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The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia.
Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication.
Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues.
The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.
To assess the structure and quality of surveillance activities and to validate outcome detection in the Swiss national surgical site infection (SSI) surveillance program.
Countrywide survey of SSI surveillance quality.
147 hospitals or hospital units with surgical activities in Switzerland.
Site visits were conducted with on-site structured interviews and review of a random sample of 15 patient records per hospital: 10 from the entire data set and 5 from a subset of patients with originally reported infection. Process and structure were rated in 9 domains with a weighted overall validation score, and sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the identification of SSI.
Of 50 possible points, the median validation score was 35.5 (range, 16.25–48.5). Public hospitals (P<.001), hospitals in the Italian-speaking region of Switzerland (P=.021), and hospitals with longer participation in the surveillance (P=.018) had higher scores than others. Domains that contributed most to lower scores were quality of chart review and quality of data extraction. Of 49 infections, 15 (30.6%) had been overlooked in a random sample of 1,110 patient records, accounting for a sensitivity of 69.4% (95% confidence interval [CI], 54.6%–81.7%), a specificity of 99.9% (95% CI, 99.5%–100%), a positive predictive value of 97.1% (95% CI, 85.1%–99.9%), and a negative predictive value of 98.6% (95% CI, 97.7%–99.2%).
Irrespective of a well-defined surveillance methodology, there is a wide variation of SSI surveillance quality. The quality of chart review and the accuracy of data collection are the main areas for improvement.
To examine the incidence of central-line–associated bloodstream infection (CLABSI) over time and to determine risk factors for CLABSI in hospitalized children.
Prospective cohort study.
Pediatric tertiary care referral center in Halifax, Nova Scotia, serving a population of 2.3 million.
Patients ages 0–18 years with central venous catheters (CVCs) inserted at this facility between 1995 and 2013.
Participants were followed from CVC insertion to CLABSI event or until CVC removal. Data were prospectively collected by clinicians, infection prevention and control staff, and nursing staff for the purposes of patient care, surveillance, and quality improvement. Cox proportional hazards regression was used to identify risk factors for CLABSI.
Among 5,648 patients, 385 developed CLABSI (0.74 CLABSI per 1,000 line days; or 3.87 per 1,000 in-hospital line days). Most infections occurred within 60 days of insertion. CLABSI rates decreased from 4.87 per 1,000 in-hospital line days in 1995 to 0.78 per 1,000 in-hospital line days in 2013, corresponding to an 84% reduction. A temporal association of CLABSI reduction with a hand hygiene promotion campaign was identified. CVC type, number of lumens, dressing type, insertion vein, and being in the critical care unit were statistically significantly associated with CLABSI.
Hospital-wide surveillance over an 18-year period identified children at highest risk for CLABSI and decreasing risk over time; this decrease was temporally associated with a hand hygiene campaign.
Drug release from oral pharmaceutical formulations can be modified by applying a polymeric coating film with controlled mass transport properties. Interaction of the coating film with water may crucially influence its composition and permeability to both water and drug. Understanding this interaction between film microstructure, wetting, and mass transport is important for the development of new coatings. We present a novel method for controlled wetting of polymer coating films in an environmental scanning electron microscope, providing direct visual information about the processes occurring as the film goes from dry to wet. Free films made of phase-separated blends of water-insoluble ethyl cellulose (EC) and water-soluble hydroxypropyl cellulose (HPC) were used as a model system, and the blend ratio was varied to study the effect on the water transport properties. Local variations in water transport through the EC/HPC films were directly observed, enabling the immediate analysis of the structure–mass transport relationships. The leaching of HPC could be studied by evaporating water from the films in situ. Significant differences were observed between films of varying composition. The method provides a valuable complement to the current approach of making distinct diffusion and microscopy experiments for studying the dynamic interaction of polymer films with water.
The center of our Galaxy is home to a massive black hole, Sgr A*, and a nuclear star cluster containing stellar populations of various ages. While the late type stars may be too old to have retained memory of their initial orbital configuration, and hence formation mechanism, the kinematics of the early type stars should reflect their original distribution. In this contribution we present a new statistic which uses directly-observable kinematic stellar data to infer orbital parameters for stellar populations, and is capable of distinguishing between different origin scenarios. We use it on a population of B-stars in the Galactic center that extends out to large radii (∼0.5 pc) from the massive black hole. We find that the high K-magnitude population (≲15 M⊙) form an eccentric distribution, suggestive of a Hills binary-disruption origin.
With its emphasis on the dynasty's concern for control of the sea – both the Mediterranean and the Red Sea – and the Nile, this book offers a new and original perspective on Ptolemaic power in a key period of Hellenistic history. Within the developing Aegean empire of the Ptolemies, the role of the navy is examined together with that of its admirals. Egypt's close relationship to Rhodes is subjected to scrutiny, as is the constant threat of piracy to the transport of goods on the Nile and by sea. Along with the trade in grain came the exchange of other products. Ptolemaic kings used their wealth for luxury ships and the dissemination of royal portraiture was accompanied by royal cult. Alexandria, the new capital of Egypt, attracted poets, scholars and even philosophers; geographical exploration by sea was a feature of the period and observations of the time enjoyed a long afterlife.