Delirium: Delirious Elders, Implementing Reduction Interventions Using Mobility

INTRODUCTION: This quality improvement project involved hiring, training, and managing 3 Delirium Mobility Aids to implement a non-pharmacologic delirium prevention bundle package, including early mobility, on hospitalized patients age \u3e65. Background: Delirium affects 20-30% of older hospitalized patients [1]. Patients with delirium have double the mortality rate [3], which increases with delirium duration [4]. Delirium worsens long term cognitive functioning [9,10,11,12]. Hospital costs increase by $2,500 per patient, totaling$6,900,000,000 in Medicare expenditures [7]. A single delirium episode increases total yearly costs by ~$64,421 [2]. Research suggests the best treatment is non-pharmacologic multicomponent interventions [6], and those with most benefit include early mobility, reorientation, cognitive/sensory stimulation, and hydration [5]. Methods: A delirium prevention protocol was created addressing four main pillars. • Hydration: water placed within patient reach. • Sensory input: • window blinds opened by 9:00 am • hearing-aids and eye-glasses retrieved and utilized. • Soothing music via delirium TV channel for non-communicative patients. • Reorientation: oriented to person/place/time 3 times daily. • Mobility: 20-min walk (mobilization event) 3 times daily Work and time constraints prohibited existing health professionals (CNA, RN, MD, PT, OT) from implementing the protocol. Thus a new job position (Delirium Mobility Aid) was created to implement this protocol for all patients age \u3e65 admitted to Medical A(28-bed medical unit). This was proposed to Providence St. Vincent Medical Foundation who awarded a$170,000 institutional grant for 12 months. The project residents reviewed applications, interviewed, and hired 3 CNA\u27s to fill the position 12 hr/day, 7 days/week. Physical and Occupational Therapy trained the aids for 3 weeks in delirium management and mobilization techniques. Data was collected in Epic flowsheetsand chart notes. Confusion-Assessment-Method (CAM) is a established delirium scoring system utilized on Medical A. Data from intervention year (2019) was compared to baseline data collected 2 years prior (2017, 2018) on the same hospital unit. Results: Preliminary data collected at month 9 of 12: • No statistically significant change in total delirium burden. However there is a trend toward decreased delirium in prolonged hospitalization (measured after day 4). For these patients with LOS \u3e 6 days, there was a 4% reduction in late-stay delirium compared to 2018 and 10% from 2017. • 7.5-13% more patients were completely delirium free after day 4 • Length of Stay (LOS): no significant change (5.5 days) • Patients admitted from home experienced a 4% increase in discharge to home (rather than care-facility) approaching near significance (p-value 0.06). • There was a trend toward reduction in hospital falls: 2017-33. 2018-29. 2019 (present)-19, projected to reach 25 by year’s end. • Press-Ganey patient satisfaction scores remained stable. Conclusion: Non-pharmacologic multicomponent prevention protocols, which include mobilization, implemented by specialized CNA’s, are a potentially viable treatment of delirium in elderly patients with prolonged hospitalization. This may increase rate of discharge to home, without worsening falls, LOS, or patient experience, and has a cost-savings benefit.https://digitalcommons.psjhealth.org/psv_internal/1004/thumbnail.jp

Crown Immunity in a Food Crisis: A Consideration of the 2008 Listeriosis Outbreak in Canada

In Canadian law, the question of whether agents for federal and provincial governments can be liable to consumers in negligence has traditionally been resolved in the negative. However, when many Canadians suddenly fell ill and others died due to exposure to listeria-infected meat products in mid-2008, the ensuing public health crisis and criticism of the government agency that handled it obliged the Prime Minister to call for an investigation and report upon the conduct of the Canadian Food Inspection Agency. In the context of the unfolding investigation, the authors examine the underlying rationale and policy reasons for the Canadian courts’ doctrine of Crown immunity and whether the time might be ripe for policy change in circumstances like those which gave rise to the losses caused by listeriosis

Initial performance metrics of a new custom-designed ArF excimer LA-ICPMS system coupled to a two-volume laser-ablation cell

We measure the performance improvement that force feedback can provide in a virtual environment, through three experiments with, and without the assistance of haptic guidance. Performance measurements were undertaken with haptic, visual and auditory feedback alternatives. The first task investigated the use of haptic guidance mimicking reality, in the form of a simulated touchable surface of an object. The second investigated haptic guidance which waxed and waned as the user violated program rules by varying amounts. The third experiment investigated whether this latter artificial guidance would inhibit the user's free will by taking control out of their hands. The results showed that a significant improvement in both accuracy and speed was achieved by the introduction of haptics in all experiments. It also found that the haptic guidance did not take control away from the user and that they had significantly more control than with conventional warning methods. These experiments were not aimed at learning, or retention of skill, but on using haptics as an aid to improve performance during a task. Due to the rapidly increasing software content in embedded systems, Hardware-dependent Software (HdS) has become a critical topic in system design. In this paper, we provide a brief overview on the topic of HdS, discuss the issues and complexities involved in the design of HdS, and motivate the need for special attention to HdS in research and development. A new custom-built excimer (193 nm) laser-ablation system with two-volume laser-ablation cell coupled to a quadrupole ICPMS is described, which combines rapid ( 10000 cps/ppm for mid-high m/z, 55 mu m, 5 Hz). An application of reconstructing medieval Pb exposure highlights the need for rapid signal washout in unravelling strongly varying Pb peaks in well-preserved archaeological tooth enamel

Identification of Sensory Processing and Integration Symptom Clusters: A Preliminary Study

Rationale. This study explored subtypes of sensory processing disorder (SPD) by examining the clinical presentations of cluster groups that emerged from scores of children with SPD on the Sensory Processing 3-Dimension (SP-3D) Inventory. Method. A nonexperimental design was used involving data extraction from the records of 252 children with SPD. Exploratory cluster analyses were conducted with scores from the SP-3D Inventory which measures sensory overresponsivity (SOR), sensory underresponsivity (SUR), sensory craving (SC), postural disorder, dyspraxia, and sensory discrimination. Scores related to adaptive behavior, social-emotional functioning, and attention among children with different sensory modulation patterns were then examined and compared. Results. Three distinct cluster groups emerged from the data: High SOR only, High SUR with SOR, and High SC with SOR. All groups showed low performance within multiple domains of adaptive behavior. Atypical behaviors associated with social-emotional functioning and attention varied among the groups. Implications. The SP-3D Inventory shows promise as a tool for assisting in identifying patterns of sensory dysfunction and for guiding intervention. Better characterization can guide intervention precision and facilitate homogenous samples for research

Addressing school bullying: Insights from theories of group processes.

In order to enhance efforts to address bullying in schools, and in response to the limited success of school-based anti-bullying programs to date, this paper considers bullying as a group phenomenon and explores theories of group processing that can inform future prevention and intervention efforts. Moving beyond efforts to reduce bullying by enhancing bystander responses, we consider research and theory addressing peer group socialization processes, the role of teachers as an "invisible hand" in structuring peer groups, social interdependence as applied to the design of cooperative learning environments, and collective efficacy. Although these theories are not in themselves developmental, and address group processes that operate across ages, they can inform both future prevention and intervention efforts and applied developmental research that explores the age-related contextual and individual factors that contribute to school bullying. </p

A Deployment of Spreadsheets

Many steganographers would agree that, had it not been for the appropriate unification of the partition table and cache coherence, the unproven unification of IPv7 and architecture might never have occurred. In fact, few researchers would disagree with the evaluation of evolutionary programming. Our focus here is not on whether the much-touted replicated algorithm for the deployment of forward-error correction by Gupta and White runs in Ω(n) time, but rather on presenting a semantic tool for deploying operating systems (Taw)

The Sensory Processing 3-Dimensions Scale: Initial Studies of Reliability and Item Analyses

Background: The Sensory Processing 3-Dimensions Scale (SP-3D) is a performance-based measure for assessing sensory processing abilities and challenges, including sensory modulation, sensory discrimination, and sensory-based motor disorders. Initial studies of reliability were conducted, and item response theory was applied to assist in refining the measure. Methods: Descriptive and correlational methods were used to examine internal consistency of the scales and inter-rater reliability. Item response theory using Rasch analyses was applied to examine unidimensionality of scales, model fit, and item difficulty. Results: Internal consistency for most measures was acceptable, demonstrating the subtests, domains, and behavior scales as distinct constructs. Inter-rater reliability results were mixed, with fair to strong reliability coefficients for most sensory discrimination and postural and praxis subtests. Scales measuring sensory modulation and motor behaviors had moderate to poor inter-observer agreement. Rasch analyses supported subtests as unidimensional and identified the most rigorous items in the subtests. Conclusions: Preliminary results show promise of the SP-3D as a stable, reliable tool. A need for refinement of some operational definitions for behavior ratings was identified, and items to consider for elimination because of redundancy or ill-fit were exposed. Directions for research include refinement of the SP-3D and the need for further reliability and validity studies

Blessing or Burden? The Impact of PTSD Service Dogs on Military Families

While PTSD service dogs are specifically trained to interact with their veterans, emerging evidence suggests that service dogs may also have an impact on other members of veteran households. To our knowledge, only one study quantifies these effects focused on veteran spouses (McCall et al., 2020). Our study aimed to quantitatively measure the impact of PTSD service dogs on military family wellbeing. Data was collected from survey responses of 88 veteran spouses who rated their experiences on standardized outcome measures. Each spouse answered the surveys at two time points: (1) baseline, and (2) three months post-baseline (follow-up). Spouses in the control group (n=40) were on the waitlist for a service dog for both baseline and follow-up, while the service dog group (n=48) received a service dog after baseline. Multiple regression analysis yielded statistically significant differences between the waitlist and service dog groups which suggested that service dogs may increase caregiver burden and decrease caregiver satisfaction, but potentially encourage increased participation in activities for veteran spouses. Small effect sizes suggested service dogs may also foster increased companionship and positive affect in veteran spouses. Analyses indicated no notable impact on veteran children. These findings suggest that the impact of PTSD service dogs may extend to veteran spouses, potentially encouraging interest and investment in this complementary intervention option. Two statistically significant negative effects emphasize the need to inform the military family of practical strategies to minimize possible detrimental effects, which would likely lead to an improved family experience with the service dog

Student radiographers’ role ideal and role reality

Background: A Diagnostic Radiographer’s role is recognised as dual in nature; to produce diagnostic images while meeting patients’ holistic needs (Møller, 2016). Notwithstanding evidence suggesting both are of equal importance, the technical demands often take precedence in practical circumstances (Munn et al, 2104). The preference for a task-centred approach is attributed to role perception (role ideal) and the realities of the role experienced (role reality), and this begins prior to qualification (Hale and White, 2021). This study explores the role ideal and the role reality of student Radiographers. Method: With ethical approval, N=6 semi-structured focus groups, with a mean number of 4 participants, were undertaken, two for each of the three-year groups from a single Diagnostic Radiography BSc (Hons) programme. Reflexive thematic analysis facilitated the identification of 6 themes. Results: Evidence suggests the role ideal is formed early on in training; each academic year perceived the role to be a balance between technical and psychosocial duties. However, the role reality differed, as participants perceived their technical role to be more important. Analysis revealed six lower-order themes relating to matters that had impacted upon role ideal: departmental pressures and responsibilities, workplace dynamics, efficiency, student radiographers’ and patients’ characteristics. These informed three global themes describing the broader and intersecting domains of such impact: structural, cultural, and personal. Conclusion: This study suggests the role reality devalues the psychosocial role, with specific barriers being identified. The barriers highlighted need to be addressed through research, education, leadership, and recruitment in order achieve the role ideal