Performed and missed nursing care in Swiss acute care hospitals: Conceptual considerations and psychometric evaluation of the German MISSCARE questionnaire

To have at hand a reliable and valid questionnaire to assess performed and missed nursing care in a Swiss acute care context.; Regular monitoring of performed and missed nursing care is crucial for nurse leaders to make evidence-based decisions. As foundation, we developed a conceptual definition. Based on this, we decided to translate and adapt the MISSCARE.; In this methodological study, our newly developed German MISSCARE and previously used BERNCA-R were tested in a pilot study using a quantitative crossover design in a sample of 1030 nurses and midwives in three Swiss acute care hospitals. Data were analyzed descriptively, then using exploratory factor analysis and Rasch modeling.; We obtained preliminary evidence that the German MISSCARE is sufficiently reliable and valid to measure performed and missed nursing care in our context but would benefit from structural adjustments. In contrast, the BERNCA-R proved insufficiently reliable for our purposes and context.; Our conceptual definition was essential for the development of the German MISSCARE. Our results support the decision to use this questionnaire.; The adapted German MISSCARE will allow both monitoring of performed and missed nursing care over time and benchmarking of hospitals

Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals : study protocol

With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs.Mit diesem Studienprotokoll wird ein Forschungsprogramm eingeführt. Dessen Ziel ist das Vorbereiten der Instrumente und das Durchführen des ersten Monitorings von Pflegekontextfaktoren an drei Universitäts- und zwei Kantonsspitälern in der Schweiz noch vor Einführung der DRG-basierten Finanzierung, sowie darauf aufbauend das Weiterentwickeln des theoretischen Modells und der dazu gehörenden Methodologie für zukünftige Monitorings nach Einführung der DRGs

Quantum Interference: From Kaons to Neutrinos (with Quantum Beats in between)

Using the vehicle of resolving an apparent paradox, a discussion of quantum interference is presented. The understanding of a number of different physical phenomena can be unified, in this context. These range from the neutral kaon system to massive neutrinos, not to mention quantum beats, Rydberg wave packets, and neutron gravity.Comment: 12 pages, LaTeX, 3 figure

Derivation and validation of a prediction model to establish nursing-sensitive quality benchmarks in medical inpatients : a secondary data analysis of a prospective cohort study

Background: Hospitals are using nursing-sensitive outcomes (NSOs) based on administrative data to measure and benchmark quality of nursing care in acute care wards. In order to facilitate comparisons between different hospitals and wards with heterogeneous patient populations, proper adjustment procedures are required. In this article, we first identify predictors for common NSOs in acute medical care of adult patients based on administrative data. We then develop and cross-validate an NSO-oriented prediction model. Methods: We used administrative data from seven hospitals in Switzerland to derive prediction models for each of the following NSO: hospital-acquired pressure ulcer (≥stage II), hospital-acquired urinary tract infection, non-ventilator hospital-acquired pneumonia and in-hospital mortality. We used a split dataset approach by performing a random 80:20 split of the data into a training set and a test set. We assessed discrimination of the models by area under the receiver operating characteristic curves. Finally, we used the validated models to establish a benchmark between the participating hospitals. Results: We considered 36,149 hospitalisations, of which 51.9% were male patients with a median age of 73 years (with an interquartile range of 59–82). Age and length of hospital stay were independently associated with all four NSOs. The derivation and validation models showed a good discrimination in the training (AUC range: 0.75–0.84) and in the test dataset (AUC range:0.77–0.81), respectively. Variation among different hospitals was relevant considering the risk for hospital-acquired pressure ulcer (≥ stage II) (adjusted Odds ratio [aOR] range: 0.51 [95% CI: 0.38–0.69] – 1.65 [95% CI:1.33–2.04]), the risk for hospital-acquired urinary tract infection infection (aOR range: 0.46 [95% CI: 0.36–0.58] – 1.45 [95% CI: 1.31–1.62]), the risk for non-ventilator hospital-acquired pneumonia (aOR range: 0.28 [95% CI: 0.09–0.89] – 2.87 [95% CI: 2.27–3.64]), and the risk for in-hospital mortality (aOR range: 0.45 [95% CI: 0.36–0.56] – 1.39 [95% CI: 1.23–1.60]). Conclusion: The application of risk adjustment when comparing nursing care quality is crucial and enables a more objective assessment across hospitals or wards with heterogeneous patient populations. This approach has potential to establish a set of benchmarks that could allow comparison of outcomes and quality of nursing care between different hospitals and wards

Assessing the impact of DRGs on patient care and professional practice in Switzerland (IDoC) : a potential model for monitoring and evaluating healthcare reform.

QUESTIONS UNDER STUDY: The starting point of the interdisciplinary project "Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice" (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an assessment. METHODS: Five sub-groups conducted separate but related research within the fields of biomedical ethics, law, nursing sciences and health services, applying a number of complementary methodological approaches. The individual research projects were framed within an overall ethical matrix. Workshops and bilateral meetings were held to identify and elaborate joint research themes. RESULTS: Four common, ethically relevant themes emerged in the results of the studies across sub-groups: (1.) the quality and safety of patient care, (2.) the state of professional practice of physicians and nurses, (3.) changes in incentives structure, (4.) vulnerable groups and access to healthcare services. Furthermore, much-needed data for future comparative research has been collected and some early insights into the potential impact of DRGs are outlined. CONCLUSIONS: Based on the joint results we developed preliminary recommendations related to conceptual analysis, methodological refinement, monitoring and implementation

Introducing a sensor to measure budburst and its environmental drivers

Budburst is a key adaptive trait that can help us understand how plants respond to a changing climate from the molecular to landscape scale. Despite this, acquisition of budburst data is constrained by a lack of information at the plant scale on the environmental stimuli associated with the release of bud dormancy. Additionally, to date, little effort has been devoted to phenotyping plants in natural populations due to the challenge of accounting for the effect of environmental variation. Nonetheless, natural selection operates on natural populations, and investigation of adaptive phenotypes in situ is warranted and can validate results from controlled laboratory experiments. To identify genomic effects on individual plant phenotypes in nature, environmental drivers must be concurrently measured, and characterized. Here, we designed and evaluated a sensor to meet these requirements for temperate woody plants. It was designed for use on a tree branch to measure the timing of budburst together with its key environmental drivers; temperature, and photoperiod. Specifically, we evaluated the sensor through independent corroboration with time-lapse photography and a suite of environmental sampling instruments.We also tested whether the presence of the device on a branch influenced the timing of budburst. Our results indicated the following: the temperatures measured by the budburst sensor’s digital thermometer closely approximated the temperatures measured using a thermocouple touching plant tissue; the photoperiod detector measured ambient light with the same accuracy as did time lapse photography; the budburst sensor accurately detected the timing of budburst; and the sensor itself did not influence the budburst timing of Populus clones. Among other potential applications, future use of the sensor may provide plant phenotyping at the landscape level for integration with landscape genomics.This is the publisher’s final pdf. The published article is copyrighted by the author(s) and published by the Frontiers Research Foundation. The published article can be found at: http://www.frontiersin.org/Plant_Science.Keywords: phenotyping, budburst, temperature, sensing, climate change, phenology, photoperiodKeywords: phenotyping, budburst, temperature, sensing, climate change, phenology, photoperio

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements