Delirium Screening to Prevent Falls in the Long-term Care Setting

Abstract Background Nearly 30 million people fall in the United States (U.S.) every year with 20% resulting in serious injury. These incidents disproportionately occur in the elderly population. Of the 1.6 million people living in long-term care (LTC) settings in the U.S., between 50-75% experience a fall annually with many experiencing multiple falls. This population is 2 times as likely to experience such an event – and due to increased age, they are least likely to recover. Delirium, a main contributing factor to fall, has been found to go undetected in as many as 66% of individuals in the clinical setting. Method A randomized sample group (N = 22) was observed over an 8-week period (T-1) in which weekly delirium screening was performed using the Simple Query for Easy Evaluation of Consciousness (SQeeC) in a LTC facility. Fall data was recorded and compared to results obtained over the previous 8-week period (T-2) in which quarterly delirium screening with the Confusion Assessment Method (CAM) was performed using an independent sample t-test to determine the impact of weekly screening on fall rates. Results During T-1, there were 12 falls. Of these, 1 was a delirium-related fall. In T-2, there were 16 falls with 4 being delirium-related. The mean fall/week in T-1 was 1.5 compared to 2.0 in T-2. There was not a statistically significant difference in falls (p=0.475) when using the SQeeC. Conclusion Though not statistically significant, there was an apparent clinical difference evidenced by a decrease in the number of falls, falls per week, and delirium-related falls. This may be attributable to increased awareness and vigilance throughout the time of the project. Further work is needed to make a determination

Grand-Canonical Ensemble of Random Surfaces with Four Species of Ising Spins

The grand-canonical ensemble of dynamically triangulated surfaces coupled to four species of Ising spins (c=2) is simulated on a computer. The effective string susceptibility exponent for lattices with up to 1000 vertices is found to be $\gamma = - 0.195(58)$. A specific scenario for $c > 1$ models is conjectured.Comment: LaTeX, 11 pages + 1 postscript figure appended, preprint LPTHE-Orsay 94/1

The Antimicrobial Effects of Allium Sativum on Escherichia Coli

Allium sativum (Garlic) is an herb that is grown all over the world, and can be found in the homes of many people. This herb has many medicinal properties, but is mainly known for its antimicrobial properties. Fresh garlic contains enzymes called “alliinase” and “alliin”. When garlic is crushed or cut into the alliinase converts the alliin into allicin. Allicin is what gives the garlic its antimicrobial properties and odor. The antimicrobial activity of the Allium sativum extract was tested on Escherichia coli, a gram-negative bacteria, using the agar-well diffusion method. A test tube containing only Escherichia coli was used as the control group. Another test tube containing Escherichia coli and the Allium sativum extract was used as the test group. It was hypothesized that the Allium sativum extract would prevent the growth of the Escherichia coli. With the rising costs of today’s society finding cheap and effective alternative treatments, will be helpful by providing medical help for those who can’t afford regular healthcare treatments

Jefferson Teamwork Observation Guide (JTOG): A Pilot Project

The critical need for students to learn to be effective members of interprofessional teams in preparation for collaborative practice-ready care provision now and in the future has been well documented1. There are increasing opportunities for students to observe interprofessional events to assist them in doing so, but often their role is passive and the teams may not demonstrate the highest level of patient-centered care, minimizing the student learning

Implementation, evaluation, and recommendations for extension of AHRQ Common Formats to capture patient- and carepartner-generated safety data

Abstract Objectives The Common Formats, published by the Agency for Healthcare Research and Quality, represent a standard for safety event reporting used by Patient Safety Organizations (PSOs). We evaluated its ability to capture patient-reported safety events. Materials and methods We formally evaluated gaps between the Common Formats and a safety concern reporting system for use by patients and their carepartners (ie friends/families) at Brigham and Women’s Hospital. Results Overall, we found large gaps between Common Formats (versions 1.2, 2.0) and our patient/carepartner reporting system, with only 22–30% of the data elements matching. Discussion We recommend extensions to the Common Formats, including concepts that capture greater detail about the submitter and safety categories relevant to unsafe conditions and near misses that patients and carepartners routinely observe. Conclusion Extensions to the Common Formats could enable more complete safety data sets and greater understanding of safety from key stakeholder perspectives, especially patients, and carepartners. </jats:sec

Expanding Rural Opioid Addictions Treatment: An Inter-institutional, Inter-professional Telehealth Case Study Simulation

Purpose: To determine if inter-institutional collaboration, using telehealth technology, inter-professional education techniques, and case study methodology is a feasible way to teach health professions students how to appropriately address opioid addictions, especially in rural populations with limited health care access. Study subjects: Ten health professions students from four Virginia universities participated. Professions represented included medicine, nursing, physical therapy, social work, nutrition, and psychology at the graduate and undergraduate levels. Methods: Inter-professional faculty from four Virginia universities developed an opioid addiction simulation case study using a standardized patient. Students from different regions engaged in a facilitated patient interview and care planning via secure virtual meeting platform. Faculty observation and feedback, student feedback, and inter-professional education assessments were used to assess this pilot study. Findings: Inter-institutional faculty collaboration and telehealth technology was successfully employed to convene multiple health professions students from different sites; simulation case study methodology using a standardized patient was effective and compelling; students effectively utilized interprofessional competencies and skills to develop a comprehensive and holistic care plan for opioid addiction treatment. Conclusions: Telehealth technology, inter-professional education, and simulation case study methodology can be successfully used to teach health professions students how to collaborate to address the opioid crisis, especially in resource-limited rural areas. Implications: Many resources are necessary to successfully treat opioid addictions. By using telehealth technology combined with inter-professional concepts and skills, resources can be shared between institutions and professions to successfully treat patients with opioid addictions in resource-limited areas

Clinical Assessment of Fetal Well-Being and Fetal Safety Indicators

Delivering safe clinical trials of novel therapeutics is central to enable pregnant women and their babies to access medicines for better outcomes. This review describes clinical monitoring of fetal well-being and safety. Current pregnancy surveillance includes regular antenatal checks of blood pressure and urine for signs of gestational hypertension. Fetal and placental development is assessed routinely using the first-trimester “dating” and mid-trimester “anomaly” ultrasound scans, but the detection of fetal anomalies can continue throughout pregnancy using targeted sonography or magnetic resonance imaging (MRI). Serial sonography can be used to assess fetal size, well-being, and placental function. Carefully defined reproducible imaging parameters, such as the head circumference (HC), abdominal circumference (AC), and femur length (FL), are combined to calculate an estimate of the fetal weight. Doppler analysis of maternal uterine blood flow predicts placental insufficiency, which is associated with poor fetal growth. Fetal doppler analysis can indicate circulatory decompensation and fetal hypoxia, requiring delivery to be expedited. Novel ways to assess fetal well-being and placental function using MRI, computerized cardiotocography (CTG), serum circulating fetoplacental proteins, and mRNA may improve the assessment of the safety and efficacy of maternal and fetal interventions. Progress has been made in how to define and grade clinical trial safety in pregnant women, the fetus, and neonate. A new system for improved safety monitoring for clinical trials in pregnancy, Maternal and Fetal Adverse Event Terminology (MFAET), describes 12 maternal and 18 fetal adverse event (AE) definitions and severity grading criteria developed through an international modified Delphi consensus process. This fills a vital gap in maternal and fetal translational medicine research

Generalized Penner models to all genera

We give a complete description of the genus expansion of the one-cut solution to the generalized Penner model. The solution is presented in a form which allows us in a very straightforward manner to localize critical points and to investigate the scaling behaviour of the model in the vicinity of these points. We carry out an analysis of the critical behaviour to all genera addressing all types of multi-critical points. In certain regions of the coupling constant space the model must be defined via analytical continuation. We show in detail how this works for the Penner model. Using analytical continuation it is possible to reach the fermionic 1-matrix model. We show that the critical points of the fermionic 1-matrix model can be indexed by an integer, $m$, as it was the case for the ordinary hermitian 1-matrix model. Furthermore the $m$'th multi-critical fermionic model has to all genera the same value of $\gamma_{str}$ as the $m$'th multi-critical hermitian model. However, the coefficients of the topological expansion need not be the same in the two cases. We show explicitly how it is possible with a fermionic matrix model to reach a $m=2$ multi-critical point for which the topological expansion has alternating signs, but otherwise coincides with the usual Painlev\'{e} expansion.Comment: 27 pages, PostScrip