Comparing Audio and Video Data for Rating Communication

Video recording has become increasingly popular in nursing research, adding rich nonverbal, contextual, and behavioral information. However, benefits of video over audio data have not been well established. We compared communication ratings of audio versus video data using the Emotional Tone Rating Scale. Twenty raters watched video clips of nursing care and rated staff communication on 12 descriptors that reflect dimensions of person-centered and controlling communication. Another group rated audio-only versions of the same clips. Interrater consistency was high within each group with ICC (2,1) for audio = .91, and video = .94. Interrater consistency for both groups combined was also high with ICC (2,1) for audio and video = .95. Communication ratings using audio and video data were highly correlated. The value of video being superior to audio recorded data should be evaluated in designing studies evaluating nursing care

Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving

© 2014 Williams et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpPurpose of the study Assisted living (AL) residents are at risk for cognitive and functional declines that eventually reduce their ability to care for themselves, thereby triggering nursing home placement. In developing a method to slow this decline, the efficacy of Reasoning Exercises in Assisted Living (REAL), a cognitive training intervention that teaches everyday reasoning and problem-solving skills to AL residents, was tested. Design and methods At thirteen randomized Midwestern facilities, AL residents whose Mini Mental State Examination scores ranged from 19–29 either were trained in REAL or a vitamin education attention control program or received no treatment at all. For 3 weeks, treated groups received personal training in their respective programs. Results Scores on the Every Day Problems Test for Cognitively Challenged Elders (EPCCE) and on the Direct Assessment of Functional Status (DAFS) showed significant increases only for the REAL group. For EPCCE, change from baseline immediately postintervention was +3.10 (P<0.01), and there was significant retention at the 3-month follow-up (d=2.71; P<0.01). For DAFS, change from baseline immediately postintervention was +3.52 (P<0.001), although retention was not as strong. Neither the attention nor the no-treatment control groups had significant gains immediately postintervention or at follow-up assessments. Post hoc across-group comparison of baseline change also highlights the benefits of REAL training. For EPCCE, the magnitude of gain was significantly larger in the REAL group versus the no-treatment control group immediately postintervention (d=3.82; P<0.01) and at the 3-month follow-up (d=3.80; P<0.01). For DAFS, gain magnitude immediately postintervention for REAL was significantly greater compared with in the attention control group (d=4.73; P<0.01). Implications REAL improves skills in everyday problem solving, which may allow AL residents to maintain self-care and extend AL residency. This benefit is particularly important given the growing population of AL residents at risk for cognitive and self-care decline

Cognitive Interventions for Older Adults: Does Approach Matter?

Assisted living (AL) is the fastest growing option for residential care that is designed to provide older adults with needed supports while promoting independence1. Nevertheless, AL residents typically experience progressive decline in cognitive ability and self-care that necessitates more intensive nursing care, and typically, most AL residents will transfer to a nursing home (NH) within one to three years1–4. Older adults require a variety of cognitive abilities to meet every day self-care challenges needed to remain in AL. Cognitive decline is key predictor of disability and NH placement for AL residents 5. Someone in the US is diagnosed with Alzheimer’s disease (AD) every 68 seconds, and the number of dementia sufferers will double by 2050, reaching 16 million6. Therefore, the development of new interventions to decrease cognitive decline is critical. Cognitive training programs are gaining popularity based on the notion that “use it or lose it” applies to cognition7,8. Research demonstrates that training in specific cognitive skills can improve memory, cognitive processing speed, spatial orientation, reasoning, and executive function in community dwelling older adults 7,9. Cognitive training can also benefit persons with dementia and mild cognitive decline. A meta-analysis of cognitive training research involving persons with early-stage AD reported overall effect sizes of 0.47 for interventions targeting learning, memory, and executive function, with improvements in activities of daily living (ADLs), problem solving, depression, and self-rated functioning10. A cognitive training intervention called Reasoning Exercises in Assisted Living (REAL) was developed to teach reasoning and problem solving skills to AL residents who are at risk for cognitive and functional decline. The intervention was modeled after the inductive reasoning skills found to improve cognition and maintain self-care over 5 years in healthy, independent older adults11. The REAL program includes six, hour-long, sessions in which providers work individually with AL residents12. The goal of this intervention is to improve older adults’ everyday problem-solving skills so they can maintain their ability to care for themselves and “age in place” in AL. REAL successfully improved problem solving scores of AL residents in a preliminary study12. Results from a subsequent cluster randomized clinical trial (reported elsewhere) also show potential for this intervention13. REAL is provided to AL residents in a one-to-one format. This approach has been successful. However, having adequate interventionists to provide REAL to individual AL residents is a challenge and is costly. Considering that cost is one predictor of successful dissemination of interventions in real-world settings, more efficient ways to provide REAL to large numbers of AL residents are needed14. Thus, the purpose of this pilot study was to examine feasibility and compare costs and outcomes for REAL provided in individual versus small group formats

Diagnosis of the neuronal ceroid lipofuscinoses: An update

AbstractFor the majority of families affected by one of the neuronal ceroid lipofuscinoses (NCLs), a biochemical and/or genetic diagnosis can be achieved. In an individual case this information not only increases understanding of the condition but also may influence treatment choices and options. The presenting clinical features prompt initial investigation and also guide clinical care. The clinical labels “infantile NCL”, “late infantile NCL” and “juvenile NCL”, therefore remain useful in practice. In unusual or atypical cases ultra-structural analysis of white blood cells or other tissue samples enables planning and prioritisation of biochemical and genetic tests.This review describes current methods available to achieve clinical, pathological, biochemical and genetic diagnosis in children presenting with symptoms suggestive of one of the NCLs

Psychometric Analysis of the Emotional Tone Rating Scale: A Measure of Person-Centered Communication

This is an Accepted Manuscript of an article published by Taylor & Francis in Clinical Gerontologist on 2012-01-01, available online: http://www.tandfonline.com/10.1080/07317115.2012.702648.Psychometric analysis of the Emotional Tone Rating Scale (ETRS) was completed using ratings of naïve listeners who evaluated staff-resident communication in three nursing homes. Interrater consistency was high with ICC (2, 1) for agreement = 0.95 and consistency = 0.95. Factor analysis revealed two factors—person-centered communication and controlling communication—that explained 84.8% of the variance. Person-centered communication included seven descriptors (items) with loadings ranging from 0.84 to 0.98 and a coefficient alpha of 0.98. Controlling communication included five items that loaded from −0.63 to .99 with a coefficient alpha of 0.94. These factors were negatively correlated p = −.64 and demonstrated good ranges, standard deviations, and high item-total correlations. Person-centered communication correlated with higher resident engagement in conversation in contrast to controlling communication. The ETRS provides a measure of person-centered communication that can be used to evaluate interactions between nursing staff and older adults who reside in long term care settings

Signature of the Simplicial Supermetric

We investigate the signature of the Lund-Regge metric on spaces of simplicial three-geometries which are important in some formulations of quantum gravity. Tetrahedra can be joined together to make a three-dimensional piecewise linear manifold. A metric on this manifold is specified by assigning a flat metric to the interior of the tetrahedra and values to their squared edge-lengths. The subset of the space of squared edge-lengths obeying triangle and analogous inequalities is simplicial configuration space. We derive the Lund-Regge metric on simplicial configuration space and show how it provides the shortest distance between simplicial three-geometries among all choices of gauge inside the simplices for defining this metric (Regge gauge freedom). We show analytically that there is always at least one physical timelike direction in simplicial configuration space and provide a lower bound on the number of spacelike directions. We show that in the neighborhood of points in this space corresponding to flat metrics there are spacelike directions corresponding to gauge freedom in assigning the edge-lengths. We evaluate the signature numerically for the simplicial configuration spaces based on some simple triangulations of the three-sphere (S^3) and three-torus (T^3). For the surface of a four-simplex triangulation of S^3 we find one timelike direction and all the rest spacelike over all of the simplicial configuration space. For the triangulation of T^3 around flat space we find degeneracies in the simplicial supermetric as well as a few gauge modes corresponding to a positive eigenvalue. Moreover, we have determined that some of the negative eigenvalues are physical, i.e. the corresponding eigenvectors are not generators of diffeomorphisms. We compare our results with the known properties of continuum superspace.Comment: 24 pages, RevTeX, 4 eps Figures. Submitted to Classical Quantum Gravit

A study of National Health Service management of chronic osteoarthritis and low back pain

AIM: To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective. BACKGROUND: Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care. METHOD: Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients’ records for three years from diagnosis (‘newly diagnosed’ patients) or for the most recent three years (‘established’ patients). FINDINGS: Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and ‘newly diagnosed’ patients were significantly more likely to visit their GP for pain management than ‘established’ patients. Although ‘newly diagnosed’ patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups. CONCLUSION: This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use