / Jones, Gareth / Sadeghi-Alavijeh, Omid / Merrick, Charles / King, Dominic / Karthikesalingam, Alan / Hughes, Cian / Ledsam, Joseph / Back, Trevor / Rees, Geraint / Raine, Rosalind / Laing, Christopher

    F1000Research

    2017  Volume 6, Page(s) 1033

    Abstract: Acute Kidney Injury (AKI), an abrupt deterioration in kidney function, is defined by changes in urine output or serum creatinine. AKI is common (affecting up to 20% of acute hospital admissions in the United Kingdom), associated with significant ... ...

    Abstract Acute Kidney Injury (AKI), an abrupt deterioration in kidney function, is defined by changes in urine output or serum creatinine. AKI is common (affecting up to 20% of acute hospital admissions in the United Kingdom), associated with significant morbidity and mortality, and expensive (excess costs to the National Health Service in England alone may exceed £1 billion per year). NHS England has mandated the implementation of an automated algorithm to detect AKI based on changes in serum creatinine, and to alert clinicians. It is uncertain, however, whether 'alerting' alone improves care quality. We have thus developed a digitally-enabled care pathway as a clinical service to inpatients in the Royal Free Hospital (RFH), a large London hospital. This pathway incorporates a mobile software application - the "Streams-AKI" app, developed by DeepMind Health - that applies the NHS AKI algorithm to routinely collected serum creatinine data in hospital inpatients. Streams-AKI alerts clinicians to potential AKI cases, furnishing them with a trend view of kidney function alongside other relevant data, in real-time, on a mobile device. A clinical response team comprising nephrologists and critical care nurses responds to these AKI alerts by reviewing individual patients and administering interventions according to existing clinical practice guidelines. We propose a mixed methods service evaluation of the implementation of this care pathway. This evaluation will assess how the care pathway meets the health and care needs of service users (RFH inpatients), in terms of clinical outcome, processes of care, and NHS costs. It will also seek to assess acceptance of the pathway by members of the response team and wider hospital community. All analyses will be undertaken by the service evaluation team from UCL (Department of Applied Health Research) and St George's, University of London (Population Health Research Institute).
    Language English
    Publishing date 2017
    Publishing country England
    Document type Journal Article
    ZDB-ID 2699932-8
    ISSN 2046-1402
    ISSN 2046-1402
    DOI 10.12688/f1000research.11637.2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Book ; Conference proceedings: Thermal movements of concrete bridges

    Emerson, Mary

    field measurements and methods of prediction ; the text of a paper presented at a World Congress on Joint Sealing and Bearing Systems for Concrete Structures

    (TRRL supplementary report ; 747)

    1982  

    Event/congress World Congress on Joint Sealing and Bearing Systems for Concrete Structures (1981.09.28-10.02, NiagaraFallsNewYorkState)
    Author's details by Mary Emerson
    Series title TRRL supplementary report ; 747
    Size I, 27 S, graph. Darst
    Publisher Structures Department, Transport and Road Research Laboratory#
    Publishing place Crowthorne
    Document type Book ; Conference proceedings
    Database Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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  8. Book: Steel box bridge temperatures in Australia and the United Kingdom

    Emerson, Mary

    (TRRL supplementary report ; 611)

    1980  

    Author's details by Mary Emerson
    Series title TRRL supplementary report ; 611
    Language English
    Size 26 S., graph. Darst.
    Publisher Transport and Road Research Laboratory
    Publishing place Crowthorne, Berkshire
    Document type Book
    Database Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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  9. Book: Temperatures in bridges during the cold winter of 1978/1979

    Emerson, Mary

    (TRRL laboratory report ; 926)

    1980  

    Author's details by Mary Emerson
    Series title TRRL laboratory report ; 926
    Language English
    Size 31 S., Ill., graph. Darst.
    Publisher Structures Dep., Transport and Road Research Laboratory
    Publishing place Crowthorne
    Document type Book
    Database Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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  10. Book: Bridge temperatures for setting bearings and expansion joints

    Emerson, Mary

    (TRRL supplementary report ; 479)

    1979  

    Author's details by Mary Emerson
    Series title TRRL supplementary report ; 479
    Language English
    Size 18 S., graph. Darst.
    Publisher Transport and Road Research Laboratory
    Publishing place Crowthorne, Berkshire
    Document type Book
    Database Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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