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A Field Report from the Sunken Village Wet Site (35MU4)
During low waters of September a wet site team, sponsored by an international grant from Japan, returned to further record the National Heritage Landmark wet site of Sunken Village (35MU4), Sauvie Island, Portland, Oregon (Figure 1). The one week project (September 16 through 22, 2007) was designed to accurately map the surface features ( especially over a hundred in situ acorn leaching pits and wooden stakes) and surface artiÂfacts (especially lithic debitage and fauna! remains) as revealed in the limited evaluation of I 060 linear feet (320 metres) of beach before the riprap repair was permitted by the U.S. Corps of Engineers in October of 2006 (Croes, Fagan and Zehendner 2007; a PDF copy of this 2006 field work is available on the web - see References below). The project continues to be co-manÂaged through the direct in-put by Cultural Resources Protection Specialists Eirik Thorsgard, Confederated Tribes of the Grand Ronde, and Robert Kentta, Confederated Tribes of Siletz IndiÂans and in consultation with the Confederated Tribes of Warms Springs. A joint team provided the expertise needed to carefully map and record the Sunken Village National Historic Landmark site, consisting of(a) the SPSCC Wet Site Archaeological InvesÂtigations and Laboratory team, lead by Dr. Dale Croes, and the SPSCC Computer Aided Drafting Department, lead by Professor Michael Martin, (b) the AINW geoarchaeological and laboratory team, lead by Dr. Michele Punke and Maureen Zehendner, and ( c) the internationally known Wetland Archaeological Team from the National Institute for Cultural Heritage, Nara, Japan, lead by Dr. Akira Matsui. This project was conducted through the sponsorship of a Japanese international grant under the administration of Dr. Akira Matsui, Chief Archaeologist, National Institute for Cultural Heritage, Nara, Japan, as well as support through the SPSCC Anthropology Club, an SPSCC Exceptional Faculty grant, Jean and Ray Auel, and volunteers from Portland State University and the Oregon Archaeological Society. Dr. Matsui brought four Japanese associates to participate in the field work: Dr. Naoto Yamamoto, Dr. Toru Miyao, Dr. Atsushi Iwasaki, and Dr. Tomonori Kanno (Figure 2)
Delirium Recognition in Hospitalized Older Patients: A Quality Improvement Project
Background: We noted a low reported prevalence of delirium (3%) in hospitalized older patients at a community teaching hospital in north central Wisconsin.
Purpose: This was a quality improvement project to report recognition of delirium by nurses before and after an educational intervention.
Methods: This project was performed on one medical unit in our hospital. Quality improvement data was collected at baseline and after the educational intervention. Data collected included observation by a geriatrician attending weekly interdisciplinary rounds to note any mention by nurses of delirium or confusion. The patient’s electronic health record (EHR) was reviewed to note delirium assessment by “confusion assessment method for the intensive care unit (Vanderbilt)” (CAM-ICU) by the nurses for 2 days prior to the team meeting. The numbers of positive and total attempted CAM-ICU were recorded. Use of antipsychotics or benzodiazepines was reported as a “delirium marker.” Diagnosis of delirium and dementia was obtained from the problem list in the EHR. The educational intervention included Just-in-Time Teaching during weekly Acute Care for Elders rounds during a 1-month period.
Results: In month 1, before intervention, CAM-ICU was performed 140 times in 2 days on 32 patients with an average CAM-ICU performed 2.2 times per patient/day. There were 3 concerning quotes for confusion during team rounds and 0 for delirium by nurses during team rounds. EHR review noted 7 patients had dementia, 2 had a positive CAM-ICU and 3 had a diagnosis of delirium. In month 2, after intervention, CAM-ICU was performed 163 times in 2 days on 35 patients with an average CAM-ICU performed 2.35 times per patient/day. There were 6 concerning quotes regarding confusion and 1 regarding delirium by nurses during team rounds. EHR review noted 1 patient had dementia, 0 had a positive CAM-ICU and 0 patients with delirium diagnosis.
Conclusion: This quality improvement project using Just-in-Time Teaching by a geriatrician during weekly rounds resulted in a modest increase in number of times CAM-ICU was performed, increased discussion of delirium during rounds, but no increase in delirium recognition using CAM-ICU. Areas for improvement include involving more physicians and nursing staff along with more structured delirium education