Detection of parametric changes in autoregressive fields

The quickest detection problem is formulated for processes defined on a two-dimensional lattice. Solutions are given when only the class of sequential probability ratio tests is considere

The treatment of soft-tissue defects of the lower leg after a traumatic open tibial fracture

The treatment of large soft-tissue defects of the lower leg remains a challenge. The timing of the operation, the most suitable type of tissue, and the decision between local or free flap coverage still remains under discussion. Fifty-two patients were treated with local or free flap coverage after a traumatic soft-tissue defect of the lower leg. We compared the results after treatment with local versus free flaps and fasciocutaneous flaps versus musculocutaneous flaps. In the case of primary reconstruction, we also compared the results regarding the timing of the operation: patients treated within 72 h after the trauma versus patients treated after 72 h. Thirty-five patients (67%) have been treated because of posttraumatic soft-tissue defects and, therefore, insufficient fracture coverage. Seventeen patients (33%) were treated because of a chronic osteomyelitis that arose after the trauma. In our study, we did not find a statistically significant difference between the postoperative complications of local and free flaps. A significant increase could be demonstrated in the number of revisions after treatment with a free flap. Treatment with a fasciocutaneous flap in the entire study group was associated with significantly more postoperative complications than treatment with a musculocutaneous flap. There was no significant difference in results after early or late flap coverage. Patients treated with local or free flaps achieved equal outcomes, except for the number of postoperative revisions in which local flaps required lesser revisions. Treatment with a musculocutaneous flap is preferable to treatment with a fasciocutaneous flap regarding postoperative complications. The timing of operation proved not to be a discriminating factor

Nurse's attunement to patients 'meaning in life. A qualitative study of experiences of Dutch adults ageing in place

Background Meaning in life (MiL) is considered to be an important part of health and is associated with many positive outcomes in older adults, such as quality of life and longevity. As health promotors, nurses may take patients’ MiL into account in the care process. There is a knowledge gap in terms of what constitutes good care in relation to older patients’ MiL, and what the benefits may be for patients when nursing is attuned to this aspect. The purpose of this study was to explore the experiences of home nursing older adults in relation to nurses’ attunement to MiL. Methods Gadamerian hermeneutic phenomenological design with semi-structured interviews. Participants were 24 aged home nursing patients. A framework of care ethical evaluation was used in the analysis. Multiple dialogues enhanced understanding. Results Patients did not expect nurses’ regard for their MiL. They rather expected ‘normal contact’ and adequate physical care. Nurses showed that they were open to patients’ MiL by being interested in the patient as a person and by being attentive to specific and hidden needs. Participants explained that the nurse’s behaviour upon arrival set the tone: they knew immediately if there was room for MiL or not. All participants had positive and negative experiences with nurses’ behaviour in relation to MiL. Valued nursing care included maintaining a long, kind and reciprocal relationship; doing what was needed; and skilled personalised care. Participants mentioned ‘special ones’: nurses who attuned to them in a special way and did more than expected. Benefits of care that was attuned to patients’ MiL were: experiencing a cheerful moment, feeling secure, feeling like a valuable person and having a good day. Older adults also stressed that consideration for MiL helps identify what is important in healthcare. Conclusion Aged homecare patients value nurses’ attunement to their MiL positively. Although patients regard MiL mostly as their own quest, nurses play a modest yet important role. Managers and educators should support nurses’ investment in reciprocal nurse-patient relationships

'Meaning in life? Make it as bearable , enjoyable and good as possible!' A qualitative study among community-dwelling aged adults who receive home nursing in the Netherlands

The population of adults ageing in place and using home‐care services is growing rapidly worldwide. Meaning in life (MiL) of this group of clients is relevant for healthcare and social workers. MiL is associated with many positive outcomes, but can be challenging for aged persons. Objective of this study was to explore MiL in daily life of community‐dwelling aged persons who receive homecare. A hermeneutic phenomenological approach was followed. Three waves of semi‐structured interviews took place among 24 clients of a home‐care organisation in the Netherlands between November 2015 and July 2018. Photo‐elicitation was part of the interview procedure. Interpretative Phenomenological Analysis and dialogues enhanced understanding. Findings show that participants derived meaning from self, others, environment and living. The process of retaining MiL involved maintaining, adapting and discovering. We conclude that community‐dwelling aged adults can draw MiL from many sources. Retaining MiL is interwoven in everyday life and requires continuous adaptation to ever‐changing life conditions during later life. Although relevant general themes were sketched in this paper, the importance of each, and the connections between them, vary and come to light at the individual level. The themes in this paper and the cases in the appendices provide insights that may help professionals recognise MiL in their work. Besides listening to the stories of aged adults, person‐centred interventions should support aged adult's strategy to retain MiL