Consistency between hydrological model, large aperture scintillometer and remote sensing based evapotranspiration estimates for a heterogeneous catchment

The catchment averaged actual evapotranspiration rate is a hydrologic model variable that is difficult to quantify. Evapotranspiration rates - up till present - cannot be continuously observed at the catchment scale. The objective of this paper is to estimate the evapotranspiration rates (or its energy equivalent, the latent heat fluxes LE) for a heterogeneous catchment of 102.3 km(2) in Belgium using three fundamentally different algorithms. One possible manner to observe this variable could be the continuous measurement of sensible heat fluxes (H) across large distances (in the order of kilometers) using a large aperture scintillometer (LAS), and converting these observations into evapotranspiration rates. Latent heat fluxes are obtained through the energy balance equation using a series of sensible heat fluxes measured with a LAS over a distance of 9.5 km in the catchment, and point measurements of net radiation (R-n) and ground heat flux (G) upscaled to catchment average through the use of TOPLATS, a physically based land surface model. The resulting LE-values are then compared to results from the remote sensing based surface energy balance algorithm ETLook and the land surface model. Firstly, the performance of ETLook for the energy balance terms has been assessed at the point scale and at the catchment scale. Secondly, consistency between daily evapotranspiration rates from ETLook, TOPLATS and LAS is shown

Probabilistic priority assessment of nurse calls

Current nurse call systems are very static. Call buttons are fixed to the wall, and systems do not account for various factors specific to a situation. We have developed a software platform, the ontology-based Nurse Call System (oNCS), which supports the transition to mobile and wireless nurse call buttons and uses an intelligent algorithm to address nurse calls. This algorithm dynamically adapts to the situation at hand by taking the profile information of staff and patients into account by using an ontology. This article describes a probabilistic extension of the oNCS that supports a more sophisticated nurse call algorithm by dynamically assigning priorities to calls based on the risk factors of the patient and the kind of call. The probabilistic oNCS is evaluated through implementation of a prototype and simulations, based on a detailed dataset obtained from 3 nursing departments of Ghent University Hospital. The arrival times of nurses at the location of a call, the workload distribution of calls among nurses, and the assignment of priorities to calls are compared for the oNCS and the current nurse call system. Additionally, the performance of the system and the parameters of the priority assignment algorithm are explored. The execution time of the nurse call algorithm is on average 50.333 ms. Moreover, the probabilistic oNCS significantly improves the assignment of nurses to calls. Calls generally result in a nurse being present more quickly, the workload distribution among the nurses improves, and the priorities and kinds of calls are taken into account

Implementation of a guideline for pressure ulcer prevention in home care: pretest-posttest study

Aims and objectives: To investigate the effect of the implementation of a patient and family education programme for pressure ulcer prevention in an organisation for home care nursing on guideline adherence and on prevalence and severity of pressure ulcers and to examine the determining factors for the application of measures for pressure ulcer prevention. Background: Quality improvement programmes in pressure ulcer prevention are not always successful. Design: Implementation study using a pretest-post-test design. Data were collected in three probability samples. The first post-test data collection was held after six months, the second after 18 months. Method: Statistical analysis was used, comparing the pretest sample and the second post-test sample. Results: After 18 months, the proportion of subjects with adherent measures had increased from 10 center dot 4-13 center dot 9%, the proportion of subjects with non-adherent measures decreased from 45 center dot 7-36 center dot 0%, the proportion of subjects without pressure ulcer prevention increased from 43 center dot 9-50 center dot 1% (p < 0 center dot 0001, Chi-square test). Sub-analysis revealed that a positive change in guideline adherence was observed principally in the group at risk. Better process-of-care indicators were associated by lower pressure ulcer prevalence and less severe skin lesions. The nurses' judgement of a patient risk status was the most important factor for applying preventive measures. Furthermore, application of pressure ulcer prevention was determined by higher age (from the age category of 70-79 years), higher dependency for the activities of daily living, higher than baseline mobility score and the presence of a pressure ulcer. Conclusions: Guideline adherence in pressure ulcer prevention changed significantly after implementation of the education programme. There might have been inconsistencies in the nurses' risk judgement. Relevance to clinical practice: Quality of pressure ulcer prevention improved, but several items for improvement remain. Adaptation of risk assessment procedures is needed

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Background. Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. Aims and objectives. The purpose of this paper is to examine the inter-rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs.Design. Survey was among pressure ulcer experts.Methods. Fifty-six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter-rater reliability was calculated.Results. The multirater-Kappa for the entire group of experts was 0.80 (P &lt; 0.001).Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers).Conclusions. The inter-rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear.Relevance to clinical practice. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning