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

Characterising group-level brain connectivity: A framework using Bayesian exponential random graph models.

The brain can be modelled as a network with nodes and edges derived from a range of imaging modalities: the nodes correspond to spatially distinct regions and the edges to the interactions between them. Whole-brain connectivity studies typically seek to determine how network properties change with a given categorical phenotype such as age-group, disease condition or mental state. To do so reliably, it is necessary to determine the features of the connectivity structure that are common across a group of brain scans. Given the complex interdependencies inherent in network data, this is not a straightforward task. Some studies construct a group-representative network (GRN), ignoring individual differences, while other studies analyse networks for each individual independently, ignoring information that is shared across individuals. We propose a Bayesian framework based on exponential random graph models (ERGM) extended to multiple networks to characterise the distribution of an entire population of networks. Using resting-state fMRI data from the Cam-CAN project, a study on healthy ageing, we demonstrate how our method can be used to characterise and compare the brain's functional connectivity structure across a group of young individuals and a group of old individuals

Development, assessment, and evolution of an interprofessional activity with senior nursing and pharmacy students: application of quality improvement in interprofessional education (IPE)

Purpose: Concurrent development IPE activities and an assessment strategy is essential for informed evolution of such initiatives. This study provides an active example of the progression of IPE at an institution utilizing an active assessment plan. Background: IPE is advocated as a method to develop students who are prepared for interprofessional practice, which is essential for optimal patient outcomes. While IPE has been integrated in many health professional curricula, focus on assessment is needed to ensure obtainment of educational outcomes and truly prepare students for interprofessional collaboration in the work place. Description of Intervention/Program: IPE activities were developed through a multidisciplinary committee consisting of health profession faculty and students. Additionally the committee developed an assessment strategy to evaluate IPE initiatives. One activity implemented over the last three years involves senior nursing and pharmacy students collaboratively addressing a complex patient care simulation. Students complete a pre/post survey evaluating the impact of the activity on their readiness for interprofessional practice, IPE perceptions, and activity impact. Group care plans and group evaluations are also evaluated. Results: Quantitative and qualitative data are reviewed by the committee annually to make informed decisions for future iterations of the activity. Conclusion: Execution of a clear assessment plan is essential to fulfill learning objectives for IPE activities. Feedback from an educational activity allowed for continuous improvement, ensuring impact on student learning, and illustrates the necessity of assessment within IPE. Relevance to IPE or Practice: The study conveys three key points that would be helpful to other institutions implementing IPE. First, the study illustrates the importance of assessment planning when implementing IPE activities. Second, the assessment plan presented serves as an example for others. Lastly, the study provides an active example of applying the assessment plan to iterations of an IPE activity. Seminar Outline/Timeframe of Presentation and Interactive Discussion: Opening discussion on IPE and assessment of IPE activities (10 minutes) Integration of IPE into the University curriculum and details regarding the senior IPE activity (10 minutes) Development of an IPE assessment plan and application to the senior IPE activity (10 minutes) Interprofessional groupwork: 5-6 multidisciplinary group members provided student feedback from an IPE activity and must determine potential adjustments to the activity for future iterations (10 minutes) Interprofessional groupwork: In the same group, discuss potential adjustments to the assessment plan for IPE activities for the activity discussed previously as well as at group members’ own institutions. Large group discussion of group work including information gleaned from student feedback, proposed changes for future activities, and ideas for assessment planning, both for the activity presented and for participants’ own institutions. Two to Three measureable learning objectives relevant to conference goals: To demonstrate successful development and application of assessment strategies in IPE activities. To guide use of student feedback in the improvement of IPE activities To stimulate discussion regarding assessment planning within IP

Interprofessional Education for Freshman Nursing and Pharmacy Students: An Application of Ethics

Purpose: The purpose is to encourage students in the health care professions to work interprofessionally to better enable them to enter the workplace as a member of the collaborative practice team. Background: In 2009, six national education associations of schools of the health professions formed a collaborative to promote and encourage constituent efforts that would advance substantive interprofessional learning experiences (IPE) to help prepare future health professionals for enhanced team-based care of patients and improved population health outcomes. By 2016, this initiative has grown significantly, even being mandated by some professions. Description of Intervention/Program: IPE activities were developed through a committee consisting of faculty and students from nursing and pharmacy programs at the institution. An activity for freshman students (N=152) was developed, focusing on each profession’s code of ethics and application to ethical situations. Students completed a pre/post survey evaluating their readiness and perceptions of IPE, as well as evaluating the activities’ effectiveness in effective collaboration using qualitative and quantitative techniques. Results: The data was evaluated by the IPE committee to determine future iterations of the activity. Conclusion: Based on both quantitative and qualitative feedback from the students, the freshman IPE activity assisted both pharmacy and nursing students to become a more effective member of the health care team, bringing students from different health care programs together to problem-solve while applying a collaboratively devised code of ethics with an application-based activity to produce a robust experience. Relevance to IPE or Practice: The study conveys two key points that would be helpful for others integrating IPE activities into their curriculum. First, the authors illustrated an IPE activity that can be implemented with lower level professional students. Second, the authors outlined a plan for continuous improvement of IPE activity, looking beyond implementation to assessment and optimization of these initiatives. Seminar Outline/Timeframe of Presentation and Interactive Discussion: Opening discussion on IPE and its integration into the university curriculum (10 minutes) Freshman activity initial ideas, design, and feedback: the value of interprofessional ethics in healthcare (10 minutes) Modifications to the freshman activity and student feedback ( 10 minutes) Interprofessional groupwork (5-6 group members made up of participants from different disciplines) to develop a shared code of ethics (10 minutes) Interprofessional groupwork (same group members) using the shared code of ethics to solve a practical, real-world problem (10 minutes) Large group discussion on the overall activity, components of the shared code of ethics, and application of the code to the problem-solving activity, and considerations for the future for this activity (10 minutes) Two to three measureable learning objectives relevant to conference goals: To create a coordinated effort across the nursing and pharmacy health profession curricula to embed essential interprofessional experience and content. To guide professional and institutional curricular development of learning approaches and assessment strategies to achieve productive outcomes for nursing and pharmacy students. To demonstrate a newly developed ethics activity for freshman students in nursing and pharmacy programs to exhibit interprofessional problem-solving

Experimental Evolution of Resistance to Artemisinin Combination Therapy Results in Amplification of the mdr1 Gene in a Rodent Malaria Parasite

Background: Lacking suitable alternatives, the control of malaria increasingly depends upon Artemisinin Combination Treatments (ACT): resistance to these drugs would therefore be disastrous. For ACTs, the biology of resistance to the individual components has been investigated, but experimentally induced resistance to component drugs in combination has not been generated. Methodology/Principal Findings: We have used the rodent malaria parasite Plasmodium chabaudi to select in vivo resistance to the artesunate (ATN) + mefloquine (MF) version of ACT, through prolonged exposure of parasites to both drugs over many generations. The selection procedure was carried out over twenty-seven consecutive sub-inoculations under increasing ATN + MF doses, after which a genetically stable resistant parasite, AS-ATNMF1, was cloned. AS-ATNMF1 showed increased resistance to ATN + MF treatment and to artesunate or mefloquine administered separately. Investigation of candidate genes revealed an mdr1 duplication in the resistant parasites and increased levels of mdr1 transcripts and protein. There were no point mutations in the atpase6 or ubp1genes. Conclusion: Resistance to ACTs may evolve even when the two drugs within the combination are taken simultaneously and amplification of the mdr1 gene may contribute to this phenotype. However, we propose that other gene(s), as ye

The two-hour orbit of a binary millisecond X-ray pulsar

Typical radio pulsars are magnetized neutron stars that are born rapidly rotating and slow down as they age on time scales of 10 to 100 million years. However, millisecond radio pulsars spin very rapidly even though many are billions of years old. The most compelling explanation is that they have been "spun up" by the transfer of angular momentum during accretion of material from a companion star in so-called low-mass X-ray binary systems, LMXBs. (LMXBs consist of a neutron star or black hole accreting from a companion less than one solar mass.) The recent detection of coherent X-ray pulsations with a millisecond period from a suspected LMXB system appears to confirm this link. Here we report observations showing that the orbital period of this binary system is two hours, which establishes it as an LMXB. We also find an apparent modulation of the X-ray flux at the orbital period (at the two per cent level), with a broad minimum when the pulsar is behind this low-mass companion star. This system seems closely related to the "black widow" millisecond radio pulsars, which are evaporating their companions through irradiation. It may appear as an eclipsing radio pulsar during periods of X-ray quiescence.Comment: 4 pages with 1 figure. Style files included. Fig. 2 deleted and text revised. To appear in Nature. Press embargo until 18:00 GMT on 1998 July 2

Intravitreal administration of recombinant human opticin protects against hyperoxia-induced pre-retinal neovascularization

Opticin is an extracellular glycoprotein present in the vitreous. Its antiangiogenic properties offer the potential for therapeutic intervention in conditions such as proliferative diabetic retinopathy and retinopathy of prematurity. Here, we investigated the hypothesis that intravitreal administration of recombinant human opticin can safely protect against the development of pathological angiogenesis and promote its regression. We generated and purified recombinant human opticin and investigated its impact on the development and regression of pathological retinal neovascularization following intravitreal administration in murine oxygen-induced retinopathy. We also investigated its effect on normal retinal vascular development and function, following intravitreal injection in neonatal mice, by histological examination and electroretinography. In oxygen-induced retinopathy, intravitreal administration of human recombinant opticin protected against the development of retinal neovascularization to similar extent as aflibercept, which targets VEGF. Opticin also accelerated regression of established retinal neovascularization, though the effect at 18 h was less than that of aflibercept. Intravitreal administration of human recombinant opticin in neonatal mice caused no detectable perturbation of subsequent retinal vascular development or function. In summary we found that intraocular administration of recombinant human opticin protects against the development of pathological angiogenesis in mice and promotes its regression