Addressing Anxiety in Hospitalized Adults Using a Music Intervention

Practice Problem: The practice problem is anxiety related to hospitalization among adults in an acute care setting. Increased anxiety can lead to other issues while hospitalized including disruptive behaviors. PICOT: The PICOT question that guided this project was: In hospitalized medical-surgical adults (P), how does the implementation of a music intervention as an adjunct to standard distraction techniques (I) compared to standard care (C) affect symptoms of anxiety as observed by the rate of behavior de-escalation team calls (O) within eight weeks (T)? Evidence: There were five systematic reviews, four systematic reviews with meta-analysis with high level of evidence, high quality rating, and high quantity of articles included emerged that led to the project. Evidence supported the use of a music intervention for therapeutic distraction and reduction of anxiety. Intervention: The intervention was a music intervention of a personalized music selection for approximately 30 minutes prior to procedures or when anxiety or disruptive behavior was noted in addition to standard care. Outcome: Music intervention use increased by 68 individual sessions during the intervention period from baseline. Utilization of the de-escalation team decreased 80% from the preceding 10 weeks prior to implementation. Data collection difficulties reduced observation of knowledge change, however, activities related to the intervention increased during the intervention period. Conclusion: The use of music as an intervention to decreasing anxiety and the use of a de-escalation team for disruptive behavior was successful though the process outcomes were not met. Staff engagement will be key in making this a sustainable practice and additional interventions for staff engagement are necessary

On the Klein-Gordon equation and hyperbolic pseudoanalytic function theory

Elliptic pseudoanalytic function theory was considered independently by Bers and Vekua decades ago. In this paper we develop a hyperbolic analogue of pseudoanalytic function theory using the algebra of hyperbolic numbers. We consider the Klein-Gordon equation with a potential. With the aid of one particular solution we factorize the Klein-Gordon operator in terms of two Vekua-type operators. We show that real parts of the solutions of one of these Vekua-type operators are solutions of the considered Klein-Gordon equation. Using hyperbolic pseudoanalytic function theory, we then obtain explicit construction of infinite systems of solutions of the Klein-Gordon equation with potential. Finally, we give some examples of application of the proposed procedure

How to improve drug dosing for patients with renal impairment in primary care - a cluster-randomized controlled trial

Background: Patients with chronic kidney disease (CKD) are at increased risk for inappropriate or potentially harmful prescribing. The aim of this study was to examine whether a multifaceted intervention including the use of a software programme for the estimation of creatinine clearance and recommendation of individual dosage requirements may improve correct dosage adjustment of relevant medications for patients with CKD in primary care. Methods: A cluster-randomized controlled trial was conducted between January and December 2007 in small primary care practices in Germany. Practices were randomly allocated to intervention or control groups. In each practice, we included patients with known CKD and elderly patients (>=70 years) suffering from hypertension. The practices in the intervention group received interactive training and were provided a software programme to assist with individual dose adjustment. The control group performed usual care. Data were collected at baseline and at 6 months. The outcome measures, analyzed across individual patients, included prescriptions exceeding recommended maximum daily doses, with the primary outcome being prescriptions exceeding recommended standard daily doses by 30% or more. Results: Data from 44 general practitioners and 404 patients are included. The intervention was effective in reducing prescriptions exceeding the maximum daily dose per patients, with a trend in reducing prescriptions exceeding the standard daily dose by more than 30%. Conclusions: A multifaceted intervention including the use of a software program effectively reduced inappropriately high doses of renally excreted medications in patients with CKD in the setting of small primary care practices

Compilation of a Database of Research Information on Legume Based Grazing Systems; a Part of the Leggraze Research Project

The establishment of a publicly accessible web-resident database of published and current European research on agronomy, animal production and environmental impact of legume based grazing systems is reported. This database facilitates the sharing of information among the partners of the Low input animal production based on forage legumes for grazing systems (Leggraze), a research project funded by the UE (QL K5 CT-2001-02328). It also forms an important tool for transferring the results of the project to the wider research community and to end users in the agricultural sector and to policy makers at national and community level

Der Medication Appropriateness Index (MAI) als Zielgröße für komplexe Interventionen: erste Erfahrungen aus der PRIMUM-Pilotstudie (BMBF-Förderkennzeichen: 01GK0702)

Meeting Abstract : 10. Deutscher Kongress für Versorgungsforschung, 18. GAA-Jahrestagung. Deutsches Netzwerk Versorgungsforschung e. V. ; Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e. V. 20.-22.10.2011, Köln Hintergrund: Multimedikation als Folge von Multimorbidität ist ein zentrales Problem der Hausarztpraxis und erhöht das Risiko für unangemessene Arzneimittel-Verordnungen (VO). Um die Medikation bei älteren, multimorbiden Patienten zu optimieren und zu priorisieren, wurde eine computergestützte, durch Medizinische Fachangestellte (MFA) assistierte, komplexe Intervention (checklistengestütztes Vorbereitungsgespräch sowie Überprüfung eingenommener Medikamente durch MFA, Einsatz des web-basierten ArzneimittelinformationsDienstes AiD, spezifisches Arzt-Patienten-Gespräch) entwickelt und in einer 12-monatigen Pilotstudie auf Machbarkeit getestet. Ein auf 9 Items reduzierter MAI [1] wurde eingesetzt, um dessen Eignung als potentielles primäres Outcome der Hauptstudie zu prüfen. Material und Methoden: In die Pilotstudie in 20 Hausarztpraxen mit Cluster-Randomisation auf Praxisebene in Kontrollgruppe (Regelversorgung b. empfohlenem Standard) vs. Interventionsgruppe (komplexe Intervention b. empfohlenem Standard) wurden 5 Pat./Praxis eingeschlossen (≥65 Jahre, ≥3 chron. Erkrankungen, ≥5 Dauermedikamente, MMSE ≥26, Lebenserwartung ≥6 Monate). Zur Bewertung des MAI wurden an Baseline (T0), 6 Wo. (T1) & 3 Mon. (T2) nach Intervention erhoben: VO, Diagnosen, Natrium, Kalium & Kreatinin i.S., Größe, Gewicht, Geschlecht, Cumulative Illness Rating Scale (CIRS) [2] durch die Hausarztpraxis; Symptome für unerwünschte Arzneimittelwirkungen im Patienten-Telefoninterview. Für den MAI wurde die Angemessenheit jeder VO in den 9 Kategorien Indikation, Effektivität, Dosierung, korrekter & praktikabler Applikationsweg, Arzneimittelwechselwirkung, Drug-disease-Interaktion, Doppelverordnung, Anwendungsdauer 3-stufig bewertet (1 = korrekt - 3 = unkorrekt) und für die Auswertung auf Patientenebene summiert. Die Bewertung erfolgte ohne Kenntnis der Gruppenzugehörigkeit. Deskriptive Statistiken und Reliabilitätsanalysen, ungewichtete Auswertung und Gewichtung n. Bregnhoj [3]. Ergebnisse: Es wurden N=100 Patienten in die Studie eingeschlossen, im Mittel 76 Jahre (Standardabweichung, SD 6; Range, R: 64-93) , 52% Frauen, durchschnittlich 9 VO/Pat. (SD 2; R 4-16), mittlerer CIRS-Score 10 (SD 4; R 0-23). Basierend auf N=851 VO (100 Pat.) zu T0 betrug der Reliabilitätskoeffizient (RK, Cronbachs Alpha) der ungewichteten 9 Items 0,70. Items 1-5 wiesen akzeptable Trennschärfen auf (0,52-0,64), die der Items 6, 7 & 9 fielen mit 0,21-0,29 niedriger aus, die des Item 8 betrug 0,06. Auf der Basis der 9 gewichteten Items fiel die interne Konsistenz des MAI erwartet höher aus (0,75). Die Reliabilitätsanalysen auf VO-Ebene zeigten einen RK von 0,67 (ungewichtet) vs. 0,75 (gewichtet), die Trennschärfen waren vergleichbar. Zur Zwischenauswertung betrug der MAI (T1-T0) in der Interventionsgruppe (5 Praxen, 24 Pat.) -0,9 (SD 5,6), in der Kontrollgruppe (7 Praxen, 35 Pat.) -0,5 (SD 4,9); die Differenz zwischen beiden Gruppen Mi–Mk -0,4 [95% Konfidenzintervall: -3,4;2,6]. Schlussfolgerung: Der MAI ist als potentielles primäres Outcome in der Hauptstudie geeignet: wenige fehlende Werte, Darstellung von Unterschieden prä-post und zwischen den Gruppen, akzeptable interne Konsistenz. Der niedrige Trennschärfekoeffizient des Items 8 weist darauf hin, dass dieses Item nicht mit dem Gesamt-Skalenwert korreliert, auch die Items 6, 7 und 9 korrelieren wesentlich schwächer mit dem Gesamt-Skalenwert als die Items 1 bis 5. Eine Wichtung z.B. der Items 2, 5, 6 und 9 könnte erwogen werden, um den Fokus der Intervention in der Hauptzielgröße angemessen abzubilden

One-Parameter Homothetic Motion in the Hyperbolic Plane and Euler-Savary Formula

In \cite{Mul} one-parameter planar motion was first introduced and the relations between absolute, relative, sliding velocities (and accelerations) in the Euclidean plane $\mathbb{E}^2$ were obtained. Moreover, the relations between the Complex velocities one-parameter motion in the Complex plane were provided by \cite{Mul}. One-parameter planar homothetic motion was defined in the Complex plane, \cite{Kur}. In this paper, analogous to homothetic motion in the Complex plane given by \cite{Kur}, one-parameter planar homothetic motion is defined in the Hyperbolic plane. Some characteristic properties about the velocity vectors, the acceleration vectors and the pole curves are given. Moreover, in the case of homothetic scale $h$ identically equal to 1, the results given in \cite{Yuc} are obtained as a special case. In addition, three hyperbolic planes, of which two are moving and the other one is fixed, are taken into consideration and a canonical relative system for one-parameter planar hyperbolic homothetic motion is defined. Euler-Savary formula, which gives the relationship between the curvatures of trajectory curves, is obtained with the help of this relative system

Transmutations, L-bases and complete families of solutions of the stationary Schr\"odinger equation in the plane

An L-basis associated to a linear second-order ordinary differential operator L is an infinite sequence of functions {\phi_k}_{k=0}^{\infty} such that L\phi_k=0 for k=0,1, L\phi_k=k(k-1)\phi_{k-2}, for k=2,3,... and all \phi_k satisfy certain prescribed initial conditions. We study the transmutation operators related to L in terms of the transformation of powers of the independent variable {(x-x_{0})^k}_{k=0}^{\infty} to the elements of the L-basis and establish a precise form of the transmutation operator realizing this transformation. We use this transmutation operator to establish a completeness of an infinite system of solutions of the stationary Schr\"odinger equation from a certain class. The system of solutions is obtained as an application of the theory of bicomplex pseudoanalytic functions and its completeness was a long sought result. Its use for constructing reproducing kernels and solving boundary and eigenvalue problems has been considered even without the required completeness justification. The obtained result on the completeness opens the way for further development and application of the tools of pseudoanalytic function theory

Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm

BACKGROUND: Unplanned hospital readmissions are common, expensive and often preventable. Strategies designed to reduce readmissions should target patients at high risk. The purpose of this study was to describe medical patients identified using a recently published and validated algorithm (the LACE index) as being at high risk for readmission and to examine their actual hospital readmission rates. METHODS: We used population-based administrative data to identify adult medical patients discharged alive from 6 hospitals in Toronto, Canada, during 2007. A LACE index score of 10 or higher was used to identify patients at high risk for readmission. We described patient and hospitalization characteristics among both the high-risk and low-risk groups as well as the 30-day readmission rates. RESULTS: Of 26 045 patients, 12.6% were readmitted to hospital within 30 days and 20.9% were readmitted within 90 days of discharge. High-risk patients (LACE ≥ 10) accounted for 34.0% of the sample but 51.7% of the patients who were readmitted within 30 days. High-risk patients were readmitted with twice the frequency as other patients, had longer lengths of stay and were more likely to die during the readmission. INTERPRETATION: Using a LACE index score of 10, we identified patients with a high rate of readmission who may benefit from improved post-discharge care. Our findings suggest that the LACE index is a potentially useful tool for decision-makers interested in identifying appropriate patients for post-discharge interventions