Engaging Patients to Improve Documentation of Oral Intake on a Cardiac Telemetry Unit: A Quality Improvement Initiative

Background InformationIt is important for patients with heart failure to have awareness of their intake & output to effectively manage their disease. There is evidence that tracking intake & output is a component of missed nursing care resulting in discrepancies between the actual patient intake and what is documented in the patient’s electronic health record (EHR). Aim The aim of this quality improvement project was to engage patients in monitoring their intake by using teach-back and patient engagement techniques to track their own oral fluid intake throughout the day. MethodsThe Plan-Do-Study-Act (PDSA) model was used as the framework for this initiative. Patients meeting inclusion criteria were given a teach-back quiz to evaluate baseline knowledge. If patients were able to pass the teach-back quiz, they were given a tracking sheet with instructions on how to use it. After a period of eight hours, the sheet was collected and fluid intake volumes were compared with those documented in the EHR. ResultsUsing the Wilcox on non-parametric test, the mean difference between volume tracked by patient and volume documented by clinician was significant at pConclusion & Implications for CNL PracticeVariation between oral fluid intake volume documented in the EHR and patient stated volumes indicates that EHR documentation is less reliable than records kept by adequately educated and engaged patients. Implications for CNL practice include identification of opportunities to increase patient engagement and to utilize evidence-based techniques for this purpose. The CNL should explore barriers that contribute to inaccuracy of documentation. The CNL may explore more reliable methods for determining accurate patient fluid balance for at-risk populations

Post Natal Impact of Maternal Tryptophan Deficiency on Central CO2/PH Chemosensitivity

Cells and mechanisms underlying central chemosensitivity, are poorly understood and can be controversial. Our overarching hypothesis is that brainstem 5-HT and/or GABA neurons contribute to detection and response to changes in pH/CO2. Our experiments are designed to provide insight into respiratory physiology, and pathologies thought to result from chemosensory dysfunction such as the Sudden Infant Death Syndrome (SIDS). A deficiency of 5-HT resulting from maternal dietary restriction could enhance vulnerability to SIDS. It was recently shown that rat pups born to dams fed a tryptophan deficient diet have a reduced number of central 5-HT neurons and reduced ventilatory sensitivity to CO2 (Nattie et al. 2011). Unknown are the relative contributions of central vs peripheral chemoreceptors to this observation, or the residual contributions of 5-HT in the face of this deficiency. In the present study we are extending this initial description using a perfused in situ brainstem model to determine the degree of central chemosensory deficit imparted by maternal tryptophan restriction. We also repeat these studies with pharmacological blockade of a population of 5-HT receptors to illustrate remaining 5-HT and non-5-HT contributions to chemosensitivity. This work reveals important interactions between nutrition and ventilatory control that may aid in the understanding of SIDS

U.S. FOOD POLICIES: THE PERSPECTIVE OF THIRD WORLD COUNTRIES

Agricultural and Food Policy,

Balloon logging with the inverted skyline

There is a gap in aerial logging techniques that has to be filled. The need for a simple, safe, sizeable system has to be developed before aerial logging will become effective and accepted in the logging industry. This paper presents such a system designed on simple principles with realistic cost and ecological benefits

FOREIGN AID ISSUES

International Relations/Trade,