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We sought to assess the presence and reporting quality of peer-reviewed literature concerning the accuracy, precision, and reliability of home monitoring technologies for vital signs and glucose determinations in older adult populations.
A narrative literature review was undertaken searching the databases Medline, Embase, and Compendex. Peer-reviewed publications with keywords related to vital signs, monitoring devices and technologies, independent living, and older adults were searched. Publications between the years 2012 and 2018 were included. Two reviewers independently conducted title and abstract screening, and four reviewers independently undertook full-text screening and data extraction with all disagreements resolved through discussion and consensus.
Two hundred nine articles were included. Our review showed limited assessment and low-quality reporting of evidence concerning the accuracy, precision, and reliability of home monitoring technologies. Of 209 articles describing a relevant device, only 45 percent (n = 95) provided a citation or some evidence to support their validation claim. Of forty-eight articles that described the use of a comparator device, 65 percent (n = 31) used low-quality statistical methods, 23 percent (n = 11) used moderate-quality statistical methods, and only 12 percent (n = 6) used high-quality statistical methods.
Our review found that current validity claims were based on low-quality assessments that do not provide the necessary confidence needed by clinicians for medical decision-making purposes. This narrative review highlights the need for standardized health technology reporting to increase health practitioner confidence in these devices, support the appropriate adoption of such devices within the healthcare system, and improve health outcomes.
The goal of this study was to evaluate the ability of semantic (animal naming) and phonemic (FAS) fluency in their ability to discriminate between normal aging, amnestic-Mild Cognitive Impairment (a-MCI), and Alzheimer’s disease (AD).
We used binary logistic regressions, multinomial regressions, and discriminant analysis to evaluate the predictive value of semantic and phonemic fluency in regards to specific diagnostic classifications.
Outpatient geriatric neuropsychology clinic.
232 participants (normal aging = 99, a-MCI = 90, AD = 43; mean age = 65.75 years).
Mini-mental State Examination (MMSE), Controlled Oral Word Association Test
Results indicate that semantic and phonemic fluency were significant predictors of diagnostic classification, and semantic fluency explained a greater amount of the discriminant ability of the model.
These results suggest that verbal fluency, particularly semantic fluency, may be an accurate and efficient tool in screening for early dementia in time-limited medical settings.
Literature is lacking to guide standardised care and assessment practices for paediatric patients post cardiac catheterisation. In response to this gap, we sought to describe the current state of practice in cardiology programmes performing paediatric cardiac catheterisations procedures in the United States of America.
Materials and methods
A web-based survey was distributed to the Congenital Cardiovascular Interventional Study Consortium Listserv, with representation from 113 identified institutions. A 36-question survey, including fixed-choice and open-ended questions, was developed and piloted for reliability and validity before distribution. Data were summarised descriptively with count and frequency or median and range.
Of the 113 identified institutions, 52% (n=59) responded to the survey. Manual pressure is used to achieve haemostasis by 94.9% of the respondents. Pressure dressings are used by a majority of the facilities and the length of time for bed rest is variable, with the majority using 6 hours for arterial access and 4 hours for venous access. Predominantly, respondents use the time of haemostasis as the start time of bed rest while a third of respondents reported using the time the sheath was removed.
In this study, variation in a number of post catheterisation care and assessment practices for paediatric patients was noted across cardiology programmes. Information from this assessment identifies key opportunities to collaborate in developing standardised practices for the care and assessment of the paediatric patients post catheterisation.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Safety at work is a core issue for mental health staff working on
in-patient units. At present, there is a limited theoretical base
regarding which factors may affect staff perceptions of safety.
This study attempted to identify which factors affect perceived staff
safety working on in-patient mental health wards.
A cross-sectional design was employed across 101 forensic and
non-forensic mental health wards, over seven National Health Service
trusts nationally. Measures included an online staff survey, Ward
Features Checklist and recorded incident data. Data were analysed using
categorical principal components analysis and ordinal regression.
Perceptions of staff safety were increased by ward brightness, higher
number of patient beds, lower staff to patient ratios, less dayroom space
and more urban views.
The findings from this study do not represent common-sense assumptions.
Results are discussed in the context of the literature and may have
implications for current initiatives aimed at managing in-patient
violence and aggression.
Previous studies have illustrated pediatric knowledge deficits among Emergency Medical Services (EMS) providers. The purpose of this study was to identify perspectives of a diverse group of EMS providers regarding pediatric prehospital care educational deficits and proposed methods of training improvements.
Purposive sampling was used to recruit EMS providers in diverse settings for study participation. Two separate focus groups of EMS providers (administrative and non-administrative personnel) were held in three locations (urban, suburban, and rural). A professional moderator facilitated focus group discussion using a guide developed by the study team. A grounded theory approach was used to analyze data.
Forty-two participants provided data. Four major themes were identified: (1) suboptimal previous pediatric training and training gaps in continuing pediatric education; (2) opportunities for improved interactions with emergency department (ED) staff, including case-based feedback on patient care; (3) barriers to optimal pediatric prehospital care; and (4) proposed pediatric training improvements.
Focus groups identified four themes surrounding preparation of EMS personnel for providing care to pediatric patients. These themes can guide future educational interventions for EMS to improve pediatric prehospital care.
BrownSA, HaydenTC, RandellKA, RappaportL, StevensonMD, KimIK. Improving Pediatric Education for Emergency Medical Services Providers: A Qualitative Study. Prehosp Disaster Med. 2017;32(1):20–26.
The Principles of Legal Research (PLR) website of the University of Ottawa's Brian Dickson Law Library is a bilingual (English and French) online learning tool for all first year students in both Common Law and Civil Law.1 Law librarians use this e-learning website to facilitate teaching components such as student assignments and assessments. This user experience study aims to investigate law students’ real experience with the system. Their feedback will be used for future development planning as well as analysing user behaviour trends. The authors investigate the following aspects: accuracy of information, interface design, navigation system, Web 2.0, social media, and smartphone version.
The question of how modernity has influenced medievalism and how medievalism has influenced modernity is the theme of this volume. The opening essays examine the 2001 film Just Visiting's comments on modern anxieties via medievalism; conflations of modernity with both medievalism and the Middle Ages in rewriting sources; the emergence of modernity amid the post-World War I movement The MostNoble Order of Crusaders; António Sardinha's promotion of medievalism as an antidote to modernity; and Mercedes Rubio's medievalism in her feminist commentary on modernity. The eight subsequent articles build on this foundation while discussing remnants of medieval London amid its modern descendant; Michel Houellebecq's critique of medievalism through his 2011 novel La Carte et le territoire; historical authenticity in Michael Morrow's approach to performing medieval music; contemporary concerns in Ford Madox Brown and David Gentleman's murals; medieval Chester in Catherine A.M. Clarkeand Nayan Kulkarni's Hryre (2012); medieval influences on the formation of and debate about modern moral panics; medievalist considerations in modern repurposings of medieval anchorholds; andmedieval sources for Paddy Molloy's Here Be Dragons (2013). The articles thus test the essays' methods and conclusions, even as the essays offer fresh perspectives on the articles.
Karl Fugelso is Professor of Art History at Towson University in Baltimore, Maryland.
Contributors: Edward Breen, Katherine A. Brown, Catherine A.M. Clarke, Louise D'Arcens, Joshua Davies, John Lance Griffith, Mike Horswell, Pedro Martins, Paddy Molloy, Lisa Nalbone, Sarah Salih, Michelle M. Sauer, James L. Smith
We present Faint Object Camera (FOC) ultraviolet images of the central 14 x 14″ of Messier 31 and Messier 32. The hot stellar population detected in the composite UV spectra of these galaxies is partially resolved into stars, and we measure their colors and apparent magnitudes. We detect 433 stars in M31 and 138 stars in M32, down to limits of mF275W = 25.5 mag and mF175W = 24.5 mag. We investigate the luminosity functions of the sources, their spatial distribution, their color-magnitude diagrams, and their total integrated far-UV flux. Although M32 has a weaker UV upturn than M31, the luminosity functions and color-magnitude diagrams of M31 and M32 are surprisingly similar, and are inconsistent with a majority contribution from any of the following: post-AGB stars more massive than 0.56 M⊙, main sequence stars, or blue stragglers. The luminosity functions and color-magnitude diagrams are consistent with a dominant population of stars evolving from the extreme horizontal branch (EHB) along tracks of mass 0.47–0.53 M⊙. These stars are well below the detection limits of our images while on the zero-age EHB, but become detectable while in the more luminous (but shorter) post-HB phases. Our observations require that only a very small fraction of the main sequence population (2% in M31 and 0.5% in M32) in these two galaxies evolve though the EHB and post-EHB phases, with the remainder rapidly evolving through bright post-AGB evolution with few resolved stars expected in the small field of view covered by the FOC.